A review of research examining the effectiveness of different obesity treatments has concluded that no matter what other forms of therapy are offered, changes in lifestyle are imperative if patients want to maximise and maintain their weight loss. This review, presented at the annual Society for Endocrinology BES meeting in Harrogate, shows that lifestyle interventions provide benefits at all stages of obesity management and should be encouraged no matter what other forms of therapy are offered.

He found that when weight loss drugs are given on their own, with no other changes in lifestyle, they produce an average weight loss of 5 kg, the same amount of weight you lose if you go on a calorie-controlled diet and take regular exercise. However, if weight loss drugs are offered in combination with behavioural therapies, their effectiveness can be increased by over 100% (from 5 kg to 12 kg average weight loss). He found that the story was the same with bariatric surgery. Patients who exercise and lose weight prior to surgery are less likely to have postoperative complications and lose more weight at a quicker rate after surgery than those who didn’t.

Overall, this review indicates, that when treating obese patients, weight loss drugs and bariatric surgery are significantly more successful if they are offered in conjunction with improvements to diet and exercise.

Full results of the review are:

- Exercise alone produces an average weight loss of 1.8 kg. The more you exercise the more weight you lose.

- Diet alone produces an average weight loss of 5.0 kg. This effect peaks 6-12 months following the start of the diet and wanes after this point. No diet is better than any other in the long term but the greater the reduction in calories, the greater the initial weight loss.

- Behavioural therapies (e.g. cognitive therapy, psychotherapy, relaxation therapy, hypnotherapy) produce an average weight loss of 2.3 kg.

- Exercise plus diet result in an average weight loss of 10.7 kg and helps to maintain weight loss for a longer period.

- Exercise plus diet plus behavioural therapies result in the greatest average weight loss of 12-15 kg.

- Taking weight loss drugs with no changes in lifestyle result in an average weight loss of 5kg. Taking weight loss drugs, in combination with behavioural therapies, leads to an average weight loss of 12 kg.

- Patients that lose more than 10% of their body weight prior to bariatric surgery are 2.12 times more likely to achieve a 70% loss of excess body weight.

Researcher Dr Rob Andrews said:

“People often forget is that there is no quick fix to obesity. Overeating and decreased activity are the fundamental problems underlying the development of obesity. Any therapy aimed at helping obese patients must have a dietary and exercise component in order to be successful. This review shows that patients who are taking weight loss drugs or have bariatric surgery lose significantly more weight if they combine these treatments with regular exercise and a calorie-controlled diet. Maintaining a healthy, balanced lifestyle is the key to maximising and maintaining weight loss.”

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Women with breast cancer have more aggressive disease and lower survival rates if they are overweight or obese, according to findings published in the March 15 issue of Clinical Cancer Research, a journal of the American Association for Cancer Research.

“The more obese a patient is, the more aggressive the disease,” said Massimo Cristofanilli, MD, associate professor of medicine in the Department of Breast Medical Oncology at The University of Texas M.D. Anderson Cancer Center. “We are learning that the fat tissue may increase inflammation that leads to more aggressive disease.”

Cristofanilli and colleagues observed 606 women with locally advanced breast cancer. These women were classified by body mass index into the following three groups: normal/underweight (24.9 or below), overweight (at least 25 but less than 30) or obese (more than 30). Body mass index is calculated by dividing a person’s weight by their height.

At five years, overall survival was 56.8 percent among obese women, 56.3 percent among overweight women and 67.4 percent among normal weight women. The 10-year survival rate was 42.7 percent among obese women, 41.8 percent among overweight women and 56.5 percent among normal weight women.

The rate of inflammatory breast cancer, previously shown to have worse outcomes than non-inflammatory breast cancer, among obese women was 45 percent compared with 30 percent in overweight women and only 15 percent in women considered normal weight, researchers found.

Risk of breast cancer recurrence was also higher in obese or overweight women. By five years, 50.8 percent of obese women reported a recurrence compared with 38.5 percent of normal weight women. By 10 years, the rate of recurrence was 58 percent among obese women and 45.4 percent among normal weight women.

“Obesity goes far beyond just how a person looks or any physical strain from carrying around extra weight. Particular attention should be paid to our overweight patients,” Cristofanilli said.

Cristofanilli said physicians need to pay close attention to breast cancer patients because commonly used drugs, such as tamoxifen, tend to increase weight gain during treatment.

“We have actually become quite good at managing acute side effects such as nausea in our chemotherapy patients and it goes away within a couple of days,” Cristofanilli said.

“Following the nausea, our patients tend to overeat, which further increases their risk of weight gain. We need to implement lifestyle modifications interventions and develop better methods to follow these patients closely.”

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