Challenges and New Directions in Obesity Management: Lifestyle modification programs, pharmacotherapy and Bariatric surgery

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Marwan El Ghoch
Rajaa Fakhoury


obesity; sarcopenic obesity, bariatric surgery, weight regain, lifestyle modification, weight-loss


Obesity is a growing health problem worldwide, associated with serious medical and psychosocial comorbidities, impairment of health-related quality of life (HRQoL) and an increased risk of mortality. This article aims to discuss challenges faced by health care providers when managing patients with obesity, and to highlight sustainable policies in clinical practice and future research. All health professionals dealing with obesity should consider lifestyle-modification programmes as the key element of weight management. However, standardization is needed in terms of nature, content and duration of these programmes in order to facilitate their implementation in clinical practice at different levels. Moreover, health professionals should be aware that these programmes, for patients indicating “non-response”, can be combined with recently approved anti-obesity drugs such as liraglutide, naltrexone/bupropion, lorcaserin and phentermine/topiramate, as well as with relatively less invasive bariatric surgery techniques such as Lap Band, endoscopic sleeve gastroplasty and gastric bypass. In any case neither anti-obesity medication nor bariatric surgery should be considered as a miracle treatment in itself. At the same time the field of obesity is still lacking in literature on some hot topics that need further investigation, including (i) a new phenotype termed sarcopenic obesity, to clarify its definition, potential health consequences and eventual treatment if necessary; (ii) issues that go beyond body weight, for instance HRQoL that has been poorly studied in some populations affected by obesity; and (iii) the long-term effect of sleeve gastrectomy technique, which is becoming the most commonly used bariatric surgical procedure, perhaps to be studied using long-term randomized controlled trials that guarantee completeness of follow-up, in order to avoid misunderstanding and bias in interpretation of results.

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1. Collaborators GBDO. Health effects of over-weight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. http://dx.doi. org/10.1056/NEJMoa1614362
2. Durrer Schutz D, Busetto L, Dicker D, Farpout-Lambert N, Pryke R, Toplak H, et al. European practical and patient-centred guidelines for adult obesity management in primary care. Obes Facts. 2019;12:40–66. http:/ / 000496183
3. El Ghoch M, Calugi S, Dalle Grave R. Weight cycling in adults with severe obesity: A longitu-dinal study. Nutr Diet. 2018;75:256–62. http://dx.
4. Wadden TA, Butryn ML, Wilson C. Lifestyle modification for the management of obesity. Gastroenterology. 2007;132:2226–38. http://dx.
5. Dalle Grave R, Calugi S, El Ghoch M. Lifestyle modification in the management of obesity: Achievements and challenges. Eat Weight Disord. 2013;18:339–49.
6. Digenio AG, Mancuso JP, Gerber RA, Dvorak RV. Comparison of methods for deliver-ing a lifestyle modification program for obese patients: A randomized trial. Ann Intern Med. 2009;150:255–62. 10.7326/0003-4819-150-4-200902170-00006
7. Kreidieh D, Itani L, El Kassas G, El Masri D, Calugi S, Dalle Grave D,et al. Long-term lifestyle-modification programs for over-weight and obesity management in the Arab States: Systematic review and meta-analysis. Curr Diabetes Rev. 2018;14:550–8. doi.10.21741573399813666170619085756
8. Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: New develop-ments in diet, physical activity, and behavior ther-apy. Circulation. 2012;125:1157–70. http://dx.doi. org/10.1161/ CIRCULATIONAHA.111.039453
9. Castelnuovo G, Pietrabissa G, Manzoni GM, Cattivelli R, Rossi A, Novelli Met al. Cognitive behavioral therapy to aid weight  loss in obese patients: Current perspectives. Psychol Res Behav Manag. 2017;10:165–73. http://dx.doi. org/10.2147/PRBM.S113278
10. Cooper Z, Doll HA, Hawker DM, Byrne S, Bonner G, Eeley E. Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year fol-low-up. Behav Res Ther. 2010;48:706–13. http:// j.brat.2010.03.008
11. Ogata K, Koyama KI, Amitani M, Amitani H, Asakawa A, Inui A.. The effectiveness of cognitive behavioral therapy with mindfulness and an Internet intervention for obe-sity: A case series. Front Nutr. 2018;5:56. http:// fnut.2018.00056
12. Barrett S, Begg S, O’Halloran P, Kingsley M. Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: A sys-tematic review and meta-analyses. BMC Public Health. 2018;18:1160. s12889-018-6062-9
13. Daneschvar HL, Aronson MD, Smetana GW. FDA-approved anti-obesity drugs in the United  States. Am J Med. 2016;129: 879.e871–876. 2016.02.009
14. Srivastava G, Apovian C. Future pharmacother-apy for obesity: New anti-obesity drugs on thehorizon. Curr Obes Rep. 2018;7:147–61. http://
15. Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M. Obesity man-agement task force of the European Association for the study of obesity released “practical recom-mendations for the post-bariatric surgery medi-cal management.” Obes Surg. 2018;28:2117–21. http://
16. O’Brien PE. Controversies in bariatric sur-gery. Br J Surg. 2015;102:611–18. http://dx.doi. org/10.1002/bjs.9760
17. Velapati SR, Shah M, Kuchkuntla AR, Abu-Dayyeh B, Grothe K, Hurt RT et al. Weight regain after bariatric surgery: Prevalence, etiology, and treatment. Curr Nutr Rep. 2018;7:329–34. http://
18. Kreidieh D, Itani L, El Masri D, Tannir H, Citarella R, El Ghoch M. Association between sarcopenic obesity, type 2 diabetes, and hypertension in overweight and obese treatment-seeking adult women. J CardiovascDev Dis. 2018;5. http:/ / jcdd5040051
19. El Ghoch M, Calugi S, Dalle Grave R. Sarcopenic obesity: Definition, health consequences and clin-ical management. Open Nutr J. 2018;12:70–3.
20. Itani L, Calugi S, Dalle Grave R, Kreidieh D, El Kassas G, El Masri D et al. . The associ-ation between body mass index and health-related quality of life in treatment-seeking Arab adults with obesity. Med Sci (Basel). 2018;6. http://dx. 10.3390/medsci6010025
21. O’Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A. Long-term outcomes after bariatric surgery: A sys-tematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29:3–14. 10.1007/s11695-018-3525-0