Treatment of morbid obesity by nonsurgical means: diet, drugs, behavior modification, exercise.

Treatment of morbid obesity requires that the patient should achieve a negative energy balance of at least 350,000 kcal. Dietary treatment under metabolic ward control in time achieves any desired weight loss, but few morbidly obese patients can maintain dietary restriction for long enough as outpatients. The objective of both surgical and nonsurgical treatments is, in effect, to encourage (or force) the patient to diet. Drug treatment and exercise are ineffective in long-term massive obesity, but behavior therapy or jaw-wiring followed by the fitting of a waist cord can achieve worthwhile weight loss maintained for 3 years of follow-up.