Helping patients lose weight--what works?

BACKGROUND: Over one in two Australians are now overweight or obese. Weight loss is difficult for patients to achieve and maintain in the current 'obesogenic' environment. However, new developments have resulted in a number of strategies and methods with a good evidence base. A 5-10% reduction in weight can result in a 35% decrease in health risk. OBJECTIVE: This article discusses the evidence base behind weight loss strategies for use in clinical practice. DISCUSSION: Obesity treatments with good evidence include counselling and behavioural approaches, exercise based programs, pre-prepared low energy meals, meal replacement, and bariatric surgery (the most effective for long term weight loss). Medication can be useful in some settings. Limited data suggests commercial diets and self help may be of some benefit. Alternative noningestible treatments (eg. creams and body wrapping) and the majority of over-the-counter medications (with the notable exception of orlistat) have no convincing evidence for efficacy. All successful strategies include some form of lifestyle change resulting in a reduction in energy consumed versus energy expended. The most effective treatments are likely to involve combining and matching strategies to the characteristics of the patient.