Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Proceedings Article
  • Published:

Filling the treatment gap in the weight management of overweight and obese patients

International Journal of Obesity Supplements volume 2, pages S39–S42 (2012)Cite this article

Subjects

Abstract

Approximately two out of three adult Americans are overweight or obese. Despite widespread recognition of this disorder, there has been little progress in the past 20 years in finding effective noninvasive treatments for weight loss. The consequences of obesity are increasingly well recognized and include increases in blood pressure, plasma lipids, the onset of type 2 diabetes, sleep apnea, asthma, osteoarthritis and a variety of cancers. Obesity can increase the rate of pregnancy complications and fetal malformations in normoglycemic women. Current medical approaches to obesity, including intensive lifestyle interventions and drug therapies, have been successful in achieving modest weight loss of 4–7%, less than the 1998 NIH Guidelines target of 10%. Surgical approaches, including laparoscopic adjustable gastric banding, vertical banded gastroplasty and Roux-en-Y gastric bypass, are much more successful, achieving weight loss of 15–50%. A treatment gap therefore exists in the management of obese and overweight patients, because many patients desire and would receive great health benefits by achieving weight loss of 7–15%. This review will discuss the dilemma of the treatment gap and explore possible ways by which it may be filled in the future by the use of innovative approaches.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Flegal KM, Carroll MD, Ogden CL, Curtin LR . Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303: 235–241.

    Article  CAS  Google Scholar 

  2. Yanovski SZ, Yanovski JA . Obesity prevalence in the United States—up, down, or sideways? N Engl J Med 2011; 364: 987–989.

    Article  CAS  Google Scholar 

  3. Mitchell NS, Catenacci VA, Wyatt HR, Hill JO . Obesity: overview of an epidemic. Psychiatr Clin North Am 2011; 34: 717–732.

    Article  Google Scholar 

  4. Friedrich MJ . Epidemic of obesity expands its spread to developing countries. JAMA 2002; 287: 1382–1386.

    Article  CAS  Google Scholar 

  5. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011; 378: 804–814.

    Article  Google Scholar 

  6. Aucott L, Rothnie H, McIntyre L, Thapa M, Waweru C, Gray D . Long-term weight loss from lifestyle intervention benefits blood pressure?: a systematic review. Hypertension 2009; 54: 756–762.

    Article  CAS  Google Scholar 

  7. Karaouzene N, Merzouk H, Aribi M, Merzouk SA, Berrouiguet AY, Tessier C et al. Effects of the association of aging and obesity on lipids, lipoproteins and oxidative stress biomarkers: a comparison of older with young men. Nutr Metab Cardiovasc Dis 2011; 21: 792–799.

    Article  CAS  Google Scholar 

  8. Gregg EW, Cheng YJ, Narayan KM, Thompson TJ, Williamson DF . The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976–2004. Prev Med 2007; 45: 348–352.

    Article  Google Scholar 

  9. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362–2374.

    Article  CAS  Google Scholar 

  10. Acioglu E, Yigit O, Volkan Sunter A, Taskin U, Bercik Inal B, Sahin M . Obesity and obstructive sleep apnea syndrome. J Otolaryngol Head Neck Surg 2010; 39: 744–751.

    Google Scholar 

  11. Kent BD, Lane SJ . Twin epidemics: asthma and obesity. Int Arch Allergy Immunol 2011; 157: 213–214.

    Article  Google Scholar 

  12. Holliday KL, McWilliams DF, Maciewicz RA, Muir KR, Zhang W, Doherty M . Lifetime body mass index, other anthropometric measures of obesity and risk of knee or hip osteoarthritis in the GOAL case-control study. Osteoarthritis Cartilage 2011; 19: 37–43.

    Article  CAS  Google Scholar 

  13. Basen-Engquist K, Chang M . Obesity and cancer risk: recent review and evidence. Curr Oncol Rep 2011; 13: 71–76.

    Article  Google Scholar 

  14. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ . Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625–1638.

    Article  Google Scholar 

  15. Owens LA, O’Sullivan EP, Kirwan B, Avalos G, Gaffney G, Dunne F . ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women. Diabetes Care 2010; 33: 577–579.

    Article  Google Scholar 

  16. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB . Years of life lost due to obesity. JAMA 2003; 289: 187–193.

    Article  Google Scholar 

  17. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W . Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Affairs (Project Hope) 2009; 28: w822–w831.

    Article  Google Scholar 

  18. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741–752.

    Article  Google Scholar 

  19. Dixon JB, Zimmet P, Alberti KG, Rubino F . Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med 2011; 28: 628–642.

    Article  CAS  Google Scholar 

  20. Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet 2011; 377: 1341–1352.

    Article  CAS  Google Scholar 

  21. NIH. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 1998.

  22. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.

    Article  CAS  Google Scholar 

  23. Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2011; 365: 1959–1968.

    Article  CAS  Google Scholar 

  24. Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 2011; 365: 1969–1979.

    Article  CAS  Google Scholar 

  25. Rucker D, Padwal R, Li SK, Curioni C, Lau DC . Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ 2007; 335: 1194–1199.

    Article  CAS  Google Scholar 

  26. Hendricks EJ, Greenway FL, Westman EC, Gupta AK . Blood pressure and heart rate effects, weight loss and maintenance during long-term phentermine pharmacotherapy for obesity. Obesity (Silver Spring) 2011; 19: 2351–2360.

    Article  CAS  Google Scholar 

  27. Smith SR, Weissman NJ, Anderson CM, Sanchez M, Chuang E, Stubbe S et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med 2010; 363: 245–256.

    Article  CAS  Google Scholar 

  28. Greenway FL, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, Erickson J et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2010; 376: 595–605.

    Article  CAS  Google Scholar 

  29. Chapman AE, Kiroff G, Game P, Foster B, O’Brien P, Ham J et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 2004; 135: 326–351.

    Article  Google Scholar 

  30. Fujioka K, DiBaise JK, Martindale RG . Nutrition and metabolic complications after bariatric surgery and their treatment. JPEN J Parenter Enteral Nutr 2011; 35: 52S–59S.

    Article  CAS  Google Scholar 

  31. Mold F, Forbes A . Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research. Health expectations: an international journal of public participation in health care and health policy 2011; Health Expect; e-pub ahead of print 7 June 2011.

  32. Familiari P, Boskoski I, Marchese M, Perri V, Costamagna G . Endoscopic treatment of obesity. Expert Rev Gastroenterol Hepatol 2011; 5: 689–701.

    Article  Google Scholar 

  33. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 2011; 365: 1597–1604.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

I would like to acknowledge Dr Christopher Gardner for his generous help and suggestions during the process of review and revision of this manuscript and to Dr Maja Artandi for her critical review and suggestions. I received no financial or grant support related to preparing this manuscript. Publication of this supplement was partially supported by Nutrilite Health Institute with an unrestricted educational contribution to Stanford Prevention Research Center.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Gerontology and Metabolism, Stanford School of Medicine, Stanford, CA, USA

    N Gesundheit

Authors
  1. N Gesundheit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N Gesundheit.

Ethics declarations

Competing interests

Dr Gesundheit is a consultant to and shareholder in VIVUS, Inc., Mountain View, CA, USA. VIVUS is developing pharmacological therapies for the treatment of obesity. Dr Gesundheit is also a consultant to Astellas Pharma in an area unrelated to obesity research or treatment.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gesundheit, N. Filling the treatment gap in the weight management of overweight and obese patients. Int J Obes Supp 2 (Suppl 1), S39–S42 (2012). https://doi.org/10.1038/ijosup.2012.10

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijosup.2012.10

Keywords

This article is cited by

Search

Advanced search

Quick links