Weight maintenance: challenges, tools and strategies for primary care physicians

Abstract

Obesity is recognized as a chronic disease and one of the major healthcare challenges facing us today. Weight loss can be achieved via lifestyle, pharmacological and surgical interventions, but weight maintenance remains a lifetime challenge for individuals with obesity. Guidelines for the management of obesity have highlighted the role of primary care providers (PCPs). This review examines the long-term outcomes of clinical trials to identify effective weight maintenance strategies that can be utilized by PCPs. Because of the broad nature of the topic, a structured PubMed search was conducted to identify relevant research articles, peer-reviewed reviews, guidelines and articles published by regulatory bodies. Trials have demonstrated the benefit of sustained weight loss in managing obesity and its comorbidities. Maintaining 5-10% weight loss for ≥1 year is known to ameliorate many comorbidities. Weight maintenance with lifestyle modification - although challenging - is possible but requires long-term support to reinforce diet, physical activity and behavioural changes. The addition of pharmacotherapy to lifestyle interventions promotes greater and more sustained weight loss. Clinical evidence and recently approved pharmacotherapy has given PCPs improved strategies to support their patients with maintenance of weight loss. Further studies are needed to assess the translation of these strategies into clinical practice.

Keywords: Maintenance; obesity; primary care; weight loss.

Figure 1

The balance between weight loss and weight regain and the associated physiological and psychological changes involved. Physiological and psychological changes that occur as a result of weight loss are shown in blue, and the pathway to overcome the propensity for weight regain in green. This pathway, which may involve pharmaceutical and behavioural interventions that improve adherence, counteracts the physiological and behavioural adaptations and re‐establish the intake–expenditure balance. (Adapted, with permission, from MacLean et al.) 82.