Options in obesity management.

The management of obesity requires acknowledgment of its heterogeneity. This derives from differences in pathogenesis, in genetic and psychological background. in physical activity. in food intake, and in aspects of lifestyle like cigarette smoking; as well as in degree, fat distribution. stability, and in consequences and associated disease. Pivotal to management is an appreciation that negative energy, balance can be achieved at various levels of energy intake. depending on physical activity or on the degree of inefficiency of energy utilization. Reduced food intake can help people start with reduction in body fatness and is sometimes necessary for extended periods. but in the long run, an emphasis on increased levels of physical activity is preferred. Management endpoints need careful consideration since a great deal can be done to help the obese without necessarily changing weight. It is important to document changes in body fat and its distribution particularly by way of abdominal girth. Setting other healthful endpoints. such as food intake itself, self-esteem, physical fitness, risk profile for non-communicable disease, and self-care, are equally important. Management options -- social, behavioural, exercise, pharmacotherapeutics and surgical - can be considered singly, sequentially or in combination. There are risks of management and these will include social, psychological (sense of failure and alteration in body image), economic nutritional and physical (eg injury), and the more specific side-effects of pharmacotherapeutics and of surgery. Finally, the prevention of obesity requires the early detection of risk, eg the emergence of abdominal fatness with little change in total body fatness, and attention to health education, regular physical activity and the use of food with little fat.