The prevalence of obesity in the United States has been increasing since the 1980s and has become a public health concern. The etiology of obesity is complex and includes a host of genetic influences in addition to overconsumption of energy and a sedentary lifestyle. Obesity is strongly associated with several chronic diseases, such as cardiovascular disease and diabetes, and thus accounts for significant morbidity and mortality. The previous failures of short-term therapy for obesity have led experts to recognize that obesity is a chronic disease that should be treated with long-term programs to ensure the best chance for maintenance of weight loss. In addition, clinical studies have demonstrated that a modest weight loss of 5% to 10% can produce significant decreases in comorbidities. This articles summarizes the current medical approach to the treatment of obesity and includes strategies for diet modification, exercise therapy, and lifestyle change. The rationale and appropriateness of pharmacotherapy are discussed, followed by case histories that highlight the management of obesity and its comorbidities by using diet, exercise, and pharmacotherapeutic modalities.
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