The medical effects of modest weight reduction (approximately 10% or less) in patients with obesity-associated medical complications were reviewed. The National Library of Medicine MEDLINE database and the Derwent RINGDOC database were searched to identify English language studies that examined the effects of weight loss in obese patients with serious medical complications commonly associated with obesity (non-insulin dependent diabetes mellitus (NIDDM or type II), hypertension, hyperlipidemia, hypercholesterolemia, and cardiovascular disease). Studies in which patients experienced approximately 10% or less weight reduction were selected for review. Studies indicated that, for obese patients with NIDDM, hypertension or hyperlipidemia, modest weight reduction appeared to improve glycemic control, reduce blood pressure, and reduce cholesterol levels, respectively. Modest weight reduction also appeared to increase longevity in obese individuals. In conclusion, a large proportion of obese individuals with NIDDM, hypertension, and hyperlipidemia experienced positive health benefits with modest weight loss. For patients who are unable to attain and maintain substantial weight reduction, modest weight loss should be recommended; even a small amount of weight loss appears to benefit a substantial subset of obese patients.

Beneficial health effects of modest weight loss.

Guidelines recommend clinicians intervene on obesity but it is unclear how people with overweight react. In this systematic review, we searched 20 online databases for qualitative studies interviewing people with overweight or obesity who had consulted a primary care clinician. Framework synthesis was used to analyse 21 studies to produce a new theoretical understanding. Consultations in which patients discussed their weight were more infrequent than patients would have liked, which some perceived was because they were unworthy of medical time; others that it indicated doctors feel being overweight is not a serious risk. Patients reported that doctors offered banal advice assuming that the patient ate unhealthily or was not trying to address their weight. Patients reported doctors assumed that their symptoms were due to overweight without a proper history or examination, creating concern that serious illness may be missed. Patients responded positively to offers of support for weight loss and active monitoring of weight. Patients with overweight internalize weight stigma sensitizing them to clues that clinicians are judging them negatively, even if weight is not discussed. Patients' negative experiences in consultations relate to perceived snap judgements and flippant advice and negative experiences appear more salient than positive ones.

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Clinical encounters about obesity: Systematic review of patients' perspectives.

No one doubts the economic costs of obesity, estimated at 5–14% of health expenditure for 2020–2050 (1), but there is disagreement whether fatness is considered a disease (2) or a behavioral risk factor, similar to smoking, alcohol and substance abuse that may lead to a disease (3). Current opinion also emphasizes social determinants and equity, thereby moving away from personal responsibility concepts (4). Although recent competencies for medical training do recommend chronic disease models and personalized obesity management care plans (5), there is no mention of topics such as self-management, locus of control or responsibility. It is not clear whether this is because they are considered unimportant or because they are not politically correct—yet, they are critical components for chronic disease management such as diabetes, post-transplant care and obesity (6). The paradigm chosen has major implications for prevention and treatment strategies.

That the obesity pandemic continues unabated represents a catastrophic failure of government policy, public health, and medicine—but not only of these domains. Table 1 lists different levels of responsibility incorporating the sociotype ecological framework (6). Levels 1–4 represent context and systems; levels 5–7 society and interpersonal relationships; and levels 8–9 parental and intrapersonal health and psychological make-up. Personal editorial input from a leading obesity journal suggested that “at this point in time, … emphasis on the personal responsibility (rather than the biology), would only add to the stigmatization of obesity in general.” I disagree—and concerning the biology—see the beginning of the discussion section. Without considering aspects of responsibility, obesity management is severely compromised. There are at least two sides to personal responsibility: medicalizing obesity, which reduces it, and parental supervision, which emphasizes it, since fat children are at high risk for adult obesity (7). Finally, I suggest an integrated nine-level approach that eschews political correctness and hopefully is not more of the same.

Table 1

The nine multilevel responsibilities and examples of strategies required for tackling obesity.

The Obesity Pandemic-Whose Responsibility? No Blame, No Shame, Not More of the Same.

Objective: We set out to investigate the behaviors of low-income African American women who successfully lost weight. Methods: From an urban, academic, family medicine practice, we used a mixed met...

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Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis.

Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight The nominal group technique was conducted to identify and rank WLM facilitators and barriers Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only) Participants (maintainers, n = 46; regainers, n = 58; 817% women, 481% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating) However, the perceived importance of these factors differed between groups (maintainer vs regainers; AA vs Whites) Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers) Salient facilitators and barriers were best represented in 2–3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA

Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss

Purpose:Low-income, African American women are disproportionately impacted by obesity. Little is known about the interactions between low-income, African American women who successfully lost weight...

/pdf/overcoming-obesity-a-mixed-methods-study-of-the-impact-of-2esh3leo0l.pdf

Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight.

Kyle Yebernetsky

Papers

Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight.

Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis.