{"id":383037,"date":"2024-07-31T00:01:00","date_gmt":"2024-07-30T22:01:00","guid":{"rendered":"https:\/\/medizinonline.com\/why-lifestyle-modification-alone-is-not-effective\/"},"modified":"2024-07-31T00:01:06","modified_gmt":"2024-07-30T22:01:06","slug":"why-lifestyle-modification-alone-is-not-effective","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/why-lifestyle-modification-alone-is-not-effective\/","title":{"rendered":"Why lifestyle modification alone is not effective"},"content":{"rendered":"\n

According to current understanding, obesity is considered a multifactorial chronic disease.\nThe overriding goals of treatment are to improve the general state of health and weight-associated diseases or risk factors.\nLifestyle modification is crucial for weight reduction, but should be part of a multimodal therapy to prevent a yo-yo effect.\nThe use of modern obesity medication supports weight reduction and helps to maintain the target weight. <\/strong><\/p>\n\n\n\n

“Obesity is a chronic multifactorial disease,” explained Prof. Dr. med. Katharina Timper, Head of the Obesity Clinic at the University Hospital Basel and Research Group Leader of the Obesity Research Unit at the Department of Biomedicine at the University of Basel [1].\nThe high prevalence of concomitant and secondary diseases of obesity (Overview 1)<\/strong> is associated with increased morbidity and mortality.\nIn addition to the body mass index (BMI), the Edmonton Obesity Staging System <\/em>(EOSS) is also used for classification [2].\nThe EOSS supplements anthropometric measurements to assess obesity and analyzes the patient’s state of health.\nThis classification is based on a grading from 0 to 4, with a higher value corresponding to an increased risk of secondary diseases, cardiovascular and all-cause mortality [3]. <\/p>\n

\n
\"\"<\/a><\/figure>\n<\/div>\n

Complex interplay of internal and external factors<\/h3>\n\n

(Epi)genetic and (neuro)biological factors are involved in the pathomechanisms of obesity, which are unfavourably influenced by external factors such as lifestyle and stigmatization (Fig. 1)<\/strong> [4].\n“Obesity is not the result of too much food, but too much food is the result of obesity,” emphasized Prof. Timper [1].\nGenetic and epigenetic changes lead to dysregulation of the feeling of hunger and satiety, as the speaker explained [1].\nA central role is played by neurobiological processes in the brain, which control eating behavior and metabolic processes in the body in a way that is largely beyond our control [5].\n“Obesity and overweight are diseases of the brain,” stated Prof. Timper [1].\nAlmost all genetic changes associated with obesity affect anatomical structures or biochemical processes of the brain.\nThis explains why short-term lifestyle interventions usually do not result in long-term and sustainable weight loss, as disease-relevant biological mechanisms are not addressed.\nIn addition, people with obesity often face stigmatization and social exclusion (box)<\/strong>. <\/p>\n\n

The prejudice that obesity is due to laziness and a lack of willpower and self-discipline is still widespread.\n“These people are systematically devalued and stigmatized, not only in the context of society as a whole, but also in the healthcare sector in particular,” said Prof. Dr. Timper.\n“This stigmatization is not only a consequence, but also a cause of obesity,” explained the speaker.\nThe experiences of stigmatization, which can affect various areas of life, encourage emotional eating behavior, which leads to further obesity. <\/td><\/tr>
according to [1]<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n

What are the dimensions of food intake?<\/h3>\n\n

Knowledge of the different dimensions of food intake is very important in order to better understand the disease process of obesity.\nThe biological side – eating because you are hungry – is determined by various intestinal hormones (e.g. GLP-1).\nThe psychological side or hedonistic food intake – i.e. eating for pleasure – is controlled by dopamine, opioid and cannabinoid receptors.\nThe third dimension concerns the executive function – the conscious decision to eat – the lifestyle component, so to speak.\nHowever, according to the speaker [1], it is a fallacy that the latter is decisive for what, when and how we eat.\nThis is because research findings show that the executive function is the weakest dimension of food intake, which is often overridden by the biological and psychological dimension.\nAs an example, Prof. Timper cited a study in which slim, healthy, young men were given a high-sugar and high-fat snack every day over a period of 8 weeks.\nIt was shown that the brain processes changed over time in such a way that the interest in healthy snacks decreased significantly [7].\nThis has a lot to do with the neurobiologically regulated reward system, Prof. Timper noted [1].\nThe mechanisms involved have not yet been clarified in detail and this is the subject of current research, but previous study findings indicate that a variety of anatomical and biochemical factors lead to hunger and satiety being disturbed. <\/p>\n

\n
\"\"<\/a><\/figure>\n<\/div>\n

Social devaluation leads to a vicious circle<\/h3>\n\n

The misconception that obesity is a result of insufficient willpower and that those affected should simply make an effort to eat less and exercise more is still widespread [8].\nThis can have serious consequences for those affected, as devaluation and stigmatization lead to internalization with self-reproach and feelings of guilt in the vast majority of people, which in turn encourages emotional eating as a reaction to the psychological stress that arises.\nThis can result in further weight gain, creating a vicious circle. <\/p>\n\n

An international survey published in 2021 by Puhl et al.\nof 13,996 overweight people in Australia, Canada, France, Germany, the UK and the USA, published in 2021, found that two thirds of respondents had already experienced weight-related stigmatization or devaluation by doctors on one or more occasions [9].\nThis is particularly significant, as a doctor’s consultation is actually a highly protected setting.\nIt can lead to a massive breach of trust in doctors and in the healthcare system in general.\nIt is important to verbalize to patients that obesity is a disease that is not self-inflicted.\nEmpathy, empowerment and appreciation are key.\n“Ask your patients for permission to bring up the subject of weight,” advised the expert.\nThis applies in particular to the primary care sector.\nIt is essential that patients are perceived and taken seriously in the reality of their lives in the protected setting of the doctor’s visit. <\/p>\n\n

Liraglutide and semaglutide support weight loss<\/h3>\n\n

In order to achieve a positive impact with regard to secondary diseases such as fatty liver disease, type 2 diabetes and cardiovascular risk, it is important to aim for a weight reduction of at least 10-15%.\nA multidisciplinary approach is practiced in the Obesity Clinic of the Department of Endocrinology, Diabetology and Metabolism at the University Hospital Basel.\nTreatment is carried out by a multi-professional team.\nInitially, the focus is on multimodal lifestyle changes with a balanced diet, behavioral therapy, psychotherapy and physical activity.\nHowever, lifestyle changes alone are not enough, as has been shown in recent decades.\nThis is because a yo-yo effect sets in; patients gain weight again as soon as the intervention is over.\nWe now know why this is the case: “Because weight loss leads to a change in hormone levels and a sometimes drastic drop in basal energy expenditure,” explained Prof. Timper [1].\nAs a result, when the calorie restriction is lifted, the weight not only increases slightly, but excessively.\n“This is why it is so important to combine this multimodal lifestyle change with specific obesity therapy,” the speaker explained [1].\nThe most important treatment options for supporting weight loss with medication are currently liraglutide (Saxenda\u00ae) and semaglutide (Wegovy\u00ae) [10].\nThese are GLP-1 receptor agonists, which are modeled on the body’s own hormone “glucagon-like peptide-1” (GLP-1) and increase the feeling of satiety.\nLiraglutide can achieve an average weight loss of around 10% and semaglutide 16%.\nAn important aspect is that these drugs facilitate the implementation of lifestyle changes.\nLiraglutide is a recombinant analog of the human incretin hormone GLP-1 and is injected subcutaneously once a day [10].\nThe most common side effects that can occur, especially in the first few weeks of therapy, include nausea, vomiting, diarrhea and constipation.\nLike liraglutide, semaglutide is a GLP-1 analog with high sequence homology to the human incretin hormone, but has a longer half-life and more stable plasma levels and is injected subcutaneously once a week up to a maximum dose of 2.4 mg [10].\nIn the pivotal studies, 51-64% of patients with overweight or obesity achieved a reduction of \u226515% of their initial weight with semaglutide [11].\nThe spectrum of side effects of semaglutide largely corresponds to that of liraglutide [10]. <\/p>\n\n

Congress: SGAIM Spring Congress<\/em><\/p>\n\n

<\/p>\n\n

Literature:<\/p>\n\n

    \n
  1. Bergmann NC, et al: Semaglutide for the treatment of overweight and obesity: a review. Diabetes Obes Metab 2023; 25(1): 18-35.<\/li>\n\n\n\n
  2. “Obesity in primary care”, Prof. Dr. med. Katharina Timper, SGAIM Spring Congress, 29-31.05.2024.<\/li>\n\n\n\n
  3. Padwal RS, et al: Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ 2011; 183(14): E1059-1066.<\/li>\n\n\n\n
  4. Kuk JL, et al: Edmonton Obesity Staging System: association with weight history and mortality risk. Appl Physiol Nutr Metab 2011; 36(4): 570-576.<\/li>\n\n\n\n
  5. Bl\u00fcher M. Obesity: global epidemiology and pathogenesis.\nNat Rev Endocrinol 2019; 15(5): 288-298. <\/li>\n\n\n\n
  6. Sharma AM, et al: Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study. Clin Obes 2019; 9(5): e12329.<\/li>\n\n\n\n
  7. Brix JM, et al: \u00dcbergewicht und Adipositas bei Erwachsenen: allgemeine Behandlungsgrunds\u00e4tze und konservatives Management [Overweight and obesity in adults: general principles of treatment and conservative management]. Wien Klin Wochenschr 2023; 135(Suppl 6): 706-720.<\/li>\n\n\n\n
  8. Thanarajah SE, et al: Habitual daily intake of a sweet and fatty snack modulates reward processing in humans. Cell Metab 2023; 35(4): 571-584.e6.<\/li>\n\n\n\n
  9. Puhl RM, Brownell KD: Confronting and coping with weight stigma: an investigation of overweight and obese adults.\nObesity (Silver Spring) 2006; 14(10): 1802-1815. <\/li>\n\n\n\n
  10. Puhl RM, et al: The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries. PLoS One 2021 Jun 1; 16(6):e0251566.<\/li>\n\n\n\n
  11. Swissmedic: Medicinal product information, www.swissmedicinfo.ch,<\/a>(last accessed 26.06.2024).<\/li>\n<\/ol>\n\n

    HAUSARZT PRAXIS 2024; 19(7): 22-23 (published on 22.7.24, ahead of print)<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    According to current understanding, obesity is considered a multifactorial chronic disease. The overriding goals of treatment are to improve the general state of health and weight-associated diseases or risk factors.…<\/p>\n","protected":false},"author":7,"featured_media":383039,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Obesity therapy","footnotes":""},"category":[11513,11384,11297,11388,11442,11548,11503],"tags":[77356,18544,77355,12389,17444],"powerkit_post_featured":[],"class_list":["post-383037","post","type-post","status-publish","format-standard","has-post-thumbnail","category-congress-reports","category-endocrinology-and-diabetology","category-general-internal-medicine","category-nutrition","category-pharmacology-and-toxicology","category-rx-en","category-studies","tag-lifestyle-modification-en","tag-liraglutide","tag-obesity-medication","tag-overweight","tag-semaglutide-en-2","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-22 01:38:39","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"en_US","wpml_translations":{"fr_FR":{"locale":"fr_FR","id":383063,"slug":"pourquoi-la-seule-modification-du-mode-de-vie-nest-pas-efficace","post_title":"Pourquoi la seule modification du mode de vie n'est pas efficace","href":"https:\/\/medizinonline.com\/fr\/pourquoi-la-seule-modification-du-mode-de-vie-nest-pas-efficace\/"},"it_IT":{"locale":"it_IT","id":383071,"slug":"perche-la-modifica-dello-stile-di-vita-da-sola-non-e-efficace","post_title":"Perch\u00e9 la modifica dello stile di vita da sola non \u00e8 efficace","href":"https:\/\/medizinonline.com\/it\/perche-la-modifica-dello-stile-di-vita-da-sola-non-e-efficace\/"},"pt_PT":{"locale":"pt_PT","id":383044,"slug":"porque-e-que-a-modificacao-do-estilo-de-vida-por-si-so-nao-e-eficaz","post_title":"Porque \u00e9 que a modifica\u00e7\u00e3o do estilo de vida por si s\u00f3 n\u00e3o \u00e9 eficaz","href":"https:\/\/medizinonline.com\/pt-pt\/porque-e-que-a-modificacao-do-estilo-de-vida-por-si-so-nao-e-eficaz\/"},"es_ES":{"locale":"es_ES","id":383048,"slug":"por-que-la-modificacion-del-estilo-de-vida-por-si-sola-no-es-eficaz","post_title":"Por qu\u00e9 la modificaci\u00f3n del estilo de vida por s\u00ed sola no es eficaz","href":"https:\/\/medizinonline.com\/es\/por-que-la-modificacion-del-estilo-de-vida-por-si-sola-no-es-eficaz\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/383037","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/comments?post=383037"}],"version-history":[{"count":2,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/383037\/revisions"}],"predecessor-version":[{"id":383512,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/383037\/revisions\/383512"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media\/383039"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media?parent=383037"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/category?post=383037"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/tags?post=383037"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/powerkit_post_featured?post=383037"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}