Approaches to holistic obesity treatment and identifying healthful behaviors
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Key takeaways:
- Behavioral modification for obesity treatment produced results similar to pharmaceutical or surgical interventions.
- Patient behaviors for long-term weight management can determine who will best respond.
BOSTON — Behavioral modification with diet and exercise demonstrated similar weight-loss benefits vs. other pharmaceutical and surgical approaches to obesity management, but patients must remain adherent, a speaker reported.
At the Cardiometabolic Health Congress, Sam Dagogo-Jack, MD, DSc, A. C. Mullins Chair in Translational Research, professor of medicine and director of the division of endocrinology, diabetes and metabolism and director of the Clinical Research Center at the University of Tennessee Health Science Center, provided an overview of holistic behavioral approaches to obesity management via diet, exercise, smoking cessation, sleep health and stress management.
“It’s a straightforward equation: Energy in equals energy out,” Dagogo-Jack said during the presentation. “When the pendulum swings in favor of adiposity, the law of thermodynamics has been violated. There is more energy in than energy out. The energy in is comprised of food intake, which is governed by our appetite, sense of fullness or satiety for when to stop and that is modulated by choices, environment and other factors.”
Lifestyle factors impacting risk for overweight and obesity include unhealthy diet, sedentary lifestyle, smoking, sleep impairment and psychosocial stress, according to the presentation.
Dagogo-Jack said both diet and exercise can improve weight management in patients with obesity, but they work best when used in concert.
Dietary strategies to confer weight loss include decreased daily calories, total fat, saturated fat and sodium; moderate carbohydrate intake; and increased dietary fiber.
Citing a meta-analysis of 48 studies published in JAMA, Dagogo-Jack said other adherence to dietary modifications such as low-fat and low-carbohydrate diets confer similar average weight loss of 7.3 kg at 12 months compared with not dieting.
Similarly, he cited another study in Diabetes, in which researchers also observed similar 21-day weight loss among individuals with diabetes on a very low-calorie diet compared with those who underwent Roux-en-Y gastric bypass surgery.
The National Academy of Medicine recommends 60 minutes per day of physical activity for weight loss/control and 30 minutes per day for the prevention of cardiovascular disease, according to the presentation.
In addition, a systematic review published in the American Journal of Clinical Nutrition showed that addition of exercise to dietary management of obesity was associated with a mean reduction of 2.9 kg more compared with those only dieting.
Citing data from the National Institute of Diabetes and Digestive and Kidney Diseases-funded Diabetes Prevention Program (DPP) ongoing DPP Outcomes Study, of which Dagogo-Jack is one of the principal investigators, researchers compared diet and exercise modification with metformin and placebo on various cardiometabolic outcomes.
The researchers reported lifestyle modification was associated with larger improvements in the incidence and prevalence of diabetes, metabolic syndrome, hypertension and dyslipidemia at 36 months compared with metformin and placebo.
Lifestyle modification resulted in lower cumulative incidence of diabetes compared with metformin and placebo, even among individuals who regained some of the weight lost, according to the presentation.
Dagogo-Jack said behaviors of individuals who maintained long-term weight loss included participating in 1 hour of physical activity per day, low-calorie diet, eating breakfast, consistent eating patterns and self-monitored body weight.
“Stress is very difficult to measure, let alone impact. ... Psychosocial stress predicted first myocardial infarction with higher population-attributable risk than diabetes and obesity combined. Hypertension is almost as toxic as smoking,” he said.
Another factor to address in obesity management is smoking cessation, he said. Approximately 11.5% of U.S. adults smoke daily or intermittently, according to a 2021 CDC estimate.
Proposed strategies for smoking cessation from the presentation included psychological support, quitting cold turkey, nicotine replacement, bupropion 150 mg initiation, varenicline 0.5 mg or 1 mg initiation or referral.
Additionally, Dagogo-Jack said, sleep health is also a significant avenue for obesity management, as sleep disturbance has been associated with dysregulation of the hormonal and autonomic nervous system, which are both linked to metabolic syndrome.
“Lifestyle intervention [for obesity management] is safe. It may not always be curable because of challenges with adherence,” he said. “Psychosocial stress is an unanswered question where clinical practice has not caught up with the research.”
References:
- Brooks GA, et al. Am J Clin Nutr. 2004;doi:10.1093/ajcn/79.5.921S.
- CDC. Current cigarette smoking among U.S. adults aged 18 years and older. https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html. Last updated May 4, 2023. Accessed Oct. 29, 2024.
- Jackness C, et al. Diabetes. 2013;doi:10.2337/db12-1762.
- Johnston BC, et al. JAMA. 2014;doi:10.1001/jama.2014.10397.
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Dagogo-Jack S. Session II: Obesity. Presented at: Cardiometabolic Health Congress; Oct. 17-19, 2024; Boston.
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