Editing Obesity (section)

==Management==
{{Main|Management of obesity}}

The main treatment for obesity consists of [[weight loss]] via lifestyle interventions, including prescribed [[Diet (nutrition)|diets]] and [[physical exercise]].<ref name="USGuidelines2013">{{cite journal | vauthors = Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC, Tomaselli GF | title = 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society | journal = Circulation | volume = 129 | issue = 25 Suppl 2 | pages = S102–S138 | date = June 2014 | pmid = 24222017 | pmc = 5819889 | doi = 10.1161/01.cir.0000437739.71477.ee }}</ref><ref name=CADG2006/><ref name="USDietaryGuidelines2015">{{cite web |author1=US Department of Health and Human Services. |title=2015–2020 Dietary Guidelines for Americans - health.gov |url=https://health.gov/dietaryguidelines/2015/ |website=health.gov |publisher=Skyhorse Publishing Inc. |access-date=30 September 2019 |date=2017}}</ref><ref name="AACAHA2019">{{cite journal | vauthors = Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B | title = 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines | journal = Circulation | volume = 140 | issue = 11 | pages = e596–e646 | date = September 2019 | pmid = 30879355 | pmc = 7734661 | doi = 10.1161/CIR.0000000000000678 | doi-access = free | author-link3 = Michelle Albert }}</ref> Although it is unclear what diets might support long-term weight loss, and although the effectiveness of [[Calorie restriction|low-calorie diets]] is debated,<ref name=Strychar /> lifestyle changes that reduce calorie consumption or increase physical exercise over the long term also tend to produce some sustained weight loss, despite slow weight regain over time.<ref name="USGuidelines2013"/><ref name=Strychar>{{cite journal | vauthors = Strychar I | title = Diet in the management of weight loss | journal = CMAJ | volume = 174 | issue = 1 | pages = 56–63 | date = January 2006 | pmid = 16389240 | pmc = 1319349 | doi = 10.1503/cmaj.045037 | type = Review }}</ref><ref>{{cite journal | vauthors = Shick SM, Wing RR, Klem ML, McGuire MT, Hill JO, Seagle H | title = Persons successful at long-term weight loss and maintenance continue to consume a low-energy, low-fat diet | journal = Journal of the American Dietetic Association | volume = 98 | issue = 4 | pages = 408–413 | date = April 1998 | pmid = 9550162 | doi = 10.1016/S0002-8223(98)00093-5 }}</ref><ref>{{cite journal | vauthors = Tate DF, Jeffery RW, Sherwood NE, Wing RR | title = Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain? | journal = The American Journal of Clinical Nutrition | volume = 85 | issue = 4 | pages = 954–959 | date = April 2007 | pmid = 17413092 | doi = 10.1093/ajcn/85.4.954 | type = Randomized Controlled Trial | doi-access = free }}</ref>

Although 87% of participants in the [[National Weight Control Registry]] were able to maintain 10% body weight loss for 10 years,<ref>{{cite journal | vauthors = Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR | title = Weight-loss maintenance for 10 years in the National Weight Control Registry | journal = American Journal of Preventive Medicine | volume = 46 | issue = 1 | pages = 17–23 | date = January 2014 | pmid = 24355667 | doi = 10.1016/j.amepre.2013.08.019 }}</ref>{{clarify|reason=unclear if this is sufficient weight loss to reduce BMI below the obesity cutoff and therefore effectively manage obesity|date=February 2022}} the most appropriate dietary approach for long term weight loss maintenance is still unknown.<ref name="Yannakoulia">{{cite journal | vauthors = Yannakoulia M, Poulimeneas D, Mamalaki E, Anastasiou CA | title = Dietary modifications for weight loss and weight loss maintenance | journal = Metabolism | volume = 92 | pages = 153–162 | date = March 2019 | pmid = 30625301 | doi = 10.1016/j.metabol.2019.01.001 | doi-access = free }}</ref> In the US, intensive behavioral interventions combining both dietary changes and exercise are recommended.<ref name="USGuidelines2013" /><ref name="USDietaryGuidelines2015" /><ref name=":7">{{cite journal |vauthors=Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Grossman DC, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW, Wong JB |date=September 2018 |title=Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement |journal=JAMA |volume=320 |issue=11 |pages=1163–1171 |doi=10.1001/jama.2018.13022 |pmid=30326502 |doi-access=free}}</ref> [[Intermittent fasting]] has no additional benefit of weight loss compared to continuous energy restriction.<ref name="Yannakoulia" /> Adherence is a more important factor in weight loss success than whatever kind of diet an individual undertakes.<ref name="Yannakoulia" /><ref>{{cite journal | vauthors = Gibson AA, Sainsbury A | title = Strategies to Improve Adherence to Dietary Weight Loss Interventions in Research and Real-World Settings | journal = Behavioral Sciences | volume = 7 | issue = 3 | page = 44 | date = July 2017 | pmid = 28696389 | pmc = 5618052 | doi = 10.3390/bs7030044 | doi-access = free }}</ref>

Several hypo-caloric diets are effective.<ref name="USGuidelines2013" /> In the short-term [[Low-carbohydrate diet|low carbohydrate diets]] appear better than [[Low-fat diet|low fat diets]] for weight loss.<ref name="SBU2013">{{Cite journal|url=http://www.sbu.se/en/publications/sbu-assesses/dietary-treatment-of-obesity/|title=Dietary treatment of obesity|journal=Annals of the New York Academy of Sciences|volume=499|issue=1|pages=250–263 | author =[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU)|access-date=17 June 2016|bibcode=1987NYASA.499..250B|year=1987|doi=10.1111/j.1749-6632.1987.tb36216.x|pmid=3300485|s2cid=45507530}}</ref> In the long term, however, all types of low-carbohydrate and low-fat diets appear equally beneficial.<ref name="SBU2013" /><ref>{{cite journal | vauthors = Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GD, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ | title = Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis | journal = JAMA | volume = 312 | issue = 9 | pages = 923–33 | date = September 2014 | pmid = 25182101 | doi = 10.1001/jama.2014.10397 | doi-access =  }}</ref> Heart disease and diabetes risks associated with different diets appear to be similar.<ref>{{cite journal | vauthors = Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J | title = Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e100652 | date = 2014 | pmid = 25007189 | pmc = 4090010 | doi = 10.1371/journal.pone.0100652 | type = Research Support | bibcode = 2014PLoSO...9j0652N | doi-access = free }}</ref>

Promotion of the Mediterranean diets among the obese may lower the risk of heart disease.<ref name="SBU2013" /> Decreased intake of [[sweet drink]]s is also related to weight-loss.<ref name="SBU2013" /> Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%.<ref>{{cite journal | vauthors = Wing RR, Phelan S | title = Long-term weight loss maintenance | journal = The American Journal of Clinical Nutrition | volume = 82 | issue = 1 Suppl | pages = 222S–225S | date = July 2005 | pmid = 16002825 | doi =  10.1093/ajcn/82.1.222S| type = Review | doi-access = free }}</ref> Dietary and lifestyle changes are effective in limiting excessive weight gain in [[pregnancy]] and improve outcomes for both the mother and the child.<ref>{{cite journal | vauthors = Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS | title = Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence | journal = BMJ | volume = 344 | pages = e2088 | date = May 2012 | pmid = 22596383 | pmc = 3355191 | doi = 10.1136/bmj.e2088 | type = Meta-analysis }}</ref> Intensive behavioral counseling is recommended in those who are both obese and have other risk factors for heart disease.<ref>{{cite journal | vauthors = LeFevre ML | title = Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force Recommendation Statement | journal = Annals of Internal Medicine | volume = 161 | issue = 8 | pages = 587–93 | date = October 2014 | pmid = 25155419 | doi = 10.7326/M14-1796 | s2cid = 262280720 | doi-access =  }}</ref>

=== Health policy ===
[[File:Prevalence Of Obesity In The Adult Population, Top Countries (2016).svg|thumb|330x330px|Prevalence of obesity in the adult population, top countries (2016)]]
[[File:Prevalence Of Obesity In The Adult Population (2016).svg|thumb|330x330px|Prevalence of obesity in the adult population in 2016]]
Obesity is a complex public health and policy problem because of its prevalence, costs, and health effects.<ref>{{cite book |author=Satcher D |url=https://www.ncbi.nlm.nih.gov/books/NBK44206/ |title=The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity |publisher=U.S. Dept. of Health and Human Services, Public Health Service, Office of Surgeon General |year=2001 |isbn=978-0-16-051005-2 |series=Publications and Reports of the Surgeon General}}</ref> As such, managing it requires changes in the wider societal context and effort by communities, local authorities, and governments.<ref name=":7" /> Public health efforts seek to understand and correct the [[Obesity and the environment|environmental factors]] responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct [[junk food|junk]] [[food marketing]] to children,<ref>{{cite news | vauthors = Barnes B |date=18 July 2007 |title=Limiting Ads of Junk Food to Children |work=The New York Times |url=https://www.nytimes.com/2007/07/18/business/18food.html |access-date=24 July 2008}}</ref> and decreasing access to sugar-sweetened beverages in schools.<ref>{{cite web |title=Fewer Sugary Drinks Key to Weight Loss |url=http://www.healthfinder.gov/news/newsstory.aspx?docID=625759 |access-date=18 October 2009 |website=U.S. Department of Health and Human Services |archive-date=16 November 2012 |archive-url=https://web.archive.org/web/20121116045620/http://www.healthfinder.gov/news/newsstory.aspx?docID=625759 |url-status=dead }}</ref> The World Health Organization recommends the taxing of sugary drinks.<ref>{{cite web |title=WHO urges global action to curtail consumption and health impacts of sugary drinks |url=https://www.who.int/mediacentre/news/releases/2016/curtail-sugary-drinks/en/ |access-date=13 October 2016 |website=WHO}}</ref> When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.<ref>{{cite journal |vauthors=Brennan Ramirez LK, Hoehner CM, Brownson RC, Cook R, Orleans CT, Hollander M, Barker DC, Bors P, Ewing R, Killingsworth R, Petersmarck K, Schmid T, Wilkinson W |date=December 2006 |title=Indicators of activity-friendly communities: an evidence-based consensus process |journal=American Journal of Preventive Medicine |type=Research Support |volume=31 |issue=6 |pages=515–24 |doi=10.1016/j.amepre.2006.07.026 |pmid=17169714|doi-access=free }}</ref> Efforts also exist to address the occurrence of [[Food swamp|food swamps]], or areas with an overabundance of convenient or fast food options, as these has been found to be strongly predictive of obesity rates.<ref>{{Cite journal |last1=Cooksey-Stowers |first1=Kristen |last2=Schwartz |first2=Marlene B. |last3=Brownell |first3=Kelly D. |date=2017-11-14 |title=Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States |journal=International Journal of Environmental Research and Public Health |volume=14 |issue=11 |pages=1366 |doi=10.3390/ijerph14111366 |doi-access=free |issn=1660-4601 |pmc=5708005 |pmid=29135909}}</ref>

[[Mass media]] campaigns seem to have limited effectiveness in changing behaviors that influence obesity, but may increase knowledge and awareness regarding physical activity and diet, which might lead to changes in the long term. Campaigns might also be able to reduce the amount of time spent [[Sedentary lifestyle|sitting or lying down]] and positively affect the intention to be active physically.<ref>{{cite journal | vauthors = Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, Lewis S, Thomas J, Campbell M, Young B, Bauld L | title = Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence | language = EN | journal = Public Health Research | volume = 7 | issue = 8 | pages = 1–206 | date = May 2019 | pmid = 31046212 | doi = 10.3310/phr07080 | doi-access = free | hdl = 1893/29477 | hdl-access = free }}</ref><ref name=":6" /> [[Nutrition facts label|Nutritional labelling]] with energy information on menus might be able to help reducing energy intake while dining in restaurants.<ref>{{cite journal | vauthors = Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, Stubbs B, Hollands GJ, Jebb SA | title = Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD009315 | date = February 2018 | pmid = 29482264 | pmc = 5846184 | doi = 10.1002/14651858.CD009315.pub2 }}</ref> Some call for policy against [[ultra-processed foods]].<ref>{{cite journal | vauthors = Nestle M | title = Regulating the Food Industry: An Aspirational Agenda | journal = American Journal of Public Health | volume = 112 | issue = 6 | pages = 853–858 | date = June 2022 | pmid = 35446606 | pmc = 9137006 | doi = 10.2105/AJPH.2022.306844 }}</ref><ref>{{Cite news | vauthors = Finlay M, van Tulleken C, Miles ND, Onuchukwu T, Bury E |date=2023-04-20 |title=How did ultra-processed foods take over, and what are they doing to us? |language=en-GB |work=the Guardian |url=https://www.theguardian.com/science/audio/2023/apr/20/how-did-ultra-processed-foods-take-over-and-what-are-they-doing-to-us |access-date=2023-04-23 |issn=0261-3077}}</ref>