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The main treatment for obesity consists of dieting and physical exercise.[67] Diet programs may produce weight loss over the short term,[145] but maintaining this weight loss is frequently difficult and often requires making exercise and a lower food energy diet a permanent part of a person's lifestyle.[146][147] Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%.[148] Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child.[149] Three medication, orlistat (Xenical), lorcaserin (Belviq) and a combination of phentermine and topiramate (Qsymia) are currently available and have evidence for long term use.[150] Weight loss with orlistat is modest, an average of 2.9 kg (6.4 lb) at 1 to 4 years.[151] Its use is associated with high rates of gastrointestinal side effects[151] and concerns have been raised about negative effects on the kidneys.[152] The other two medications are available in the United States but not Europe.[153] Lorcaserin results in an average 3.1 kg weight loss (3% of body weight) greater than placebo over a year;[154] however it may increase heart valve problems.[153] A combination of phentermine and topiramate is also somewhat effective;[155] however, it may be associated with heart problems.[153] There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death.[150] The most effective treatment for obesity is bariatric surgery.[156] Surgery for severe obesity is associated with long-term weight loss, improvement in obesity related conditions,[157] and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[158] Complications occur in about 17% of cases and reoperation is needed in 7% of cases.[157] Due to its cost and risks, researchers are searching for other effective yet less invasive treatments. |
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