Obesity: Risk factors, complications, and strategies for sustainable long-term weight management

Abstract

Background and purpose: The aims of this article are to review the effects of obesity on health and well-being and the evidence indicating they can be ameliorated by weight loss, and consider weight-management strategies that may help patients achieve and maintain weight loss.

Methods: Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as "obesity," "overweight," "weight loss," "comorbidity," "diabetes," cardiovascular," "cancer," "depression," "management," and "intervention."

Conclusions: Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%-10% range, and above, can significantly improve health-related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal-setting and increased consultation frequency can greatly improve the success of weight-management programs. Nurse practitioners have key roles in establishing weight-loss targets, providing motivation and support, and implementing weight-loss programs.

Implications for practice: With their in-depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight-management strategies deployed in clinical practice.

Keywords: Obesity; effects; health; nurse practitioner communication; weight management.

Figure 1

U.S. obesity epidemic 2015. Source. Figure adapted from Centers for Disease Control and Prevention (CDC). Retrieved from https://www.cdc.gov/obesity/data/prevalence-maps.html.

Figure 2

Association between EOSS stage and risk of all‐cause (A), CVD (B), cancer (C), and non‐CVD or noncancer mortality (D) in men and women. © 2011. Source. Reproduced with permission from NRC Research Press, from Kuk et al. (2011). CVD, cardiovascular disease; NW, normal weight.

Figure 3

Benefits of modest weight loss. Lines demonstrate the ranges in which weight loss has been investigated and shown to have clinical benefits. Arrows indicate that additional benefits may be seen with further weight loss. Source. Figure adapted from Cefalu et al. (2015).

Figure 4

Reduction in cardiovascular mortality with modest weight reduction. Cumulative incidence of CVD mortality during 23 years of follow‐up in the Da Qing study (Li et al., 2014). Figure © 2014 Elsevier. Source. Reproduced with permission from Li et al. (2014).