obesity essay uk

Internet explorer is no longer supported

We have detected that you are using Internet Explorer to visit this website. Internet Explorer is now being phased out by Microsoft. As a result, NHS Digital no longer supports any version of Internet Explorer for our web-based products, as it involves considerable extra effort and expense, which cannot be justified from public funds. Some features on this site will not work. You should use a modern browser such as Edge, Chrome, Firefox, or Safari. If you have difficulty installing or accessing a different browser, contact your IT support team.

Publication, Part of Health Survey for England

Health Survey for England, 2021 part 1

Official statistics, National statistics, Survey

Previous Chapter

• Part 3: Drinking alcohol

Current Chapter

• Overweight and obesity in adults

Next Chapter

• Part 1: Methods and definitions

This report examines the prevalence of overweight and obesity among adults in 2021. The estimates were produced using prediction equations that adjusted self-reported values of height and weight in order to predict measured values of height and weight. 

Detailed tables accompanying this report can be accessed here .  

Key findings for 2021

• In 2021, 26% of adults in England were obese. 
• A higher proportion of men than women were either overweight or obese (69% compared with 59%). 
• Obesity prevalence was lowest among adults living in the least deprived areas (20%) and highest in the most deprived areas (34%).
• 11% of obese adults reported that they had had a diagnosis of diabetes from a doctor, compared with 5% of overweight adults and 3% of those who were neither overweight nor obese.  
• Introduction

Obesity is a major public health problem in England and globally (Source: World Health Organization ). In adults, overweight and obesity are associated with life-limiting conditions, such as Type 2 diabetes, cardiovascular disease, and some cancers. 

The burden on the National Health Service (NHS) due to obesity and related illnesses is well recognised. The monetary cost each year, uplifted for inflation, was estimated at £6.1 billion in 2019 (Source: Department of Health and Social Care ). 

The COVID-19 pandemic has had a disproportionate effect on people with obesity, who are at increased risk of being hospitalised, admitted to intensive care, and of dying from COVID-19 (Public Health England, 2020; Saul, Gursul and Piernas, 2022). 

The Health Survey for England (HSE) is the main data source for monitoring overweight and obesity in the general population in England. Between 1993 and 2019, height and weight were directly measured during the interviewer visit in each year of the HSE series, and these values were used to calculate body mass index (BMI). 

For most of 2021 it was not possible to directly measure participants’ height and weight because of COVID-19 pandemic precautions. Instead, participants were asked about their height and weight during the telephone interview. This report presents findings on the prevalence of overweight (including obesity) and obesity for adults after applying adjustments to these self-reported heights and weights. 

Last edited: 15 December 2022 5:13 pm

Pages in this publication

• Adults' health-related behaviours
• Part 1: Smoking
• Part 2: E-cigarette use
• Part 2: Overweight and obesity
• Part 3: Overweight, obesity and health
• Part 4: Trends
• Part 5: References
• Part 6: Technical appendix
• Data Quality Statement

This website is intended for healthcare professionals

• { $refs.search.focus(); })" aria-controls="searchpanel" :aria-expanded="open" class="hidden lg:inline-flex justify-end text-gray-800 hover:text-primary py-2 px-4 lg:px-0 items-center text-base font-medium"> Search

Search menu

Health matters: whole systems approach to obesity. 2019. https://tinyurl.com/7vwz465t (accessed 18 May 2021)

Tackling obesities. Future choices—project report. 2007. https://tinyurl.com/8thk3r2z (accessed 18 May 2021)

Brown A, Flint SW, Kalea AZ, O'Kane M, Williams S, Batterham RL. Negative impact of the first COVID-19 lockdown upon health-related behaviours and psychological wellbeing in people living with severe and complex obesity in the UK. EClinicalMedicine.. 2021; 34 https://doi.org/10.1016/j.eclinm.2021.100796

Department of Health and Social Care. Tackling obesity: empowering adults and children to live healthier lives. 2020. https://tinyurl.com/2ff3ups7 (accessed 18 May 2021)

Department of Health and Social Care. New specialised support to help those living with obesity to lose weight. 2021. https://tinyurl.com/64ms26ev (accessed 18 May 2021)

Patterns and trends in excess weight among adults in England. 2021. https://tinyurl.com/52rtcvhf (accessed 18 May 2021)

Hart JT The inverse care law. Lancet.. 1971; 1:(7696)405-412 https://doi.org/10.1016/s0140-6736(71)92410-x

National Institute for Health and Care Excellence. Obesity. Identification, assessment and management of overweight and obesity in children, young people and adults. Partial update of CG43. 2014. https://tinyurl.com/58a9vcv2 (accessed 18 May 2021)

Newton JN, Briggs AD, Murray CJ Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet.. 2015; 386:(10010)2257-2274 https://doi.org/10.1016/S0140-6736(15)00195-6

Public Health England. About the All Our Health programme. 2019. https://tinyurl.com/4c2x7453 (accessed 18 May 2021)

Public Health England. Beyond the data: understanding the impact of COVID-19 on BAME groups. 2020a. https://tinyurl.com/y2ktevvv (accessed 18 May 2021)

Public Health England. Excess weight and COVID-19. Insights from new evidence. 2020b. https://tinyurl.com/arud4rff (accessed 18 May 2021)

Public Health England. Supporting weight management services during the COVID-19 pandemic. 2020c. https://tinyurl.com/4cszppcu (accessed 18 May 2021)

Public Health England. Better health. Overview. 2021a. https://tinyurl.com/2ns9rm96 (accessed 18 May 2021)

Public Health England. Better health. Kickstart your health. 2021b. https://www.nhs.uk/better-health/ (accessed 18 May 2021)

Investing in weight management services. 2021. https://tinyurl.com/4djhne68 (accessed 18 May 2021)

Obesity: the biggest public health challenge facing nursing this century

Rita Newland

Nurse Advisor, Research, Public Health England

View articles

Jamie Blackshaw

National Lead for Physical Activity and Healthy Weight, Public Health England

Jamie Waterall

Deputy Chief Nurse, Public Health England

View articles · Email Jamie

Obesity and overweight is arguably the largest and most complex non-communicable disease of the 21st century, threatening future progress in reducing preventable ill health, premature death and addressing unacceptable health inequalities in the UK. Around two-thirds (63%) of adults are above a healthy weight and, of these, half are living with obesity. In England, one in three children leaving primary school are overweight or living with obesity. Living with overweight or obesity is linked to a wide range of diseases, most commonly type 2 diabetes, hypertension, some cancers, heart disease, stroke and liver disease ( Department of Health and Social Care (DHSC), 2020 ; Hancock, 2021 ). Overweight and obesity terms and body mass index (BMI) ranges are set out in Table 1 and Table 2 .

Source: NICE, 2014

A complex public health challenge, overweight and obesity is driven by social, economic, biological, environmental and cultural factors that influence people's lives and behaviour ( Butland et al, 2007 ). These drivers, compounded by the wider social determinants of health, affect people differently, resulting in inequalities. This means that the prevalence of obesity is greater for people living in more deprived areas, among older adults, and in some ethnic communities ( Public Health England (PHE), 2020a ; Hancock, 2021 ; Tedstone and McManus, 2021 ).

Nurses in all sectors are likely to engage daily with people living with overweight or obesity. It is therefore imperative that they understand the complex causative factors, can listen empathetically and provide these people with the support needed to reduce or manage potential poor health outcomes.

As England progresses along the roadmap to recovery from the COVID-19 pandemic, taking steps to create health-promoting environments has never been more important. Clear opportunities for this are outlined in the Government's Obesity Strategy ( DHSC, 2020 ). As the largest registered professional workforce within the health and care system and the most trusted, nurses, play a vital role in the strategy's success.

Obesity and the pandemic

Research during the COVID-19 pandemic has illustrated the serious impact that obesity has on a person's physical and psychological health ( PHE, 2020b ; 2020c ; Brown et al, 2021 ). It also plays a significant role in health outcomes for people coping with a life-limiting disease ( Newton et al, 2015 ). For example, people living with excess weight who contracted COVID-19 were more likely to experience severe illness, which required intensive care or resulted in death ( PHE, 2020b ).

During the pandemic, nurses have adapted service delivery practices to accommodate the need for social distancing and isolation. For example, the use of internet-based (online) delivery mechanisms enabled nurses to support people in their homes. In addition, people's increased familiarity with the use of smartphone technology has also allowed nurses to share health information using apps. For example, the Better Health campaign, developed by PHE, supports adults living with overweight or obesity to look after their physical and mental health in combination rather than in isolation ( PHE, 2021a ). The Better Health campaign provides practical approaches to increasing physical activity, positive mental health and losing weight.

For example, the NHS 12-week weight loss app provides easy to follow information and support to help people manage their physical and mental health when losing weight. It includes information about calorie intake, dietary choices and food preparation, as well as how to manage mental health through lifestyle changes, including daily exercise.

However, some people may not have access to the internet or own a smartphone or computer and so therefore apps are only part of the solution. As such, local approaches to promote a healthier weight, which can be tailored to how people live their lives, remain vital ( DHSC, 2021 ). Such place-based approaches can help design ways to enable underserviced communities to access, engage and maximise the benefits provided ( Blackshaw and Van Dijik, 2019 ; PHE, 2020a ). This is particularly important as people living in more deprived areas may have limited access to safe and quality green spaces. Moreover, local high streets may be saturated with outlets providing and marketing foods and drinks high in fat, salt, sugar and calories, with less prominence given to healthier options. This means that, despite good intentions, the people most in need of public health strategies and services are often the ones least likely to be able to access or use them. The principle of the ‘inverse care law’ has been recognised for more than 50 years; however, the pandemic has made the impact more explicit ( Hart, 1971 ).

Enhancing knowledge and confidence to act

To support all health and care professionals to enhance their knowledge and act to help the population address overweight and obesity, PHE has published online e-learning resources. The All Our Health ( PHE, 2019 ) framework is a call to action for all health and care professionals to embed prevention, early intervention and health improvement in their day-to-day practice. Current resources include content focusing on obesity in children and adults, and an interactive townscape that explores a place-based approach to tackling childhood obesity. These resources have been purposely designed for health and care professionals to provide bite-sized learning and action-based summaries to enhance their public health impact.

As we start to focus on the recovery phase of the COVID-19 pandemic, nurses must appraise the lessons learnt and consider the changes needed to ensure that we truly build back better and fairer. It will be essential that we use the 2020s as a decade of transformation, which allows our nursing profession to challenge the way that we work—to pay the same attention to preventing, protecting and promoting the health and wellbeing of the public as we do to treating ill health and disease. In this way, we will be able to adapt the nursing model so it enables the workforce to address health inequalities and the unacceptable outcome differences that have been amplified by the pandemic. Given the threat that overweight and obesity poses to the public's health, they must be central to any future model.

Priya, aged 57, was originally from India, and has now lived in England for more than 40 years. She is the carer for her elderly mother, husband and five children, who all live at home.

As the practice nurse, you have been seeing Priya monthly because her GP was concerned about her increasing weight. With a BMI of 28kg/m 2 , you know that Priya is at increased risk of developing type 2 diabetes, and having recently completed PHE's (2019) All Our Health Adult Obesity e-learning resource, you are aware that this also puts Priya at increased risk of several other diseases, including heart disease, stroke and liver disease.

Through monthly contact you have got to know Priya and see that she has very little time for herself. She recounts the time spent preparing family meals, and how her husband does the food shopping so she can supervise her mother. In the pandemic, you have relied on telephone conversations to assess her progress.

During the pandemic, Priya's weight has increased. She has been too worried to focus on her diet and has found it hard to exercise due to caring responsibilities. Today you calculate her BMI is now 31kg/m 2 , and the results of her recent HbA1c blood test suggests that she has developed prediabetes.

During your telephone conversation, you know you must explain the diagnosis to Priya and use a health-coaching approach to agree on what action she would like to take. You recognise the complexity of this issue, so decide to offer Priya twice-weekly telephone appointments over the next 2 months, rather than covering this in one appointment.

You want to establish a way that will help Priya to identify for herself that integrating lifestyle changes relating to diet and physical activity into her daily routine will help her to reduce her weight. Recognising that it is also important to monitor the prediabetes, you decide that your first task is to address the most likely cause of the prediabetes (excess weight). Addressing both major issues concurrently may leave Priya at risk of not being able to manage either problem.

Priya is worried about her weight and tells you that she wants to focus on eating less and has arranged with her sister-in-law to walk in the local park each day. Her daughter, who is 18, has agreed to supervise her grandmother at those times. When you next talk to Priya, she tells you that she has been using the ‘Couch to 5k’ app that you recommended and had managed to walk each day for the past week ( PHE, 2021b ). She is also using a smaller dinner plate at mealtimes to reduce her portion sizes. Her weight has reduced by 1 kg.

Despite having little impact on her BMI, you know that this is a significant breakthrough for Priya, because it illustrates her ability to take control and engage with the health information you have shared.

Cookies on GOV.UK

We use some essential cookies to make this website work.

We’d like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services.

We also use cookies set by other sites to help us deliver content from their services.

You have accepted additional cookies. You can change your cookie settings at any time.

You have rejected additional cookies. You can change your cookie settings at any time.

• Health and social care
• Public health
• Health improvement
• Healthy eating

Tackling obesity: government strategy

Sets out the actions the government will take to tackle obesity and help adults and children to live healthier lives.

Tackling obesity: empowering adults and children to live healthier lives

We have known for decades that living with obesity reduces life expectancy and increases the chance of serious diseases such as cancer, heart disease and type 2 diabetes. In the last few months we have seen that excess weight puts individuals at risk of worse outcomes from coronavirus (COVID-19).

This publication outlines actions the government will take to tackle obesity and help adults and children to live healthier lives.

Related content

Is this page useful.

• Yes this page is useful
• No this page is not useful

Help us improve GOV.UK

Don’t include personal or financial information like your National Insurance number or credit card details.

To help us improve GOV.UK, we’d like to know more about your visit today. Please fill in this survey (opens in a new tab) .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Wiley Open Access Collection

Obesity: Risk factors, complications, and strategies for sustainable long‐term weight management

Sharon m. fruh.

1 College of Nursing, University of South Alabama, Mobile, Alabama

Background and Purpose

The aims of this article are to review the effects of obesity on health and well‐being and the evidence indicating they can be ameliorated by weight loss, and consider weight‐management strategies that may help patients achieve and maintain weight loss.

Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as “obesity,” “overweight,” “weight loss,” “comorbidity,” “diabetes,” cardiovascular,” “cancer,” “depression,” “management,” and “intervention.”

Conclusions

Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%–10% range, and above, can significantly improve health‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal‐setting and increased consultation frequency can greatly improve the success of weight‐management programs. Nurse practitioners have key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs.

Implications for Practice

With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight‐management strategies deployed in clinical practice.

Introduction

Obesity is an increasing, global public health issue. Patients with obesity are at major risk for developing a range of comorbid conditions, including cardiovascular disease (CVD), gastrointestinal disorders, type 2 diabetes (T2D), joint and muscular disorders, respiratory problems, and psychological issues, which may significantly affect their daily lives as well as increasing mortality risks. Obesity‐associated conditions are manifold; however, even modest weight reduction may enable patients to reduce their risk for CVD, diabetes, obstructive sleep apnea (OSA), and hypertension among many other comorbidities (Cefalu et al., 2015 ). A relatively small and simple reduction in weight, for example, of around 5%, can improve patient outcomes and may act as a catalyst for further change, with sustainable weight loss achieved through a series of incremental weight loss steps. In facilitating the process of losing weight for patients, nurse practitioners play an essential role. Through assessing the patient's risk, establishing realistic weight‐loss targets, providing motivation and support, and supplying patients with the necessary knowledge and treatment tools to help achieve weight loss, followed by tools for structured lifestyle support to maintain weight lost, the nurse practitioner is ideally positioned to help patient's achieve their weight‐loss—and overall health—targets.

The obesity epidemic

The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health (WHO, 2016a ). A body mass index (BMI) ≥25 kg/m 2 is generally considered overweight, while obesity is considered to be a BMI ≥ 30 kg/m 2 . It is well known that obesity and overweight are a growing problem globally with high rates in both developed and developing countries (Capodaglio & Liuzzi, 2013 ; WHO, 2016a , 2016b ).

In the United States in 2015, all states had an obesity prevalence more than 20%, 25 states and Guam had obesity rates >30% and four of those 25 states (Alabama, Louisiana, Mississippi, and West Virginia) had rates >35% (Centres for Disease Control and Prevention, 2016 ; Figure ​ Figure1). 1 ). Approximately 35% and 37% of adult men and women, respectively, in the United States have obesity (Yang & Colditz, 2015 ). Adult obesity is most common in non‐Hispanic black Americans, followed by Mexican Americans, and non‐Hispanic white Americans (Yang & Colditz, 2015 ). Individuals are also getting heavier at a younger age; birth cohorts from 1966 to 1975 and 1976 to 1985 reached an obesity prevalence of ≥20% by 20–29 years of age, while the 1956–1965 cohort only reached this prevalence by age 30–39 years (Lee et al., 2010 ). Additionally, the prevalence of childhood obesity in 2‐ to 17‐year‐olds in the United States has increased from 14.6% in 1999–2000 to 17.4% in 2013–2014 (Skinner & Skelton, 2014 ). Childhood obesity is an increasing health issue because of the early onset of comorbidities that have major adverse health impacts, and the increased likelihood of children with obesity going on to become adults with obesity (50% risk vs. 10% for children without obesity; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997 ).

U.S. obesity epidemic 2015.

Source . Figure adapted from Centers for Disease Control and Prevention (CDC). Retrieved from https://www.cdc.gov/obesity/data/prevalence-maps.html .

Association of obesity with mortality and comorbid disease

Obesity is associated with a significant increase in mortality, with a life expectancy decrease of 5–10 years (Berrington de Gonzalez et al., 2010 ; Kuk et al., 2011 ; Prospective Studies Collaboration et al., 2009 ). There is evidence to indicate that all‐cause, CVD‐associated, and cancer‐associated mortalities are significantly increased in individuals with obesity, specifically those at Stages 2 or 3 of the Edmonton Obesity Staging System (EOSS; Kuk et al., 2011 ; Figure ​ Figure2). 2 ). Mortality related to cancer is, however, also increased at Stage 1, when the physical symptoms of obesity are marginal (Figure ​ (Figure2). 2 ). Recently, a large‐scale meta‐analysis that included studies that had enrolled over 10 million individuals, indicated that, relative to the reference category of 22.5 to <25 kg/m 2 , the hazard ratio (HR) for all‐cause mortality rose sharply with increasing BMI (The Global BMI Mortality Collaboration, 2016 ). For a BMI of 25.0 to <30.0 kg/m 2 , the HR was 1.11 (95% confidence interval [CI] 1.10, 1.11), and this increased to 1.44 (1.41, 1.47), 1.92 (1.86, 1.98), and 2.71 (2.55, 2.86) for a BMI of 30.0 to <35.0, 35.0 to <40.0, and 40.0 to <60.0 kg/m 2 , respectively.

Association between EOSS stage and risk of all‐cause (A), CVD (B), cancer (C), and non‐CVD or noncancer mortality (D) in men and women. © 2011.

Source . Reproduced with permission from NRC Research Press, from Kuk et al. ( 2011 ). CVD, cardiovascular disease; NW, normal weight.

Comorbidities

Obesity is a chronic disease that is associated with a wide range of complications affecting many different aspects of physiology (Dobbins, Decorby, & Choi, 2013 ; Guh et al., 2009 ; Martin‐Rodriguez, Guillen‐Grima, Marti, & Brugos‐Larumbe, 2015 ; summarized in Table ​ Table1). 1 ). To examine these obesity‐related morbidities in detail is beyond the scope of this review and therefore only a brief overview of some of the key pathophysiological processes is included next.

Morbidities associated with obesity (Hamdy, 2016 ; Petry, Barry, Pietrzak, & Wagner, 2008 ; Pi‐Sunyer, 2009 ; Sakai et al., 2005 ; Smith, Hulsey, & Goodnight, 2008 ; Yosipovitch, DeVore, & Dawn, 2007 )

The progression from lean state to obesity brings with it a phenotypic change in adipose tissue and the development of chronic low‐grade inflammation (Wensveen, Valentic, Sestan, Turk Wensveen, & Polic, 2015 ). This is characterized by increased levels of circulating free‐fatty acids, soluble pro‐inflammatory factors (such as interleukin [IL] 1β, IL‐6, tumor necrosis factor [TNF] α, and monocyte chemoattractant protein [MCP] 1) and the activation and infiltration of immune cells into sites of inflammation (Hursting & Dunlap, 2012 ). Obesity is also usually allied to a specific dyslipidemia profile (atherogenic dyslipidemia) that includes small, dense low‐density lipoprotein (LDL) particles, decreased levels of high‐density lipoprotein (HDL) particles, and raised triglyceride levels (Musunuru, 2010 ). This chronic, low‐grade inflammation and dyslipidemia profile leads to vascular dysfunction, including atherosclerosis formation, and impaired fibrinolysis. These, in turn, increase the risk for CVD, including stroke and venous thromboembolism (Blokhin & Lentz, 2013 ).

The metabolic and cardiovascular aspects of obesity are closely linked. The chronic inflammatory state associated with obesity is established as a major contributing factor for insulin resistance, which itself is one of the key pathophysiologies of T2D (Johnson, Milner, & Makowski, 2012 ). Furthermore, central obesity defined by waist circumference is the essential component of the International Diabetes Federation (IDF) definition of the metabolic syndrome (raised triglycerides, reduced HDL cholesterol, raised blood pressure, and raised fasting plasma glucose; International Diabetes Federation, 2006 ).

Obesity is also closely associated with OSA. To start, a number of the conditions associated with obesity such as insulin resistance (Ip et al., 2002 ), systemic inflammation, and dyslipidemia are themselves closely associated with OSA, and concurrently, the obesity‐associated deposition of fat around the upper airway and thorax may affect lumen size and reduce chest compliance that contributes to OSA (Romero‐Corral, Caples, Lopez‐Jimenez, & Somers, 2010 ).

The development of certain cancers, including colorectal, pancreatic, kidney, endometrial, postmenopausal breast, and adenocarcinoma of the esophagus to name a few, have also been shown to be related to excess levels of fat and the metabolically active nature of this excess adipose tissue (Booth, Magnuson, Fouts, & Foster, 2015 ; Eheman et al., 2012 ). Cancers have shown to be impacted by the complex interactions between obesity‐related insulin resistance, hyperinsulinemia, sustained hyperglycemia, oxidative stress, inflammation, and the production of adipokines (Booth et al., 2015 ). The wide range of morbidities associated with obesity represents a significant clinical issue for individuals with obesity. However, as significant as this array of risk factors is for patient health, the risk factors can be positively modified with weight loss.

Obesity‐related morbidities in children and adolescents

As was referred to earlier, children and adolescents are becoming increasingly affected by obesity. This is particularly concerning because of the long‐term adverse consequences of early obesity. Obesity adversely affects the metabolic health of young people and can result in impaired glucose tolerance, T2D, and early‐onset metabolic syndrome (Pulgaron, 2013 ).There is also strong support in the literature for relationships between childhood obesity and asthma, poor dental health (caries), nonalcoholic fatty liver disease (NAFLD), and gastroesophageal reflux disease (GERD; Pulgaron, 2013 ). Obesity can also affect growth and sexual development and may delay puberty in boys and advance puberty in some girls (Burt Solorzano & McCartney, 2010 ). Childhood obesity is also associated with hyperandrogenism and polycystic ovary syndrome (PCOS) in girls (Burt Solorzano & McCartney, 2010 ). Additionally, obesity is associated with psychological problems in young people including attention deficit hyperactivity disorder (ADHD), anxiety, depression, poor self‐esteem, and problems with sleeping (Pulgaron, 2013 ).

Modest weight loss and its long‐term maintenance: Benefits and risks

Guidelines endorse weight‐loss targets of 5%–10% in individuals with obesity or overweight with associated comorbidities, as this has been shown to significantly improve health‐related outcomes for many obesity‐related comorbidities (Cefalu et al., 2015 ; Figure ​ Figure3), 3 ), including T2D prevention, and improvements in dyslipidemia, hyperglycemia, osteoarthritis, stress incontinence, GERD, hypertension, and PCOS. Further benefits may be evident with greater weight loss, particularly for dyslipidemia, hyperglycemia, and hypertension. For NAFLD and OSA, at least 10% weight loss is required to observe clinical improvements (Cefalu et al., 2015 ).

Benefits of modest weight loss. Lines demonstrate the ranges in which weight loss has been investigated and shown to have clinical benefits. Arrows indicate that additional benefits may be seen with further weight loss.

Source . Figure adapted from Cefalu et al. ( 2015 ).

Importantly, the weight‐loss benefits in terms of comorbidities are also reflected in improved all‐cause mortality. A recent meta‐analysis of 15 studies demonstrated that relatively small amounts of weight loss, on average 5.5 kg in the treatment arm versus 0.2 kg with placebo from an average baseline BMI of 35 kg/m 2 , resulted in a substantial 15% reduction in all‐cause mortality (Kritchevsky et al., 2015 ).

Cardiovascular health

Weight loss is associated with beneficial changes in several cardiovascular risk markers, including dyslipidemia, pro‐inflammatory/pro‐thrombotic mediators, arterial stiffness, and hypertension (Dattilo & Kris‐Etherton, 1992 ; Dengo et al., 2010 ; Goldberg et al., 2014 ; Haffner et al., 2005 ; Ratner et al., 2005 ). Importantly, weight loss was found to reduce the risk for CVD mortality by 41% up to 23 years after the original weight‐loss intervention (Li et al., 2014 ; Figure ​ Figure4). 4 ). Evidence including the biological effects of obesity and weight loss, and the increased risk for stroke with obesity indicates that weight loss may be effective for primary‐ and secondary‐stroke prevention (Kernan, Inzucchi, Sawan, Macko, & Furie, 2013 ).

Reduction in cardiovascular mortality with modest weight reduction. Cumulative incidence of CVD mortality during 23 years of follow‐up in the Da Qing study (Li et al., 2014 ). Figure © 2014 Elsevier.

Source . Reproduced with permission from Li et al. ( 2014 ).

Type 2 diabetes

Three major long‐term studies, the Diabetes Prevention Program (DPP), the Diabetes Prevention Study (DPS), and the Da Qing IGT and Diabetes (Da Qing) study, have demonstrated that modest weight loss through short‐term lifestyle or pharmacologic interventions can reduce the risk for developing T2D by 58%, 58%, and 31%, respectively, in individuals with obesity and prediabetes (DPP Research Group et al., 2009 ; Pan et al., 1997 ; Tuomilehto et al., 2001 ). Long‐term benefits were maintained following the interventions; for example, in the DPP, the risk reduction of developing T2D versus placebo was 34% at 10 years and 27% at 15 years following the initial weight‐loss intervention (DPP Research Group, 2015 ; DPP Research Group et al., 2009 ). Weight loss increased the likelihood of individuals reverting from prediabetes to normoglycemia (DPP Research Group et al., 2009 ; Li et al., 2008 ; Lindstrom et al., 2003 , 2006 ; Tuomilehto et al., 2001 ), and also improved other aspects of glycemic control including fasting and postprandial glucose, and insulin sensitivity (Haufe et al., 2013 ; Li et al., 2008 ).

Sleep apnea

Data indicate that weight loss is beneficial, although not curative, in patients with obesity who experience OSA. Meta‐analyses of patients who underwent treatment with either intensive lifestyle intervention (Araghi et al., 2013 ) or bariatric surgery (Greenburg, Lettieri, & Eliasson, 2009 ) demonstrated improvements in apnea‐hypopnea index (AHI) following treatment. In the first of these meta‐analyses, in randomized controlled trials, lifestyle intervention lead to a mean reduction in BMI of 2.3 kg/m 2 , which was associated with a decrease in mean AHI of 6.0 events/h. As expected, weight loss was much higher in the second meta‐analysis that investigated the effect of bariatric surgery on measures of OSA, and this was associated with greater reductions in AHI; the mean BMI reduction of 17.9 kg/m 2 resulted in AHI events being reduced by a mean of 38.2 events/h. Once these improvements in AHI have occurred, they seem to persist for some time, irrespective of a certain degree of weight regain. In one study, an initial mean weight loss of 10.7 kg resulted in a persistent improvement in AHI over a 4‐year period despite weight regain of approximately 50% by Year 4 (Kuna et al., 2013 ).

Intentional weight loss of >9 kg reduced the risk for a range of cancers including breast, endometrium, and colon in the large‐scale Iowa Women's Health Study (Parker & Folsom, 2003 ). The overall reduction in the incidence rate of any cancer was 11% (relative risk, 0.89; 95% CI 0.79, 1.00) for participants who lost more than 9 kg compared with those who did not achieve a more than 9 kg weight loss episode. Additionally, weight loss in participants with obesity has been established to be associated with reductions in cancer biomarkers including soluble E‐selectin and IL‐6 (Linkov et al., 2012 ).

Additional health benefits

The substantial weight loss associated with bariatric surgery has been shown to improve asthma with a 48%–100% improvement in symptoms and reduction in medication use (Juel, Ali, Nilas, & Ulrik, 2012 ); however, there is a potential threshold effect so that modest weight loss of 5%–10% may lead to clinical improvement (Lv, Xiao, & Ma, 2015 ). Similarly, modest weight loss of 5%–10% improves GERD (Singh et al., 2013 ) and liver function (Haufe et al., 2013 ). A study utilizing MRI scanning to examine the effects of weight loss on NAFLD has reported a reduction in liver fat from 18.3% to 13.6% ( p = .03), a relative reduction of 25% (Patel et al., 2015 ). Taking an active role in addressing obesity through behavioral modifications or exercise can also reduce the symptoms of depression (Fabricatore et al., 2011 ), improve urinary incontinence in men and women (Breyer et al., 2014 ; Brown et al., 2006 ), and improve fertility outcomes in women (Kort, Winget, Kim, & Lathi, 2014 ). Additionally, weight loss can reduce the joint‐pain symptoms and disability caused by weight‐related osteoarthritis (Felson, Zhang, Anthony, Naimark, & Anderson, 1992 ; Foy et al., 2011 ).

Mitigating risks

Despite the array of benefits, weight loss can also be linked with certain risks that may need to be managed. One such example is the risk for gallstones with rapid weight loss, which is associated with gallstone formation in 30%–71% of individuals. Gallstone formation is particularly associated with bariatric surgery when weight loss exceeds 1.5 kg/week and occurs particularly within the first 6 weeks following surgery when weight loss is greatest. Slower rates of weight loss appear to mitigate the risk for gallstone formation compared to the general population but may not eliminate it entirely; as was noted in the year‐long, weight‐loss, SCALE trial that compared liraglutide 3.0 mg daily use to placebo and resulted in gallstone formation in 2.5% of treated subjects compared to 1% of subjects taking placebo. For this reason, the risk for cholethiasis should be considered when formulating weight‐loss programs (Weinsier & Ullmann, 1993 ).

Strategies to help individuals achieve and maintain weight loss

Rogge and Gautam have covered the biology of obesity and weight regain within another section of this supplement (Rogge & Gautam, 2017 ), so here we focus on some of the clinical strategies for delivering weight loss and weight loss maintenance lifestyle programs. Structured lifestyle support plays an important role in successful weight management. A total of 34% of participants receiving structured lifestyle support from trained‐nursing staff achieved weight loss of ≥5% over 12 weeks compared with approximately 19% with usual care (Nanchahal et al., 2009 ). This particular structured program, delivered in a primary healthcare setting, included initial assessment and goal setting, an eating plan and specific lifestyle goals, personalized activity program, and advice about managing obstacles to weight loss. Additionally, data from the National Weight Control Registry (NWCR), which is the longest prospective compilation of data from individuals who have successfully lost weight and maintained their weight loss, confirm expectations that sustained changes to both diet and activity levels are central to successful weight management (Table ​ (Table2). 2 ). Therefore, an understanding of different clinical strategies for delivery‐structured support is essential for the nurse practitioner.

Lifestyle factors associated with achieving and maintaining weight loss

Note . Data from (NWCR, 2016 ).

a Walking was the most common activity undertaken.

Realistic weight‐loss targets

From the outset, a patient's estimate of their achievable weight loss may be unrealistic. Setting realistic weight‐loss goals is often difficult because of misinformation from a variety of sources, including friends, media, and other healthcare professionals (Osunlana et al., 2015 ). Many individuals with obesity or overweight have unrealistic goals of 20%–30% weight loss, whereas a more realistic goal would be the loss of 5%–15% of the initial body weight (Fabricatore et al., 2007 ). Promoting realistic weight‐loss expectations for patients was identified as a key difficulty for nurse practitioners, primary care nurses, dieticians, and mental health workers (Osunlana et al., 2015 ). Visual resources showing the health and wellness benefit of modest weight loss may thus be helpful (Osunlana et al., 2015 ). Healthcare practitioners should focus on open discussion about, and re‐enforcement of, realistic weight‐loss goals and assess outcomes consistently according to those goals (Bray, Look, & Ryan, 2013 ).

Maintaining a food diary

The 2013 White Paper from the American Nurse Practitioners Foundation on the Prevention and Treatment of Obesity considers a food diary as an important evidence‐based nutritional intervention in aiding weight loss (ANPF). Consistent and regular recording in a food diary was significantly associated with long‐term weight‐loss success in a group of 220 women (Peterson et al., 2014 ). This group lost a mean of 10.4% of their initial body weight through a 6‐month group‐based weight‐management program and then regained a mean of 2.3% over a 12‐month follow‐up period, during which participants received bimonthly support in person, by telephone, or by e‐mail (Peterson et al., 2014 ). Over the 12‐month follow‐up, women who self‐monitored consistently (≥50% of the extended‐care year) had a mean weight loss of 0.98%, while those who were less consistent (<50%) gained weight (5.1%; p < .01). Therefore, frequent and consistent food monitoring should be encouraged, particularly in the weight‐maintenance phase of any program.

Motivating and supporting patients

Motivational interviewing is a technique that focuses on enhancing intrinsic motivation and behavioral changes by addressing ambivalence (Barnes & Ivezaj, 2015 ). Interviews focus on “change talk,” including the reasons for change and optimism about the intent for change in a supportive and nonconfrontational setting, and may help individuals maintain behavioral changes.

For patients that have achieved weight loss, the behavioral factors associated with maintaining weight loss include strong social support networks, limiting/avoiding disinhibited eating, avoiding binge eating, avoiding eating in response to stress or emotional issues, being accountable for one's decisions, having a strong sense of autonomy, internal motivation, and self‐efficacy (Grief & Miranda, 2010 ). Therefore, encouraging feelings of “self‐worth” or “self‐efficacy” can help individuals to view weight loss as being within their own control and achievable (Cochrane, 2008 ).

Strengthening relationships with patients with overweight or obesity to enhance trust may also improve adherence with weight‐loss programs. Patients with hypertension who reported having “complete trust” in their healthcare practitioner were more than twice as likely to engage in lifestyle changes to lose weight than those who lacked “complete trust” (Jones, Carson, Bleich, & Cooper, 2012 ). It may be prudent to ensure the healthcare staff implementing weight‐loss programs have sufficient time to foster trust with their patients.

Continued support from healthcare staff may help patients sustain the necessary motivation for lifestyle changes. A retrospective analysis of 14,256 patients in primary care identified consultation frequency as a factor that can predict the success of weight‐management programs (Lenoir, Maillot, Guilbot, & Ritz, 2015 ). Individuals who successfully maintained ≥10% weight loss over 12 months visited the healthcare provider on average 0.65 times monthly compared with an average of 0.48 visits/month in those who did not maintain ≥10% weight loss, and 0.39 visits/month in those who failed to achieve the initial ≥10% weight loss ( p < .001; Lenoir et al., 2015 ).

Educational and environmental factors

It is important to consider a patient's education and environment when formulating a weight loss strategy as environmental factors may need to be challenged to help facilitate weight loss. A family history of obesity and childhood obesity are strongly linked to adult obesity, which is likely to be because of both genetic and behavioral factors (Kral & Rauh, 2010 ). Parents create their child's early food experiences and influence their child's attitudes to eating through learned eating habits and food choices (Kral & Rauh, 2010 ). Families can also impart cultural preferences for less healthy food choices and family food choices may be affected by community factors, such as the local availability and cost of healthy food options (Castro, Shaibi, & Boehm‐Smith, 2009 ). Alongside this, genetic variation in taste sensation may influence the dietary palate and influence food choices (Loper, La Sala, Dotson, & Steinle, 2015 ). For example, sensitivity to 6‐n‐propylthiouracil (PROP) is genetically determined, and PROP‐tasting ability ranges from super taster to nontaster. When offered buffet‐style meals over 3 days, PROP nontasters consumed more energy, and a greater proportion of energy from fat compared with super tasters. So it is possible that a family's genetic profile could contribute to eating choices. To address behavioral factors, it is important to ensure that families have appropriate support and information and that any early signs of weight gain are dealt with promptly.

A healthy home food environment can help individuals improve their diet. In children, key factors are availability of fresh fruit and vegetables at home and parental influence through their own fresh fruit and vegetable intake (Wyse, Wolfenden, & Bisquera, 2015 ). In adults, unhealthy home food environment factors include less healthy food in the home and reliance on fast food ( p = .01) are all predictors of obesity (Emery et al., 2015 ).

Family mealtimes are strongly associated with better dietary intake and a randomized controlled trial to encourage healthy family meals showed a promising reduction in excess weight gain in prepubescent children (Fulkerson et al., 2015 ). Another study showed that adolescents with any level of baseline family meal frequency, 1–2, 3–4, and ≥5 family meals/week, had reduced odds of being affected by overweight or obesity 10 years later than adolescents who never ate family meals (Berge et al., 2015 ). Community health advocates have identified the failure of many families to plan meals or prepare food as a barrier to healthy family eating patterns (Fruh, Mulekar, Hall, Fulkerson et al., 2013 ). Meal planning allows healthy meals to be prepared in advance and frozen for later consumption (Fruh, Mulekar, Hall, Adams et al., 2013 ) and is associated with increased consumption of vegetables and healthier meals compared with meals prepared on impulse (Crawford, Ball, Mishra, Salmon, & Timperio, 2007 ; Hersey et al., 2001 ).

The role of the nurse practitioner

The initial and ongoing interactions between patient and nurse practitioner are keys for the determination of an effective approach and implementation of a weight loss program and subsequent weight maintenance. The initial interaction can be instigated by either the nurse practitioner or the patient and once the decision has been made to manage the patient's weight, the evaluation includes a risk assessment, a discussion about the patient's weight, and treatment goal recommendations (American Nurse Practitioner Foundation, 2013 ). Across this process, it may be advantageous to approach this using objective data and language that is motivational and/or nonjudgmental. Patients may struggle with motivation, and therefore, ongoing discussions around the health benefits and improvements to quality of life as a result of weight loss may be required (American Nurse Practitioner Foundation, 2013 ). It may be valuable to allocate personalized benefits to the weight loss such as playing with children/grandchildren (American Nurse Practitioner Foundation, 2013 ). Treatment approaches encompass nonpharmacological and pharmacological strategies; however, it is important to remember that any pharmacological agent used should be used as an adjunct to nutritional and physical activity strategies (American Nurse Practitioner Foundation, 2013 ). Pharmacotherapy options for weight management are discussed further in the article by Golden in this supplement.

Conclusions/summary

The importance of obesity management is underscored both by the serious health consequences for individuals, but also by its increasing prevalence globally, and across age groups in particular. Obesity promotes a chronic, low‐grade, inflammatory state, which is associated with vascular dysfunction, thrombotic disorders, multiple organ damage, and metabolic dysfunction. These physiological effects ultimately lead to the development of a range of morbidities, including CVD, T2D, OSA, and certain cancers along with many others, as well as causing a significant impact on mortality.

However, even modest weight loss of 5%–10% of total body weight can significantly improve health and well‐being, and further benefits are possible with greater weight loss. Weight loss can help to prevent development of T2D in individuals with obesity and prediabetes and has a positive long‐term impact on cardiovascular mortality. Beneficial, although not curative, effects have also been noted on OSA following >10% weight loss. In addition, weight loss reduces the risk for certain cancer types and has positive effects on most comorbidities including asthma, GERD, liver function, urinary incontinence, fertility, joint pain, and depression.

Weight‐loss programs that include realistic weight loss goals, frequent check‐in, and meal/activity diaries may help individuals to lose weight. Setting realistic weight‐loss goals can be difficult; however, visual resources showing the health and wellness benefit of weight loss may be helpful in discussing realistic goals, and help motivate the patient in maintaining the weight loss. Techniques such as motivational interviewing that focus on addressing resistance to behavioral change in a supportive and optimistic manner may help individuals in integrating these changes to allow them to become part of normal everyday life and thus help with maintaining the weight loss. Positive reinforcement in terms of marked early‐weight loss may also assist in improving adherence, so this should be a key goal for weight‐loss programs. Encouraging feelings of “self‐worth” or “self‐efficacy” can help individuals to view weight loss as being within their own control.

Nurse practitioners play a major role in helping patients achieve weight loss through all aspects of the process including assessment, support, motivation, goal‐setting, management, and treatment. With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in the weight‐management strategies deployed in clinical practice.

List of helpful resources

Acknowledgments.

The authors are grateful to Watermeadow Medical for writing assistance in the development of this manuscript. This assistance was funded by Novo Nordisk, who also had a role in the review of the manuscript for scientific accuracy. The author discussed the concept, drafted the outline, commented in detail on the first iteration, made critical revision of later drafts, and has revised and approved the final version for submission.

Dr. Sharon Fruh serves on the Novo Nordisk Obesity Speakers Bureau. In compliance with national ethical guidelines, the author reports no relationship with business or industry that would post a conflict of interest.

Writing and editorial support was provided by Watermeadow Medical, and funded by Novo Nordisk.

The copyright line in this article was changed on 9 August 2018 after online publication.

• American Nurse Practitioner Foundation . (2013). Nurse practitioners and the prevention and treatment of adult obesity—A White Paper of the American Nurse Practitioner Foundation (electronic version) . Summer. Retrieved from https://international.aanp.org/Content/docs/ObesityWhitePaper.pdf
• Araghi, M. H. , Chen, Y. F. , Jagielski, A. , Choudhury, S. , Banerjee, D. , Hussain, S. , … Taheri, S. , et al. (2013). Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): Systematic review and meta‐analysis . Sleep , 36 ( 10 ), 1553–1562, 1562a–1562e. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Barnes, R. D. , & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight loss among adults in primary care . Obesity Reviews , 16 ( 4 ), 304–318. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Berge, J. M. , Wall, M. , Hsueh, T. F. , Fulkerson, J. A. , Larson, N. , & Neumark‐Sztainer, D. (2015). The protective role of family meals for youth obesity: 10‐year longitudinal associations . Journal of Pediatrics , 166 ( 2 ), 296–301. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Berrington de Gonzalez, A. , Hartge, P. , Cerhan, J. R. , Flint, A. J. , Hannan, L. , MacInnis, R. J. , … Thun, M. J. , et al. (2010). Body‐mass index and mortality among 1.46 million white adults . New England Journal of Medicine , 363 ( 23 ), 2211–2219. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Blokhin, I. O. , & Lentz, S. R. (2013). Mechanisms of thrombosis in obesity . Current Opinion in Hematology , 20 ( 5 ), 437–444 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Booth, A. , Magnuson, A. , Fouts, J. , & Foster, M. (2015). Adipose tissue, obesity and adipokines: Role in cancer promotion . Hormone Molecular Biology and Clinical Investigation , 21 ( 1 ), 57–74. [ PubMed ] [ Google Scholar ]
• Bray, G. , Look, M. , & Ryan, D. (2013). Treatment of the obese patient in primary care: Targeting and meeting goals and expectations . Postgraduate Medical Journal , 125 ( 5 ), 67–77. [ PubMed ] [ Google Scholar ]
• Breyer, B. N. , Phelan, S. , Hogan, P. E. , Rosen, R. C. , Kitabchi, A. E. , Wing, R. R. , … the Look AHEAD Research Group , et al. (2014). Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with type 2 diabetes: Results from the Look AHEAD trial . Journal of Urology , 192 ( 1 ), 144–149. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Brown, J. S. , Wing, R. , Barrett‐Connor, E. , Nyberg, L. M. , Kusek, J. W. , Orchard, T. J. , … Diabetes Prevention Program Research Group , et al. (2006). Lifestyle intervention is associated with lower prevalence of urinary incontinence: The Diabetes Prevention Program . Diabetes Care , 29 ( 2 ), 385–390. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Burt Solorzano, C. M. , & McCartney, C. R. (2010). Obesity and the pubertal transition in girls and boys . Reproduction , 140 ( 3 ), 399–410. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Capodaglio, P. , & Liuzzi, A. (2013). Obesity: A disabling disease or a condition favoring disability ? European Journal of Physical and Rehabilitation Medicine , 49 ( 3 ), 395–398. [ PubMed ] [ Google Scholar ]
• Castro, F. G. , Shaibi, G. Q. , & Boehm‐Smith, E. (2009). Ecodevelopmental contexts for preventing type 2 diabetes in Latino and other racial/ethnic minority populations . Journal of Behavioral Medicine , 32 ( 1 ), 89–105. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Cefalu, W. T. , Bray, G. A. , Home, P. D. , Garvey, W. T. , Klein, S. , Pi‐Sunyer, F. X. , … Ryan, D. H. , et al. (2015). Advances in the science, treatment, and prevention of the disease of obesity: Reflections from a diabetes care editors' expert forum . Diabetes Care , 38 ( 8 ), 1567–1582. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Centres for Disease Control and Prevention . (2016). Overweight and obesity . Retrieved from https://www.cdc.gov/obesity/
• Cochrane, G. (2008). Role for a sense of self‐worth in weight‐loss treatments: Helping patients develop self‐efficacy . Canadian Family Physician , 54 ( 4 ), 543–547. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Crawford, D. , Ball, K. , Mishra, G. , Salmon, J. , & Timperio, A. (2007). Which food‐related behaviours are associated with healthier intakes of fruits and vegetables among women ? Public Health Nutrition , 10 ( 3 ), 256–265. [ PubMed ] [ Google Scholar ]
• Dattilo, A. M. , & Kris‐Etherton, P. M. (1992). Effects of weight reduction on blood lipids and lipoproteins: A meta‐analysis . American Journal of Clinical Nutrition , 56 ( 2 ), 320–328. [ PubMed ] [ Google Scholar ]
• Dengo, A. L. , Dennis, E. A. , Orr, J. S. , Marinik, E. L. , Ehrlich, E. , Davy, B. M. , & Davy, K. P. (2010). Arterial destiffening with weight loss in overweight and obese middle‐aged and older adults . Hypertension , 55 ( 4 ), 855–861. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Diabetes Prevention Program ( DPP) Research Group . (2015). Long‐term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15‐year follow‐up: The Diabetes Prevention Program Outcomes Study . Lancet Diabetes & Endocrinology , 3 ( 11 ), 866–875. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Diabetes Prevention Program ( DPP) Research Group , Knowler, W. C. , Fowler, S. E. , Hamman, R. F. , Christophi, C. A. , Hoffman, H. J. , … Nathan, D. M. , et al. (2009). 10‐year follow‐up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study . Lancet , 374 ( 9702 ), 1677–1686. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Dobbins, M. , Decorby, K. , & Choi, B. C. (2013). The association between obesity and cancer risk: A meta‐analysis of observational studies from 1985 to 2011 . ISRN Preventive Medicine , 2013 , 680536 10.5402/2013/680536. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Eheman, C. , Henley, S. J. , Ballard‐Barbash, R. , Jacobs, E. J. , Schymura, M. J. , Noone, A. M. , … Edwards, B. K. , et al. (2012). Annual Report to the Nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity . Cancer , 118 ( 9 ), 2338–2366. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Emery, C. F. , Olson, K. L. , Lee, V. S. , Habash, D. L. , Nasar, J. L. , & Bodine, A. (2015). Home environment and psychosocial predictors of obesity status among community‐residing men and women . International Journal of Obesity , 39 ( 9 ), 1401–1407. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fabricatore, A. N. , Wadden, T. A. , Higginbotham, A. J. , Faulconbridge, L. F. , Nguyen, A. M. , Heymsfield, S. B. , & Faith, M. S. (2011). Intentional weight loss and changes in symptoms of depression: A systematic review and meta‐analysis . International Journal of Obesity , 35 ( 11 ), 1363–1376. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fabricatore, A. N. , Wadden, T. A. , Womble, L. G. , Sarwer, D. B. , Berkowitz, R. I. , Foster, G. D. , & Brock, J. R. (2007). The role of patients' expectations and goals in the behavioral and pharmacological treatment of obesity . International Journal of Obesity , 31 ( 11 ), 1739–1745. [ PubMed ] [ Google Scholar ]
• Felson, D. T. , Zhang, Y. , Anthony, J. M. , Naimark, A. , & Anderson, J. J. (1992). Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study . Annals of Internal Medicine , 116 ( 7 ), 535–539. [ PubMed ] [ Google Scholar ]
• Foy, C. G. , Lewis, C. E. , Hairston, K. G. , Miller, G. D. , Lang, W. , Jakicic, J. M. , … the Look AHEAD Research Group , et al. (2011). Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD trial . Obesity (Silver Spring) , 19 ( 1 ), 83–93. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fruh, S. M. , Mulekar, M. S. , Hall, H. R. , Adams, J. R. , Lemley, T. , Evans, B. , & Dierking, J. (2013). Meal‐planning practices with individuals in health disparity zip codes . Journal for Nurse Practitioners , 9 ( 6 ), 344–349. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fruh, S. M. , Mulekar, M. S. , Hall, H. R. , Fulkerson, J. A. , Hanks, R. S. , Lemley, T. , … Dierking, J. , et al. (2013). Perspectives of community health advocates: Barriers to healthy family eating patterns . Journal for Nurse Practitioners , 9 ( 7 ), 416–421. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fulkerson, J. A. , Friend, S. , Flattum, C. , Horning, M. , Draxten, M. , Neumark‐Sztainer, D. , … Kubik, M. , et al. (2015). Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial . International Journal of Behavioral Nutrition and Physical Activity , 12 , 154. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Goldberg, R. B. , Temprosa, M. G. , Mather, K. J. , Orchard, T. J. , Kitabchi, A. E. , & Watson, K. E. , for the Diabetes Prevention Program Research Group . (2014). Lifestyle and metformin interventions have a durable effect to lower CRP and tPA levels in the diabetes prevention program except in those who develop diabetes . Diabetes Care , 37 ( 8 ), 2253–2260. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Greenburg, D. L. , Lettieri, C. J. , & Eliasson, A. H. (2009). Effects of surgical weight loss on measures of obstructive sleep apnea: A meta‐analysis . American Journal of Medicine , 122 ( 6 ), 535–542. [ PubMed ] [ Google Scholar ]
• Grief, S. N. , & Miranda, R. L. (2010). Weight loss maintenance . American Family Physician , 82 ( 6 ), 630–634. [ PubMed ] [ Google Scholar ]
• Guh, D. P. , Zhang, W. , Bansback, N. , Amarsi, Z. , Birmingham, C. L. , & Anis, A. H. (2009). The incidence of co‐morbidities related to obesity and overweight: A systematic review and meta‐analysis . BMC Public Health , 9 , 88. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Haffner, S. , Temprosa, M. , Crandall, J. , Fowler, S. , Goldberg, R. , Horton, E. , … Diabetes Prevention Program Research Group , et al. (2005). Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance . Diabetes , 54 ( 5 ), 1566–1572. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hamdy, O. (2016). Obesity . Retrieved from https://emedicine.medscape.com/article/123702-overview
• Haufe, S. , Haas, V. , Utz, W. , Birkenfeld, A. L. , Jeran, S. , Bohnke, J. , … Engeli, S. , et al. (2013). Long‐lasting improvements in liver fat and metabolism despite body weight regain after dietary weight loss . Diabetes Care , 36 ( 11 ), 3786–3792. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hersey, J. , Anliker, J. , Miller, C. , Mullis, R. M. , Daugherty, S. , Das, S. , … Olivia, A. H. , et al. (2001). Food shopping practices are associated with dietary quality in low‐income households . Journal of Nutrition Education , 33 ( Suppl 1 ), S16–S26. [ PubMed ] [ Google Scholar ]
• Hursting, S. D. , & Dunlap, S. M. (2012). Obesity, metabolic dysregulation, and cancer: A growing concern and an inflammatory (and microenvironmental) issue . Annals of the New York Academy of Sciences , 1271 , 82–87. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• International Diabetes Federation . (2006). The IDF consensus worldwide definition of the metabolic syndrome (electronic version). Retrieved from https://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf
• Ip, M. S. , Lam, B. , Ng, M. M. , Lam, W. K. , Tsang, K. W. , & Lam, K. S. (2002). Obstructive sleep apnea is independently associated with insulin resistance . American Journal of Respiratory and Critical Care Medicine , 165 ( 5 ), 670–676. [ PubMed ] [ Google Scholar ]
• Johnson, A. R. , Milner, J. J. , & Makowski, L. (2012). The inflammation highway: Metabolism accelerates inflammatory traffic in obesity . Immunological Reviews , 249 ( 1 ), 218–238. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Jones, D. E. , Carson, K. A. , Bleich, S. N. , & Cooper, L. A. (2012). Patient trust in physicians and adoption of lifestyle behaviors to control high blood pressure . Patient Education and Counseling , 89 ( 1 ), 57–62. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Juel, C. T. , Ali, Z. , Nilas, L. , & Ulrik, C. S. (2012). Asthma and obesity: Does weight loss improve asthma control? A systematic review . Journal of Asthma and Allergy , 5 , 21–26. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kernan, W. N. , Inzucchi, S. E. , Sawan, C. , Macko, R. F. , & Furie, K. L. (2013). Obesity: A stubbornly obvious target for stroke prevention . Stroke , 44 ( 1 ), 278–286. [ PubMed ] [ Google Scholar ]
• Kort, J. D. , Winget, C. , Kim, S. H. , & Lathi, R. B. (2014). A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility . Fertility and Sterility , 101 ( 5 ), 1400–1403. [ PubMed ] [ Google Scholar ]
• Kral, T. V. , & Rauh, E. M. (2010). Eating behaviors of children in the context of their family environment . Physiology & Behavior , 100 ( 5 ), 567–573. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kritchevsky, S. B. , Beavers, K. M. , Miller, M. E. , Shea, M. K. , Houston, D. K. , Kitzman, D. W. , & Nicklas, B. J. (2015). Intentional weight loss and all‐cause mortality: A meta‐analysis of randomized clinical trials . PLoS One , 10 ( 3 ), e0121993. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kuk, J. L. , Ardern, C. I. , Church, T. S. , Sharma, A. M. , Padwal, R. , Sui, X. , … Blair, S. N. , et al. (2011). Edmonton obesity staging system: Association with weight history and mortality risk . Applied Physiology, Nutrition, and Metabolism , 36 ( 4 ), 570–576. [ PubMed ] [ Google Scholar ]
• Kuna, S. T. , Reboussin, D. M. , Borradaile, K. E. , Sanders, M. H. , Millman, R. P. , Zammit, G. , … Sleep AHEAD Research Group of the Look AHEAD Research Group , et al. (2013). Long‐term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes . Sleep , 36 ( 5 ), 641–649A. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lee, J. M. , Pilli, S. , Gebremariam, A. , Keirns, C. C. , Davis, M. M. , Vijan, S. , … Gurney, J. G. , et al. (2010). Getting heavier, younger: Trajectories of obesity over the life course . International Journal of Obesity , 34 ( 4 ), 614–623. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lenoir, L. , Maillot, M. , Guilbot, A. , & Ritz, P. (2015). Primary care weight loss maintenance with behavioral nutrition: An observational study . Obesity (Silver Spring) , 23 ( 9 ), 1771–777. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Li, G. , Zhang, P. , Wang, J. , An, Y. , Gong, Q. , Gregg, E. W. , … Bennett, P. H. , et al. (2014). Cardiovascular mortality, all‐cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: A 23‐year follow‐up study . Lancet Diabetes & Endocrinology , 2 ( 6 ), 474–480. [ PubMed ] [ Google Scholar ]
• Li, G. , Zhang, P. , Wang, J. , Gregg, E. W. , Yang, W. , Gong, Q. , … Bennett, P. H. , et al. (2008). The long‐term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20‐year follow‐up study . Lancet , 371 ( 9626 ), 1783–1789. [ PubMed ] [ Google Scholar ]
• Lindstrom, J. , Eriksson, J. G. , Valle, T. T. , Aunola, S. , Cepaitis, Z. , Hakumaki, M. , … Tuomilehto, J. , et al. (2003). Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study: Results from a randomized clinical trial . Journal of the American Society of Nephrology , 14 ( 7 Suppl 2 ), S108–S113. [ PubMed ] [ Google Scholar ]
• Lindstrom, J. , Ilanne‐Parikka, P. , Peltonen, M. , Aunola, S. , Eriksson, J. G. , Hemio, K. , … Finnish Diabetes Prevention Study Group , et al. (2006). Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: Follow‐up of the Finnish Diabetes Prevention Study . Lancet , 368 ( 9548 ), 1673–1679. [ PubMed ] [ Google Scholar ]
• Linkov, F. , Maxwell, G. L. , Felix, A. S. , Lin, Y. , Lenzner, D. , Bovbjerg, D. H. , … DeLany, J. P. , et al. (2012). Longitudinal evaluation of cancer‐associated biomarkers before and after weight loss in RENEW study participants: Implications for cancer risk reduction . Gynecologic Oncology , 125 ( 1 ), 114–119. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Loper, H. B. , La Sala, M. , Dotson, C. , & Steinle, N. (2015). Taste perception, associated hormonal modulation, and nutrient intake . Nutrition Reviews , 73 ( 2 ), 83–91. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lv, N. , Xiao, L. , & Ma, J. (2015). Weight management interventions in adult and pediatric asthma populations: A systematic review . J Pulm Respir Med , 5 ( 232 ), pii: 1000232. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Martin‐Rodriguez, E. , Guillen‐Grima, F. , Marti, A. , & Brugos‐Larumbe, A. (2015). Comorbidity associated with obesity in a large population: The APNA study . Obesity Research & Clinical Practice , 9 ( 5 ), 435–447. [ PubMed ] [ Google Scholar ]
• Musunuru, K. (2010). Atherogenic dyslipidemia: Cardiovascular risk and dietary intervention . Lipids , 45 ( 10 ), 907–914. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nanchahal, K. , Townsend, J. , Letley, L. , Haslam, D. , Wellings, K. , & Haines, A. (2009). Weight‐management interventions in primary care: A pilot randomised controlled trial . British Journal of General Practice , 59 ( 562 ), e157–e166. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Osunlana, A. M. , Asselin, J. , Anderson, R. , Ogunleye, A. A. , Cave, A. , Sharma, A. M. , & Campbell‐Scherer, D. L.. (2015). 5As team obesity intervention in primary care: Development and evaluation of shared decision‐making weight management tools . Clinical Obesity , 5 ( 4 ), 219–225. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pan, X. R. , Li, G. W. , Hu, Y. H. , Wang, J. X. , Yang, W. Y. , An, Z. X. , … Howard, B. V. , et al. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and diabetes study . Diabetes Care , 20 ( 4 ), 537–544. [ PubMed ] [ Google Scholar ]
• Parker, E. D. , & Folsom, A. R. (2003). Intentional weight loss and incidence of obesity‐related cancers: The Iowa Women's Health Study . International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity , 27 ( 12 ), 1447–1452. [ PubMed ] [ Google Scholar ]
• Patel, N. S. , Doycheva, I. , Peterson, M. R. , Hooker, J. , Kisselva, T. , Schnabl, B. , … Loomba, R. , et al. (2015). Effect of weight loss on magnetic resonance imaging estimation of liver fat and volume in patients with nonalcoholic steatohepatitis . Clinical Gastroenterology and Hepatology , 13 ( 3 ), 561–568 e561. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Peterson, N. D. , Middleton, K. R. , Nackers, L. M. , Medina, K. E. , Milsom, V. A. , & Perri, M. G. (2014). Dietary self‐monitoring and long‐term success with weight management . Obesity (Silver Spring) , 22 ( 9 ), 1962–1967. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Petry, N. M. , Barry, D. , Pietrzak, R. H. , & Wagner, J. A. (2008). Overweight and obesity are associated with psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions . 70 ( 3 ), 288–297. [ PubMed ] [ Google Scholar ]
• Pi‐Sunyer, X. (2009). The medical risks of obesity . Postgraduate Medicine , 121 ( 6 ), 21–33. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Prospective Studies Collaboration , Whitlock, G. , Lewington, S. , Sherliker, P. , Clarke, R. , Emberson, J. , … Peto, R. , et al. (2009). Body‐mass index and cause‐specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies . Lancet , 373 ( 9669 ), 1083–1096. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pulgaron, E. R. (2013). Childhood obesity: A review of increased risk for physical and psychological comorbidities . Clin Ther 35 ( 1 ), A18–A32. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ratner, R. , Goldberg, R. , Haffner, S. , Marcovina, S. , Orchard, T. , Fowler, S. , … Diabetes Prevention Program Research Group , et al. (2005). Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program . Diabetes Care , 28 ( 4 ), 888–894. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rogge, M. M. , & Gautam, B. (2017). Biology of obesity and weight regain: Implications for clinical practice . Journal of the American Association of Nurse Practitioners , 29 (Supplement 1), S15–S29. [ PubMed ] [ Google Scholar ]
• Romero‐Corral, A. , Caples, S. M. , Lopez‐Jimenez, F. , & Somers, V. K. (2010). Interactions between obesity and obstructive sleep apnea: Implications for treatment . Chest , 137 ( 3 ), 711–719. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sakai, R. , Matsui, S. , Fukushima, M. , Yasuda, H. , Miyauchi, H. , & Miyachi, Y. (2005). Prognostic factor analysis for plaque psoriasis . Dermatology , 211 ( 2 ), 103–106. [ PubMed ] [ Google Scholar ]
• Singh, M. , Lee, J. , Gupta, N. , Gaddam, S. , Smith, B. K. , Wani, S. B. , … Sharma, P. , et al. (2013). Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: A prospective intervention trial . Obesity (Silver Spring) , 21 ( 2 ), 284–290. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Skinner, A. C. , & Skelton, J. A. (2014). Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012 . JAMA Pediatrics , 168 ( 6 ), 561–566. [ PubMed ] [ Google Scholar ]
• Smith, S. A. , Hulsey, T. , & Goodnight, W. (2008). Effects of obesity on pregnancy . J Obstet Gynecol Neonatal Nurs , 37 ( 2 ), 176–184. [ PubMed ] [ Google Scholar ]
• The Global BMI Mortality Collaboration . (2016). Body‐mass index and all‐cause mortality: Individual participant‐data meta‐analysis of 239 prospective studies in four continents . Lancet , 388 , 734–736. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• The National Weight Control Registry ( NWCR) . (2016). NCWR facts . Retrieved from https://www.nwcr.ws/
• Tuomilehto, J. , Lindstrom, J. , Eriksson, J. G. , Valle, T. T. , Hamalainen, H. , Ilanne‐Parikka, P. , … Finnish Diabetes Prevention Study Group , et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance . New England Journal of Medicine , 344 ( 18 ), 1343–1350. [ PubMed ] [ Google Scholar ]
• Weinsier, R. L. , & Ullmann, D. O. (1993). Gallstone formation and weight loss . Obesity Research , 1 ( 1 ), 51–56. [ PubMed ] [ Google Scholar ]
• Wensveen, F. M. , Valentic, S. , Sestan, M. , Turk Wensveen, T. , & Polic, B. (2015). The "Big Bang" in obese fat: Events initiating obesity‐induced adipose tissue inflammation . European Journal of Immunology , 45 ( 9 ), 2446–2456. [ PubMed ] [ Google Scholar ]
• Whitaker, R. C. , Wright, J. A. , Pepe, M. S. , Seidel, K. D. , & Dietz, W. H. (1997). Predicting obesity in young adulthood from childhood and parental obesity . New England Journal of Medicine , 337 ( 13 ), 869–873. [ PubMed ] [ Google Scholar ]
• World Health Organization (WHO) . (2016a). 10 Facts on obesity . Retrieved from https://www.who.int/features/factfiles/obesity/facts/en/
• World Health Organization (WHO) . (2016b). Obesity . Retrieved from https://www.who.int/topics/obesity/en/
• Wyse, R. , Wolfenden, L. , & Bisquera, A. (2015). Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: Mediation analysis from the Healthy Habits cluster randomised controlled trial . International Journal of Behavioral Nutrition and Physical Activity , 12 , 118. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Yang, L. , & Colditz, G. A. (2015). Prevalence of overweight and obesity in the United States, 2007–2012 . JAMA Internal Medicine , 175 ( 8 ), 1412–1413. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Yosipovitch, G. , DeVore, A. , & Dawn, A. (2007). Obesity and the skin: Skin physiology and skin manifestations of obesity . J Am Acad Dermatol , 56 ( 6 ), 901–916; quiz 917–920. [ PubMed ] [ Google Scholar ]

New Cochrane reviews published: Preventing obesity in children and adolescents

22 May 2024

The highly cited Cochrane review ‘Interventions for preventing obesity in children’ has undergone a major update by researchers at NIHR ARC West, Fuse (the Centre for Translational Research in Public Health) at Durham University and the Universities of Bristol and Newcastle, Australia.

One of Cochrane’s most cited reviews and encompassing 153 studies at its last update in 2019, it has now been broken down into smaller age ranges. Cochrane has published the two reviews focusing on studies of interventions aimed at children aged 5-11 and 12-18 .

The reviews show that a range of physical activity interventions, with or without a diet component, can have a modest beneficial effect on obesity in children and adolescents, without affecting health inequalities and without serious adverse events.

The ‘parent’ Cochrane review of interventions to prevent obesity in children focused on children aged 0-18. It has been updated five times since it was first published with seven studies in 2000.

Cochrane and the author team decided to divide it into four reviews for several reasons. Alongside the increased volume of studies, the need to consider children’s different developmental stages and the development of research methods and searching led to the change.

The review has been broken down by age. Today sees the publication of the primary school (5-11) and secondary school children and adolescents (12-18) reviews. The pre-school (2-4) review is due to be published later this year.

These reviews are the first to be published from these new groupings. The research team included 74 studies in the 12-18 age group review and 172 studies in the 5-11 one. Of these, 54 and 149 studies, respectively, contributed to the meta-analyses.

They looked at BMI, age- and sex-standardised BMI (zBMI) and percentile BMI, reported in randomised controlled trials with interventions aimed at changing diet, physical activity levels (including sedentary time) or both. The trials were delivered in any setting, with most being in schools.

In the younger age-group, they found that a range of school-based physical activity interventions, alone or in combination with diet interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term follow-up (between 3 and 15 months), but not at long term follow-up (15 months or more). Diet interventions alone may result in little to no difference.

In the older age group, they found at medium- and long-term follow-up (9 months or more) physical activity interventions may have a small beneficial effect on reducing BMI gain, whereas diet alone or diet plus physical activity interventions may result in little to no difference. They found no effect of interventions on zBMI. Certainty in evidence was low to very low.

They found no adverse effects of the interventions in either age group review and, although the information was limited, there is no evidence of increased inequalities.

The same team has been investigating, using more complex analytic syntheses, what specific characteristics of these interventions make them more effective in reducing BMI and make them more equitable. The findings will be published in research papers later this year.

The reviews are informing guidance on childhood obesity, with NICE including the analyses in their new guidance due to be published in Autumn 2024.

Dr Francesca Spiga, Senior Research Associate at the University of Bristol, is the lead first author of the updated reviews. She said:

“In terms of clinical relevance, it is important to point out that at a population level, even a very small benefit of an intervention that prevents the gain of excess weight, is meaningful. “We know that the diet and activity habits adopted in childhood carry on throughout life. Therefore, there is the potential for a cumulative effect of small but sustainable changes towards a healthier diet and a more physically active lifestyle. “A healthy diet and being physically active have many health and wellbeing benefits for children and adolescents beyond the promotion of a healthy body weight, including positive associations with academic achievement.”

Professor Carolyn Summerbell, Durham University and Deputy Director of Fuse, the Centre for Translational Research in Public Health, is the lead senior author of the updated reviews. She said:

“The number of new trials included in these reviews allows us to be more confident about the overall small but positive impact of this type of public health intervention to prevent obesity in school age children and adolescents. Indeed, I doubt more of the same school-based trials which target individual behaviour change would change these findings. “But did these interventions increase health inequalities? Although many studies didn’t report on this, those that did suggest there was no impact. Those responsible for public health policy and implementing these types of interventions need this information. “What we do know is that some children and adolescents who are most at risk of obesity don’t engage well with school (or school-based interventions) or are often excluded from trials. Knowing how these interventions work in community settings such as local youth clubs and faith-based groups, and in children and adolescents with disabilities, remains a gap in the evidence base.”

Luke Wolfenden, Co-ordinating Editor of Cochrane Public Health and Associate Professor at the University of Newcastle, Australia, is another author of the reviews. He said:

“Childhood and adolescence are a critical period for unhealthy weight gain. These reviews provide a comprehensive synthesis of evidence and useful guidance to support policy and practice decisions to improve child and adolescent health. They extend an earlier heavily cited review by this team.”

Professor Louise Baur, President of the World Obesity Federation and Chair of Child and Adolescent Health at the University of Sydney, said:

“It is very helpful to see this update of the Cochrane Review on the prevention of obesity. The evidence has grown in recent years and hence we now see, for the first time, specific reviews just for the 5-11 and 12-18 year age groups. “The review team has undertaken a careful and detailed analysis of what are now many studies, especially in school settings. The review team rightly points out there is modest evidence of the effectiveness of school-based interventions on obesity in these age groups, with no evidence of adverse effects or any worsening of health inequalities. “This information is very reassuring to policy-makers and practitioners alike.  However, as noted by the review team, more evidence is needed in broader scale settings – outside of the school setting – and in a more diverse range of children and adolescents, especially those with disabilities.”

Read the reviews:

• Interventions for Preventing Obesity in Children Aged 5-11 Cochrane Review
• Interventions for Preventing Obesity in Children Aged 12-18 Cochrane Review

To what extent are the views and experiences around disordered eating pathology or behaviours considered in the current qualitative research around obesity prevention in the United Kingdom?

• Rachel Reed

Background: Eating disorders affect a large portion of the population of globally and within the United Kingdom, and so must be considered as a public health problem. While the topic of obesity is well explored from a public health perspective, eating disorders historically have not been. Literature suggests there may be a link between models of obesity and disordered eating behaviour, particularly Binge Eating Disorder. There has also been recent media attention around the introduction of obesity prevention legislation to make calorie labelling on food menu’s mandatory, particularly how this will affect the eating disorder community. The purpose of this systematic review was to examine the extent to which eating disorders are considered within obesity prevention research. The study aimed to synthesize the current research on obesity prevention, under the lens of whether any considerations toward the eating disorder community have been made in study designs and discussion, to identifying gaps in the literature and the absence of nuance in obesity prevention considering the complex relationship between obesity and eating disorders.

Methods: A PICO (Population, Intervention, Control, Outcomes) framework was used to refine key search terms by population, phenomenon of interest and context. Following this, searches were conducted across five databases to produce a list of articles which were then screened by title/abstract for relevance to search terms. The subsequent list was screened by full text for relevancy to the review question. A critical appraisal skills programme qualitative checklist was used to assess the quality of papers included in the final review. The final papers were then coded inductively to produce categories. Categories were then reviewed to create overarching themes, the relationship between categories and themes was then examined to produce the key findings of the results.

Results: Only one direct reference to eating disorders was identified from the data analysed. Four overarching themes were identified: holistic approaches to weight management, obesity stigma, responsibility and rationale for interventions.

Conclusion: There are significant gaps in the literature examining the relationship between eating disorders and obesity. Further research is required to examine the role of obesity-stigma as a barrier to accessing weight management services and the extent to which it exists amongst healthcare professionals.

Copyright (c) 2024 Rachel Reed

This work is licensed under a Creative Commons Attribution 4.0 International License .

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Developed By

Hosted by LJMU Library Journal Hosting Service

Home — Essay Samples — Nursing & Health — Obesity — Obesity And Its Effects In The United Kingdom

Obesity and Its Effects in The United Kingdom

• Categories: Nursing Care Plan Obesity Stress

About this sample

Words: 2178 |

11 min read

Published: Jan 28, 2021

Words: 2178 | Pages: 5 | 11 min read

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Dr. Heisenberg

Verified writer

• Expert in: Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

2 pages / 991 words

3 pages / 1169 words

3 pages / 1382 words

13 pages / 5869 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Obesity

Obesity has become a major public health concern in the United States, with rates steadily increasing over the past few decades. The documentary "Fed Up" explores the role of the food industry, government policies, and societal [...]

Obesity is a prevalent disease in many countries today, leading to various complications and life-threatening illnesses. While medication intervention is not always necessary, lifestyle changes are often required to treat and [...]

According to the World Health Organization, in 2016, more than 1.9 billion adults were overweight, of which around 650 million were obese. In the United States alone, more than 42% of the population is considered obese. This [...]

Obesity has become a major health issue in recent times, with over 39% of adults around the world being overweight and 13% being obese. In the United States, 42.4% of adults are obese, costing the country a staggering $147 [...]

It is well known today that the obesity epidemic is claiming more and more victims each day. The Centers for Disease Control and Prevention writes “that nearly 1 in 5 school age children and young people (6 to 19 years) in the [...]

The overweight or obese among the U.S. citizens is inclining at a shocking rate. Currently, it stands at 74.1% which is almost ¾ of our country’s population. It is a frightening truth that needs to be acknowledged by the entire [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

• Search Menu
• Sign in through your institution
• Advance Articles
• Editor's Choice
• Braunwald's Corner
• ESC Guidelines
• EHJ Dialogues
• Issue @ a Glance Podcasts
• CardioPulse
• Weekly Journal Scan
• European Heart Journal Supplements
• Year in Cardiovascular Medicine
• Asia in EHJ
• Most Cited Articles
• ESC Content Collections
• Author Guidelines
• Submission Site
• Why publish with EHJ?
• Open Access Options
• Submit from medRxiv or bioRxiv
• Author Resources
• Self-Archiving Policy
• Read & Publish
• Advertising and Corporate Services
• Advertising
• Reprints and ePrints
• Sponsored Supplements
• Journals Career Network
• About European Heart Journal
• Editorial Board
• About the European Society of Cardiology
• ESC Publications
• War in Ukraine
• ESC Membership
• ESC Journals App
• Developing Countries Initiative
• Dispatch Dates
• Terms and Conditions
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Semaglutide and diuretic use in obesity-related heart failure with preserved ejection fraction: a pooled analysis of the step-hfpef and step-hfpef-dm trials.

• Article contents
• Figures & tables
• Supplementary Data

Sanjiv J Shah, Kavita Sharma, Barry A Borlaug, Javed Butler, Melanie Davies, Dalane W Kitzman, Mark C Petrie, Subodh Verma, Shachi Patel, Khaja M Chinnakondepalli, Mette N Einfeldt, Thomas J Jensen, Søren Rasmussen, Rabea Asleh, Tuvia Ben-Gal, Mikhail N Kosiborod, for the STEP-HFpEF Trial Committees and Investigators, Semaglutide and Diuretic Use in Obesity-Related Heart Failure with Preserved Ejection Fraction: A Pooled Analysis of the STEP-HFpEF and STEP-HFpEF-DM trials, European Heart Journal , 2024;, ehae322, https://doi.org/10.1093/eurheartj/ehae322

• Permissions Icon Permissions

In the STEP-HFpEF trial program, treatment with semaglutide resulted in multiple beneficial effects in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Efficacy may vary according to baseline diuretic use, and semaglutide treatment could modify diuretic dose.

In this pre-specified analysis of pooled data from the STEP-HFpEF and STEP-HFpEF-DM trials (n=1145), which randomized participants with HFpEF and body mass index ≥30 kg/m 2 to once weekly semaglutide 2.4 mg or placebo for 52 weeks, we examined whether efficacy and safety endpoints differed by baseline diuretic use, as well as the effect of semaglutide on loop diuretic use and dose changes over the 52-week treatment period.

At baseline, across no diuretic (n=220), non-loop diuretic only (n=223), and loop diuretic (<40 [n=219], 40 [n=309], and >40 [n=174] mg/day furosemide-equivalents) groups, there was progressively higher prevalence of hypertension and atrial fibrillation; and severity of obesity and heart failure. Over 52 weeks of treatment, semaglutide had a consistent beneficial effect on change in body weight across diuretic use categories (adjusted mean difference vs. placebo ranged from -8.8% [95% CI -10.3, -6.3] to -6.9% [95% CI -9.1, -4.7] from no diuretics to the highest loop diuretic dose category; interaction P=0.39). Kansas City Cardiomyopathy Questionnaire clinical summary score improvement was greater in patients on loop diuretics compared to those not on loop diuretics (adjusted mean difference vs. placebo: +9.3 [6.5; 12.1] vs. +4.7 points [1.3, 8.2]; P=0.042). Semaglutide had consistent beneficial effects on all secondary efficacy endpoints (including 6-min walk distance) across diuretic subgroups (interaction P=0.24-0.92). Safety also favored semaglutide versus placebo across the diuretic subgroups. From baseline to 52 weeks, loop diuretic dose decreased by 17% in the semaglutide group vs. a 2.4% increase in the placebo group (P<0.0001). Semaglutide (vs. placebo) was more likely to result in loop diuretic dose reduction (odds ratio [OR] 2.67 [95% CI 1.70, 4.18]) and less likely dose increase (OR 0.35 [95% CI 0.23, 0.53]; P<0.001 for both) from baseline to 52 weeks.

In patients with obesity-related HFpEF, semaglutide improved heart failure-related symptoms and physical limitations across diuretic use subgroups, with more pronounced benefits among patients receiving loop diuretics at baseline. Reductions in weight and improvements in exercise function with semaglutide versus placebo were consistent in all diuretic use categories. Semaglutide also led to a reduction in loop diuretic use and dose between baseline and 52 weeks.

NCT04788511 and NCT04916470

• loop diuretics
• heart failure with preserved ejection fraction
• semaglutide

Supplementary data

Email alerts, more on this topic, related articles in pubmed, citing articles via, looking for your next opportunity, affiliations.

• Online ISSN 1522-9645
• Print ISSN 0195-668X
• Copyright © 2024 European Society of Cardiology
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Switch language:

NICE recommends Rhythm’s Imcivree for rare genetic obesity disorder

Rhythm expects Imcivree will be available on the NHS in England and Wales within the next three months.

• Share on Linkedin
• Share on Facebook

As increasing varieties of drugs aimed at weight loss hit the shelves, a new treatment that targets obesity and hunger control with a genetic cause will soon be available on England and Wales’ NHS.

This news comes after the National Institute for Health and Care Excellence (NICE) recommended Rhythm Pharmaceuticals ’ Imcivree (setmelanotide) injection for the treatment of obesity and extreme hunger – also known as hyperphagia – in patients with Bardet-Biedl syndrome.

Go deeper with GlobalData

LOA and PTSR Model - Bimagrumab in Obesity

Npvm: revolution medicines inc's rmc-4630, premium insights.

The gold standard of business intelligence.

Find out more

Related Company Profiles

Rhythm pharmaceuticals inc, lg chem ltd.

Those who are genetically confirmed to have the disease and between six and 17 years of age will be eligible to start the therapy. Patients who continue to benefit from treatment can carry on taking the injection into adulthood.  

US-based Rhythm expects Imcivree will be funded and available on the NHS in England and Wales within the next three months.

The biotech stated it is also pressing ahead with a submission to the Scottish Medicines Consortium, with a decision expected next year.

Bardet-Biedl syndrome is a rare genetic condition that affects many parts of the body. In addition to issues with vision, the number of digits, and kidney function, all of which are impaired in this condition, early obesity is a major clinical feature of the disease. According to the NHS, Bardet-Biedl syndrome patients struggle to manage their weight due to lower energy needs and hyperphagia.

How well do you really know your competitors?

Access the most comprehensive Company Profiles on the market, powered by GlobalData. Save hours of research. Gain competitive edge.

Your download email will arrive shortly

Not ready to buy yet? Download a free sample

We are confident about the unique quality of our Company Profiles. However, we want you to make the most beneficial decision for your business, so we offer a free sample that you can download by submitting the below form

UCL Great Ormond Street Institute of Child Health’s Dr Philip Beales said: “Hyperphagia – the feeling of extreme hunger that stays with patients all the time – leads to early-onset, life-long, severe obesity that affects many aspects of daily living. Until now there have been no licensed treatments for obesity and hyperphagia caused by [Bardet-Biedl syndrome].”

Rhythm’s Imcivree can reduce weight and body mass index (BMI), along with lowering hyperphagia. The injection works by activating melanocortin receptor 4, which promotes a feeling of fullness after eating.

The drug was approved in Europe for treating obesity and the control of hunger associated with deficiency of three genes in 2021. The UK’s Medicines & Healthcare products Regulatory Agency (MHRA) expanded approval in 2022 to include patients with Bardet-Biedl syndrome.

Rhythm has plans for the drug beyond the currently approved indications. The biotech reported positive results from a Phase II trial investigating Imcivree in the treatment of hypothalamic obesity last year.

In January 2024, the company added a clinical-stage weight loss drug to its portfolio after licensing South Korea-based LG Chem ’s LB54640 in a deal worth up to a potential $305m .

Sign up for our daily news round-up!

Give your business an edge with our leading industry insights.

More Relevant

AstraZeneca makes another obesity play funnelling $80m into SixPeaks Bio

Ema recommends suspension of 17-ohpc medicines in eu, denosumab biosimilar by celltrion for bone disorders: likelihood of approval, psilocybin by compass pathways for obsessive-compulsive disorder: likelihood of approval, sign up to the newsletter: in brief, your corporate email address, i would also like to subscribe to:.

Pharma Technology Focus : Pharmaceutical Technology Focus (monthly)

Thematic Take (monthly)

I consent to Verdict Media Limited collecting my details provided via this form in accordance with Privacy Policy

Thank you for subscribing

View all newsletters from across the GlobalData Media network.