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The future of obesity reduction: beyond weight loss

Abstract

Obesity increases the risk of morbidity and mortality and reduces quality of life independent of age, sex or ethnicity. Leading health authorities recommend weight loss as a primary treatment strategy for obesity reduction—weight loss goals range from 5% to 10% of initial body weight. Intentional weight loss in most adults is associated with a reduction in many of the health complications of obesity. Nonetheless, emerging evidence supports the notion that a lifestyle-modification program characterized by an increase in physical activity and a balanced diet can reduce obesity and the risk of obesity-related comorbid conditions despite minimal or no weight loss. The benefits of such an approach include appreciable reductions in abdominal obesity, visceral fat and cardiometabolic risk factors, and increases in both skeletal muscle mass and cardiorespiratory fitness. Individuals with obesity face a serious challenge if they are to attain even modest weight loss in today's obesogenic environment. Clinicians could encourage positive lifestyle changes in their patients by counseling them that obesity and its associated health risks can be reduced in response to an increase in physical activity with or without weight loss.

Key Points

  • Leading organizations recommend 5–10% initial weight loss as the primary treatment strategy for obesity and related comorbid conditions

  • Physical activity combined with a healthy diet is associated with numerous improvements in metabolic risk factors, despite no or minimal weight loss (up to 3% of initial weight)

  • Exercise without weight loss is associated with marked reductions in abdominal obesity and increases in skeletal muscle mass, regardless of age or sex

  • Prospective analyses with long-term follow-up indicate that physically fit individuals have reduced risks of mortality and morbidity, independent of their body size

  • Health-care practitioners who assess obese patients should measure waist circumference, cardiorespiratory fitness and/or physical activity behaviors

  • Adoption of healthy lifestyle behaviors with minimal or no weight loss is a viable treatment strategy for obesity reduction, in particular abdominal obesity, and associated health risks

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Figure 1: Improvements in insulin sensitivity and AUC for insulin levels after the OGTT with weight gain or loss subsequent to exercise.
Figure 2: Disconnect between changes in weight and those in waist circumference and visceral fat.
Figure 3: Relative changes in body weight, waist circumference, visceral fat and skeletal muscle in obese individuals aged 60–80 years after a 6-month trial of various exercise interventions.

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R. Ross declares associations with the following companies: GlaxoSmithKline (speakers bureau), Roche (speakers bureau, grant/research support), Sanofi-Aventis (speakers bureau, grant/research support) and Theratechnologies (speakers bureau). A. J. Bradshaw declares no competing interests.

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Ross, R., Bradshaw, A. The future of obesity reduction: beyond weight loss. Nat Rev Endocrinol 5, 319–325 (2009). https://doi.org/10.1038/nrendo.2009.78

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