CHALLENGES AND NEW DIRECTIONS IN OBESITY MANAGEMENT LIFESTYLE MODIFICATION PROGRAMS, PHARMACOTHERAPY, AND BARIATRIC SURGERY

Abstract

Obesity is a growing health problem worldwide, and it is associated with serious medical and psychosocial comorbidities, impairment of health-related quality of life (HRQoL) and an increased risk of mortality. This article aims to discuss challenges faced by health-care providers when managing patients with obesity and to highlight sustainable policies in clinical practice and future research. All health professionals dealing with obesity should consider lifestyle-modification programmes within a  multidisciplinary setting as the key element of weight management. However, standardisation is needed in terms of nature, content and duration of these programmes in order to facilitate their implementation in clinical practice at different levels. Moreover, health professionals should be aware that these programmes, for patients indicating “non-response,” can be combined with recently approved anti-obesity drugs such as liraglutide, naltrexone/bupropion, lorcaserin and phentermine/topiramate, as well as with relatively less invasive bariatric surgery techniques such as Lap Band, endoscopic sleeve gastroplasty and gastric bypass. In any case, neither anti-obesity medication nor bariatric surgery should be considered as a miracle treatment in itself.  At  the  same  time,  the  field  of   obesity  is  still  lacking  in  literature  on  some  hot topics that need further investigation, including (i) a new phenotype termed sarcopenic obesity, to clarify its  definition,  potential  health  consequences  and  eventual  treatment  if   necessary;  (ii)  issues  that  go beyond body weight, for instance, HRQoL that has been poorly studied in some populations affected by obesity;  and  (iii)  the  long-term  effect  of   sleeve  gastrectomy  technique,  which  is  becoming  the  most commonly used bariatric surgical procedure, perhaps to be studied using long-term randomised controlled trials that guarantee completeness of  follow-up, in order to avoid misunderstanding and bias in interpretation of  results.