Evidence‐based weight loss interventions: Individualized treatment options to maximize patient outcomes
Abstract
Against the backdrop of obesity as a major public health problem, we examined three questions: How much weight loss is needed to benefit patients with obesity? How well do current therapies do in producing weight loss? What strategies can be used to improve patient outcomes using evidence‐based studies. This paper reviews literature on the outcomes of lifestyle, diet, medications and surgical treatments for obesity using literature searches for obesity treatments. Current treatments, including lifestyle, diet and exercise, produce a weight loss of 5% to 7% on average. Despite continued attempts to identify superior dietary approaches, most careful comparisons find that low carbohydrate diets are not significantly better than low fat diets for weight loss. The four medications currently approved by the US Food and Drug Administration for long‐term management of obesity are not as effective as surgery, adding about 5% on average to lifestyle approaches to weight loss. Two new medications that are under investigation, semaglutide and tirzepatide, significantly improve on this. For all treatments for weight loss, including lifestyle, medications and surgery, there is enormous variability in the amount of weight lost. Examination of this literature has yielded evidence supporting baseline and process predictors, but the effect sizes associated with these predictors are small and there are no prospective studies showing that a personalized approach based on genotype or phenotype will yield uniform success. Because obesity is a chronic disease it requires a ‘continuous treatment model’ across the lifespan.
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Traditional weight-loss strategies, such as lifestyle behavioural interventions, often yield only limited weight loss.
“Traditional weight‐loss strategies, such as lifestyle behavioural interventions, often yield only limited weight loss and struggle to maintain a clinically relevant weight loss over time. 7 , 8”
Comparably little is known about utilization patterns and clinical effects on both weight loss and associated comorbidities of these newer medications in the population-based setting.
“In contrast, evidence on their long‐term effects and hard clinical outcomes in broad populations with obesity in real‐world clinical practice is still limited, and comparably little is known about the utilization patterns and clinical effects on both weight loss and associated comorbidities of these newer medications in the population‐based setting. 7 , 14 , 20 , 21”
Traditional weight-loss strategies struggle to maintain a clinically relevant weight loss over time.
“Traditional weight‐loss strategies, such as lifestyle behavioural interventions, often yield only limited weight loss and struggle to maintain a clinically relevant weight loss over time. 7 , 8”
Evidence on long-term effects and hard clinical outcomes of GLP-1RAs in broad populations with obesity in real-world clinical practice is still limited.
“In contrast, evidence on their long‐term effects and hard clinical outcomes in broad populations with obesity in real‐world clinical practice is still limited, and comparably little is known about the utilization patterns and clinical effects on both weight loss and associated comorbidities of these newer medications in the population‐based setting. 7 , 14 , 20 , 21”
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- Authors
- Bray, G. A., & Ryan, D. H.
- Affiliations
- Pennington Biomedical Research Center (US)
- Corresponding author
- Bray, George A.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2020-11-24
- Volume
- 23
- Issue
- S1
- Pages
- 50-62
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W3088051473
- Cited by
- 148
- References
- 26
- Citations by year
- 2026: 29 · 2025: 31 · 2024: 27 · 2023: 23 · 2022: 26 · 2021: 11 · 2020: 1
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity, weight loss interventions, lifestyle therapy, dietary therapy, low-carbohydrate diet, low-fat diet, anti-obesity drugs, bariatric surgery, semaglutide, tirzepatide, predictors of treatment response, personalized treatment, chronic disease management
- MeSH terms
- Humans, Life Style, Obesity, Weight Loss, Exercise, Diet, Fat-Restricted
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