Weight Gain Prevention Strategies


Definition/Introduction

Obesity is defined as an increase in body weight when compared to height. To classify obesity, the standard practice is to use a Body Mass Index scale which puts weight in kilograms divided by height in meters squared. An individual is considered obese at BMI level of 30 except in Asian where a BMI of 27 or higher is considered obese.[1] When we look at the cause of weight gain it is essentially excess energy consumption. Energy intake is through food, and energy expenditure is through physical activity. These two main factors need to be in balance for an individual to remain weight neutral. In the population, the energy balance can be misaligned due to a variety of factors such as genetics, behavior, environment, and socioeconomic factors.[2]

Obesity is more prevalent now more than ever, and many factors come into play such as foods with high sugar and fat content, increased fast-food restaurants, modes of transportation, increased sedentary work lifestyles, and urbanization. Due to the changing environment, it is important now more than ever to implement weight prevention strategies. These strategies can vary from policy changes, increased health services, and efforts from the local community. Ultimately, these changes should target the causes of obesity which are unhealthy eating habits and lack of physical activity.[3]

Issues of Concern

Obesity is an issue of concern because it is a significant cause of co-morbidities, which include diabetes, hypertension, cancer, and cardiovascular disease.[4] This situation raises overall mortality in overweight individuals and puts a strain on the healthcare system with obesity-related spending estimated at 190 billion in the US.[5] Data from the National Health and Nutrition Examination Survey have shown an increasing prevalence of obesity in adults and children over the past years with no signs of slowing down.[6] As of 2015 to 2016, the prevalence of obesity in adults is 39.8 percent, and it predicted that by 2030, it would be every 1 in 2 adults.[6][7] This data positions obesity as a public health concern as its trends upward, affecting millions of people. This upward trend also raises the question if the current public health weight gain prevention strategies are effective, and if new public health strategies should be implemented.

Clinical Significance

As obesity levels rise in both children and adults, the healthcare team must educate the population on weight gain prevention. Possible clinical interventions are in areas of diet, physical activity, surgery, and pharmacotherapy. Even just a modest reduction in weight can improve many obesity-related conditions leading to better healthcare outcomes, improved quality of life, and reduced socioeconomic costs. 

First-line management in obesity is through diet and exercise. In terms of diet, various options can be recommended, such as a low carbohydrate diet, low-fat diet, Mediterranean diet, and the Paleo diet. No one single diet is considered superior to the other in terms of weight loss, as long term adherence to a healthy eating plan is the most crucial factor for successful weight management.[8] Because of this, the clinician should recommend a diet plan with foods that the patient still enjoys for sustainability and the prevention of relapse.  Another part of the energy balance equation is physical activity. The recommendation is to start slow and gradually increase activity level with the amount of activity-dependent on the individual. Simple decisions such as taking the stairs or parking farther from the grocery store can summate throughout the day, not only leading to weight loss but a multitude of benefits associated with exercise.

For diet and physical exercise to be maintained, an individual must make permanent lifestyle changes. The healthcare professional needs to assist the patient in areas such as self-monitoring, physical activity, problem-solving, stress management, relapse prevention, and social support.[8] Improvement in all these areas will help a patient consistently make healthier choices and maintain energy balance. Overall, each individual has a specific requirement of energy based on various factors such as size, activity level, and hormones, so it is critical that diet and exercise be individualized and regularly monitored to provide optimal results.[9] 

When physical exercise and diet are not successful, pharmacotherapy can be involved with multiple drugs on the market proven to be effective. These drugs are potentially useful when patients attempt lifestyle interventions for six months with no results, BMI is greater than 30, or if BMI is greater than 27 with an obesity-related condition. The FDA approved medications for weight management include orlistat, phentermine/topiramate, bupropion/naltrexone, liraglutide, and phentermine.[10] FDA reviewed the concerns of increased cancer incidence with lorcaserin, which led to its withdrawal from the market as of March 2020. 

Lastly, surgery can be a consideration if an individual is extremely obese with no success in diet, exercise, or pharmacotherapy. Surgery can restrict energy intake by reduction of the gastric pouch and also reducing the absorption of the stomach. Various procedures can be done, such as a roux-en-y gastric bypass, sleeve gastrectomy, and implantation of certain devices. The type of procedure performed is all dependent on a various amount of factors such as surgical risk and patient desires. Less invasive procedures tend to have fewer surgical complications, but less weight loss and more invasive procedures tend to have more surgical complications but increased weight loss.[11]

Nursing, Allied Health, and Interprofessional Team Interventions

On a large scale, strategies to counter obesity are abundant with multiple programs and policies in place, tackling the first intervention in obesity management, diet, and exercise. These programs aim to improve access to healthier food and provide a more friendly environment that encourages physical activity. Some examples of these programs include Pennsylvania Fresh Food Financing Incentives, Kids in Parks, and Baltimore Healthy Stores.[12] In a review article by Sallis and Glanz (2009), these changes in the environment were proven effective.[13] In general, these studies demonstrated that when people had access to healthier food, they tended to have better diets. When communities have recreational facilities, residents are more likely to be physically active.

On the primary care level, the treatment of obesity tends to be poor. In a prospective cohort study, researchers found that many obese patients are not receiving appropriate counsel during primary care visits. Possible reasons for the lack of counseling include time constraints, compensation, and low self-efficacy. When patients did receive counseling, it correlated with a moderate reduction in weight.[14] This area should be the target of improvement in the healthcare system as primary care physicians tend to be the gatekeepers of medicine. 

The US Preventative Serves Tasks Force recommends for Primary care providers to use the 5 As approach which includes: Assess, Advise, Agree, Assist, and Arrange. This method helps the physician identify any medical issues, delivers thorough counseling, and provides the patient with resources to make healthy lifestyle changes. This approach also helps build a multidisciplinary team for the patient, which is more likely to produce clinically significant weight loss than if the physician treated the patient alone.[15] Overall, it is ultimately up to the patient to implement lifestyle changes, but the physician and healthcare team should motivate, counsel, and screen for all patients on the trend toward obesity. 


Article Details

Article Author

Jeffrey Alookaran

Article Editor:

Anis Rehman

Updated:

5/8/2022 2:19:02 AM

References

[1]

Hruby A,Hu FB, The Epidemiology of Obesity: A Big Picture. PharmacoEconomics. 2015 Jul     [PubMed PMID: 25471927]

[2]

Hill JO,Wyatt HR,Peters JC, Energy balance and obesity. Circulation. 2012 Jul 3     [PubMed PMID: 22753534]

[3]

Chan RS,Woo J, Prevention of overweight and obesity: how effective is the current public health approach. International journal of environmental research and public health. 2010 Mar     [PubMed PMID: 20617002]

[4]

Djalalinia S,Qorbani M,Peykari N,Kelishadi R, Health impacts of Obesity. Pakistan journal of medical sciences. 2015 Jan-Feb;     [PubMed PMID: 25878654]

[5]

Cawley J,Meyerhoefer C, The medical care costs of obesity: an instrumental variables approach. Journal of health economics. 2012 Jan;     [PubMed PMID: 22094013]

[6]

Purnell JQ,Feingold KR,Anawalt B,Boyce A,Chrousos G,de Herder WW,Dhatariya K,Dungan K,Grossman A,Hershman JM,Hofland J,Kalra S,Kaltsas G,Koch C,Kopp P,Korbonits M,Kovacs CS,Kuohung W,Laferrère B,McGee EA,McLachlan R,Morley JE,New M,Purnell J,Sahay R,Singer F,Stratakis CA,Trence DL,Wilson DP, Definitions, Classification, and Epidemiology of Obesity Endotext. 2000     [PubMed PMID: 25905390]

[7]

Ward ZJ,Bleich SN,Cradock AL,Barrett JL,Giles CM,Flax C,Long MW,Gortmaker SL, Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. The New England journal of medicine. 2019 Dec 19     [PubMed PMID: 31851800]

[8]

Koliaki C,Spinos T,Spinou Μ,Brinia ΜE,Mitsopoulou D,Katsilambros N, Defining the Optimal Dietary Approach for Safe, Effective and Sustainable Weight Loss in Overweight and Obese Adults. Healthcare (Basel, Switzerland). 2018 Jun 28     [PubMed PMID: 29958395]

[9]

Plourde G,Prud'homme D, Managing obesity in adults in primary care. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2012 Jun 12;     [PubMed PMID: 22586330]

[10]

Milano W,De Biasio V,Di Munzio W,Foggia G,Capasso A, Obesity: the New Global Epidemic. Pharmacological Treatment, Opportunities and Limits for Personalized Therapy. Endocrine, metabolic     [PubMed PMID: 32410565]

[11]

Wolfe BM,Kvach E,Eckel RH, Treatment of Obesity: Weight Loss and Bariatric Surgery. Circulation research. 2016 May 27     [PubMed PMID: 27230645]

[12]

Khan LK,Sobush K,Keener D,Goodman K,Lowry A,Kakietek J,Zaro S, Recommended community strategies and measurements to prevent obesity in the United States. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2009 Jul 24;     [PubMed PMID: 19629029]

[13]

Sallis JF,Glanz K, Physical activity and food environments: solutions to the obesity epidemic. The Milbank quarterly. 2009 Mar     [PubMed PMID: 19298418]

[14]

Rodondi N,Humair JP,Ghali WA,Ruffieux C,Stoianov R,Seematter-Bagnoud L,Stalder H,Pecoud A,Cornuz J, Counselling overweight and obese patients in primary care: a prospective cohort study. European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 2006 Apr     [PubMed PMID: 16575276]

[15]

Fitzpatrick SL,Wischenka D,Appelhans BM,Pbert L,Wang M,Wilson DK,Pagoto SL, An Evidence-based Guide for Obesity Treatment in Primary Care. The American journal of medicine. 2016 Jan;     [PubMed PMID: 26239092]