Authors

1 Departments of Medicine

2 Departments of Gastroenterology and Human Nutrition, AIIMS, New Delhi, India

Abstract

Obesity is a commonly encountered health‑care problem that is an independent risk factor for chronic
metabolic complications. Primary care physicians are the first point of contact in the management
of obesity. Weight management is a step‑wise intensification of interventions that initiates with
lifestyle modification. Dietary and physical activity advices are integral components of all weight
loss consultations and should ideally be imparted by a dietician or a nutritionist. In case of their
nonavailability, the onus for lifestyle counseling rests with the physician. The prescription for a
low‑calorie diet coupled with increased physical activity might seem simple, but the success lies in
compliance and sustainability of this advice. Compliance can be enhanced through patient‑specific
diet and activity plans along with corrections in eating and activity behavior. Barriers in patient’s
environment must also be addressed to achieve sustainable weight loss. This review covers practical
insights in standard lifestyle management techniques, which can help the physicians to set better
weight loss goals, adapt to patient specific lifestyle counseling, and apply strategies to enhance
compliance for sustained weight loss.

Keywords

1. Mattar A, Carlston D, Sariol G, Yu T, Almustafa A, Melton GB,
et al. The prevalence of obesity documentation in primary care
electronic medical records. Are we acknowledging the problem?
Appl Clin Inform 2017;8:67‑79.
2. Andolfi C, Fisichella PM. Epidemiology of obesity and associated
comorbidities. J Laparoend Adv Surg Tech 2018;28:919‑24.
3. Sturgiss EA, Elmitt N, Haesler E, van Weel C, Douglas KA. Role
of the family doctor in the management of adults with obesity:
A scoping review. BMJ Open 2018;8:e019367.
4. National Heart, Lung, and Blood Institute. Clinical guidelines on
the identification, evaluation, and treatment of overweight and
obesity in adults: The evidence report. Obes Res 1998;6 Suppl:
51S‑210S.
5. Thom G, Lean M. Is there an optimal diet for weight management
and metabolic health? Gastroenterology 2017;152:1739‑51.
6. Dwyer JT, Melanson KJ, Sriprachy-anunt U, Cross P, Wilson M.
Dietary treatment of obesity. In: Feingold KR, Anawalt B, Boyce A,
Chrousus G, Dungan K, Grossman A, Chrousos G et al. Endotext.
South Dartmouth (MA): MDText.com, Inc.; 2000. Available
from: http://www.ncbi.nlm.nih.gov/books/NBK279060/. [Last
citeded on 2020 Sep 23].
7. Kadouh HC, Acosta A. current paradigms in the etiology of
obesity. Techniq Gastrointestinal Endoscopy 2017;19:2‑11.
8. Kushner RF. Weight loss strategies for treatment of obesity:
Lifestyle management and pharmacotherapy. Progress Cardiov
Dis 2018;61:246‑52.
9. Wing RR, Lang W, Wadden TA, Safford M, Knowler WC,
Bertoni AG, et al. Benefits of modest weight loss in improving
cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diab Care 2011;34:1481‑6.
10. Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME,
Murad MH, Pagotto U, et al. Pharmacological management of
obesity: An Endocrine Society Clinical Practice Guideline. J Clin
Endocrinol Metab 2015;100:342‑62.
11. Behl S, Misra A. Management of obesity in adult Asian Indians.
Indian Heart J 2017;69:539‑44.
12. Ard J D, Miller G, Kahan S. Nutrition interventions for obesity.
Med Clin North Am 2016;100:1341‑56.
13. Dwyer JT, Melanson KJ, Sriprachy-anunt U, Cross P, Wilson M.
Dietary treatment of obesity. In: Feingold KR, Anawalt B, Boyce A,
Chrousus G, Dungan K, Grossman A, Chrousos G, et al. Endotext.
South Dartmouth (MA): MDText.com, Inc.; 2000. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK278991/.
[Last updated on 2015 Feb 28].
14. Sackner‑Bernstein J, Kanter D, Kaul S. Dietary intervention for
overweight and obese adults: Comparison of low‑carbohydrate
and low‑fat diets. A meta‑analysis. PLoS One 2015;10:e0139817.
15. Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A,
Pfeiffer AF, et al. Diets with high or low protein content and
glycemic index for weight‑loss maintenance. N Engl J Med
2010;363:2102‑13.
16. GudzuneK. Dietary and behavioral approaches in the management
of obesity. Gastroenterol Clin North Am 2016;45:653‑61.
17. Sturgiss E, van Weel C. The 5 As framework for obesity
management: Do we need a more intricate model? Can Fam
Physician 2017;63:506‑8.
18. Wadden TA, Didie E. What’s in a name? Patients’ preferred terms
for describing obesity. Obes Res 2003;11:1140‑6.
19. Ceccarini M, Borrello M, Pietrabissa G, Manzoni GM,
Castelnuovo G. Assessing motivation and readiness to change
for weight management and control: An in‑depth evaluation of
three sets of instruments. Front Psychol 2015;6:511.
20. Casadei K, Kiel J. Anthropometric Measurement. In:
StatPearls. Treasure Island (FL): Stat Pearls Publishing;
2019. Available from: https://www.ncbi.nlm.nih.go
v/books/NBK537315/. [Last updated on 2019 Mar 24].
21. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist
circumference and Health risk: evidence in support of current
National Institute of Health Guidelines. Arch Intern Med
2002;162:2074‑9.
22. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG,
Donato KA, et al. AHA/ACC/TOS Guideline for the
management of overweight and obesity in adults. Circulation
2013;129 25 Suppl 2:102‑38.
23. Food and Agriculture Organisation. Dietary Assessment:
A Resource Guide to Method Selection and Application in Low
Resource Settings. Rome: Food and Agriculture Organisation.
Available from: http://www.fao.org/3/i9940en/I9940EN.
pdf. [Last accessed on 2019 Jul 09].
24. Al‑Eisa E, Alghadir AH, Iqbal ZA. Measurement of physical
activity in obese persons: how and why? A review. J Phys Ther
Sci 2016;28:2670‑4.
25. Cleland CL, Hunte RF, Kee F, Cupples ME, Sallis JF, Tully MA.
Validity of the global physical activity questionnaire (GPAQ) in
assessing levels and change in moderate‑vigorous physical activity
and sedentary behaviour. BMC Public Health 2014;14:1255.
26. McInnis KJ, Franklin BA, Rippe JM. Counseling for physical
activity in overweight and obese patients. Am Fam Physician
2003;67:1249‑56.
27. Skerrett PJ, Willett WC. Essentials of healthy eating: A guide.
J Midwifery Womens Health 2010;55:492‑501.
28. Smethers AD, Rolls BJ. Dietary management of obesity:
Cornerstones of healthy eating patterns. Med Clin North Am
2018;102:107‑24.
29. Steenhuis I, Poelman M. Portion size: Latest developments and
interventions. Curr Obes Rep 2017;6:10‑7.
30. Rebello CJ, Liu AG, Greenway FL, Dhurandhar NV. Dietary
strategies to increase satiety. Adv Food Nutr Res 2013;69:105‑82.
31. Misra A, Nigam P, Hills AP, Chadha DS, Sharma V, Deepak KK,
et al. Consensus physical activity guidelines for Asian Indians.
Diab Technol Ther 2012;14:83‑98.
32. YangYJ. An overview of current physical activity recommendations
in primary care. Korean J Fam Med 2019;40:135‑42.
33. Burke LE, Wang J, Sevick MA. Self‑monitoring in weight
loss: A systematic review of the literature. J Am Diet Assoc
2011;111:92‑102.
34. Vallis M, Piccinini‑Vallis H, Sharma AM, Freedhoff Y. Clinical
review: Modified 5 As: Minimal intervention for obesity
counseling in primary care. Can Fam Physician 2013;59:27‑31.
35. MacLean PS, Rothman AJ, Nicastro HL, Czajkowski SM,
Agurs‑Collins T, Rice EL, et al. The accumulating data to optimally
predict obesity treatment(ADOPT) core measures project: Rationale
and approach. Obesity (Silver Spring) 2018;26 Suppl 2:S6‑15.
36. McVay MA, Yancy WS, Bennett GG, Jung SH, Voils CI. Perceived
barriers and facilitators of initiation of behavioral weight loss
interventions among adults with obesity: A qualitative study.
BMC Public Health 2018;18:854.
37. Abolhassani S, Irani MD, Sarrafzadegan N, Rabiei K, Shahrokhi S,
Pourmoghaddas Z, et al. Barriers and facilitators of weight
management in overweight and obese people: Qualitative
findings of TABASSOM project. Iran J Nurs Midwifery Res
2012;17:205‑10.
38. Sharifi N, MahdaviR, Ebrahimi‑Mameghani M. Perceived barriers
to weight loss programs for overweight or obese women. Health
Promot Perspect 2013;3:11‑22.