Long-term weight loss strategies for obesity.

Context Obesity is a chronic disease that is difficult to manage without holistic therapy. The therapeutic armamentarium for obesity primarily consists of four forms of therapy: lifestyle modification (i.e., diet and exercise), cognitive behavioral therapy, pharmacotherapy, and bariatric surgery. Evidence acquisition Evidence was consolidated from randomized controlled trials, observational studies, and meta-analyses. Evidence synthesis After two years, lifestyle interventions can facilitate weight loss that equates to ~5%. Even though lifestyle interventions are plagued by weight regain, they can have substantial effects on type 2 diabetes and cardiovascular disease risk. Although 10-year percent excess weight loss can surpass 50% after bariatric surgery, weight regain is likely. To mitigate weight regain, instituting a multifactorial maintenance program is imperative. Such a program can integrate diet, exercise, and pharmacotherapy. Moreover, behavioral therapy can complement a maintenance program well. Conclusions Obesity is best managed by a multidisciplinary clinical team that integrates diet, exercise, and pharmacotherapy. Bariatric surgery is needed to manage T2D and obesity in select patients.