Dietary Approaches to Obesity Treatment

Function

The latest knowledge about the pathophysiology of obesity stems from the discovery of hormones and pathways important in appetite and weight regulation. Lifestyle modification is the first step in weight management. Lifestyle modification consists of a healthy diet, exercise, quality sleep, and stress management. The 2020 to 2025 Dietary Guidelines for Americans moved from isolated nutrient targets toward a dietary pattern framework, emphasizing overall food quality, dietary diversity, and reduction of added sugars, saturated fats, and sodium across the lifespan.[USDA. Dietary Guidelines for Americans. 2020] Dietary guidelines have been updated multiple times based on available scientific evidence. In popular culture, dozens of diets are targeted towards weight loss. Unfortunately, the general population tends to favor quick fixes and rapid results, which are not necessarily sustainable in the long term. In addition, some of these diets may focus on weight loss and ignore overall health promotion.

One kilogram of fat contains 9,000 kilocalories (kcal). To lose half a kilogram of fat per week, a person should achieve a net deficit of 4,500 kcal, or 642 kcal per day. Net energy deficit is achieved by decreasing food intake (dieting) and increasing physical activity. For example, a 55-year-old, moderately active, 136-kg woman needs 2,600 kcal daily. For a person who consumes a 2,600 kcal diet, creating a 642 kcal deficit requires a 25% reduction in daily energy intake if the individual does not increase physical activity. Therefore, the patient must invest time and effort, and usually some extra money, to lose 26 kg of fat annually. The effort can be overwhelming, and the time required to reach the target weight is too long for some individuals. Reaching ideal body weight might seem too slow for some individuals, triggering them to give up on lifestyle treatment. Consequently, setting realistic, achievable goals is advisable. 

No single diet can fit everyone for weight-loss benefits. The initial dietary approach focused on achieving an energy deficit by varying the macronutrient composition. Unfortunately, the "calorie in, calorie out "concept of weight regulation oversimplifies the physiologic process of appetite and weight regulation.[6] A complex interaction of hormonal and neuronal pathways maintains weight and appetite regulation. Adaptive physiologic mechanisms in the human body resist changes in body weight resulting from diet, exercise, or pharmacotherapy. Meaningful improvement in overall health outcomes requires at least 10% weight loss.[7] A 5% to 10% weight loss is associated with a reduced risk of diabetes mellitus and coronary artery disease.[8] 

Therefore, at least 5% weight loss is recommended in obesity management as an initial goal, and achieving 5% weight loss is considered a success when assessing response to therapy. Successful diets have beneficial effects based not only on macronutrient composition aimed at creating a negative energy balance but also have salutary effects on satiety, appetite, and insulin resistance. Increasingly, dietary quality, not caloric quantity alone, is recognized as an independent determinant of long-term metabolic health; food matrix, nutrient density, and degree of processing all influence downstream physiologic effects beyond macronutrient ratios.[8] 

Issues of Concern

Mortality from cardiovascular causes has gone down with advances in science and technology in modern medical science. The rate of decline in cardiovascular mortality has unfortunately stagnated, but recently, rates have been going up in 35 to 46-year-old males and females in the United States. This stagnation is primarily linked to rising obesity rates and unhealthy lifestyles, including unhealthy diets, lack of physical activity, chronic psychosocial stress, and poor sleep quality.[9][10]The The 

Western diet is typically rich in refined carbohydrates (mainly from refined grains), sugar, salt, animal fats, processed meats, food additives, and preservatives. The Western diet is also characterized by a lack of fiber, vitamins, antioxidants, and micronutrients, likely because of inadequate intake of fruits and vegetables. This dietary pattern involves high caloric intake, which results in insulin resistance and weight gain. The Western diet has been associated with elevated serum inflammatory markers.[11] 

A growing body of evidence now specifically implicates ultra-processed foods (UPFs), defined by the NOVA classification system as foods produced by industrial processing for the purpose of extending shelf life, in the pathogenesis of obesity and cardiometabolic disease. A landmark inpatient randomized controlled trial by Hall and colleagues (2019) demonstrated that an ultra-processed diet led to significantly greater ad libitum energy intake (~500 kcal/day more) and weight gain compared with an unprocessed diet matched for macronutrients, sugar, fiber, and sodium, implicating non-nutritional mechanisms, including eating rate, food texture, and food reward signaling, in UPF-driven overconsumption.[WHO. Global Action Plan for the Prevention and Control of Noncommunicable Diseases. 2013] Kimmons and coworkers found that less than 10% of American adolescents or adults reported consuming the recommended fruits or vegetables. Adults preferred whole fruits, while adolescents preferred fruit juices, mainly orange juice. Herrick and coworkers reported that apples, apple juice, citrus juice, and bananas were responsible for almost half of the total fruit consumption in American Youth. American adults and youth do not consume a sufficient variety of fruits and vegetables.[12][13]

Unfortunately, the wide availability of calorie-dense, nutritionally poor processed foods, high prevalence of sedentary lifestyle, chronic psychosocial stress, and sleep deprivation create an obesogenic environment with the modern lifestyle. Genetic influences might also be responsible for food preferences. Chronic overnutrition, on top of a sedentary lifestyle, is the perfect recipe for weight gain, chronic inflammation, and metabolic disorders. The combination of chronic inflammation and metabolic disorders is known as metaflammation.[14] Chronic low-grade inflammation contributes to the development of diseases such as obesity, type 2 diabetes, fatty liver, cardiovascular disease, and neurodegenerative diseases, eg, Alzheimer disease.

Clinical Significance

Dietary Approach by Restriction of Macronutrients 

There are 3 primary macronutrients, namely carbohydrates, fat, and protein. Carbohydrate yields 4 kcal per gram, protein yields 4 kcal per gram, and fat provides 9 kcal per gram. Manipulation of macronutrient composition to achieve energy restriction as a dietary intervention has been studied extensively and used for a long time. Even in energy-matched diets, varying macronutrient compositions yield different weight-loss outcomes and overall health benefits. These different outcomes are likely secondary to differences in endocrine effects and changes in the gut microbiome that ultimately impact fat storage and body weight.[15]

Low-fat diet 

A low-fat diet has been traditionally advocated for the prevention of heart disease. Energy from fat is 9 kcal per gram, which is the basis for considering fat an energy-rich macronutrient. A low-fat diet was expected to impose energy restrictions that would be beneficial for weight loss. A low-fat diet consists of 20% to 30% of energy from fat, whereas a very low-fat diet contains 10% to 15% of energy from fat.[16][17] The original promise of cardioprotective benefits from the low-fat diet also presumed weight loss as an added benefit.[18] 

A recent meta-analysis of trials comparing the efficacy of a low-fat diet to a low-carbohydrate diet showed that a low-fat diet was less effective than a low-carbohydrate diet in achieving sustainable long-term weight loss. When the low-fat diet was compared with the usual diet in non-weight-loss trials, the 2 diets led to similar weight loss. Evidence from randomized controlled trials shows that a low-fat diet is not superior to other dietary interventions for obesity. A very low-fat diet is challenging to sustain over the long term.[19] Importantly, the 2020 to 2025 Dietary Guidelines for Americans no longer recommend a specific cap on fat percentage and instead emphasize fat type over total fat quantity, recognizing that unsaturated fats are preferable to saturated fats regardless of total fat intake. This shift aligns with evolving evidence that dietary fat quality, not quantity alone, drives cardiometabolic risk.[USDA. Dietary Guidelines for Americans. 2020]

Low-carbohydrate diet

The modern diet is very calorie-dense and very high in refined carbohydrates, partly owing to historical guidelines recommending a low-fat diet. Carbohydrates have earned an unpopular reputation for being an unhealthy macronutrient. Historical data show that during Paleolithic times, human ancestors procured food by hunting and gathering; paradoxically, their primary energy source was carbohydrates. Understanding that this diet is high in fiber, low glycemic, and plant-based is essential. The source of fat in the ancestral Paleolithic diet primarily came from meat and fish.[20] A typical American diet has a carbohydrate energy intake of 45% to 65%. Therefore, a low-carbohydrate diet can be defined as less than 45% dietary energy from carbohydrates. Definitions of low-carbohydrate diets vary, which makes studying the outcomes of a low-carbohydrate diet without a precise definition challenging.[21] A low-carbohydrate diet typically contains 52 to 150 g of carbohydrates per day.

The presumed weight-loss mechanism of a low-carbohydrate diet relies on reduced insulin secretion secondary to low carbohydrate intake, thereby inhibiting lipogenesis and stimulating lipolysis. Ketones are formed with a very low-carbohydrate diet with carbohydrate restriction between 20 and 50 g. When the body faces a low glucose supply, the first adaptive mechanism is glycogenolysis (a fast, immediate response), followed by gluconeogenesis (a slower, long-term response). When the gluconeogenesis reserve is exhausted, fat is broken down to fatty acids for oxidation. This rationale also forms the basis of a low-carb, high-fat diet. Nowadays, a low-carbohydrate, healthy-fat diet is trendy.

A low-carbohydrate diet improves insulin sensitivity and benefits patients with diabetes, prediabetes, metabolic syndrome, overweight, and obesity. Long-term weight loss and health-promoting benefits of a low-carbohydrate, high-fat diet have not been demonstrated. The long-term sustainability of a low-carbohydrate, high-fat diet is also questionable. Evidence of health-promoting and weight-loss benefits of a relatively high-carbohydrate, plant-based, low-glycemic, high-fiber diet that is sustainable over the long term is abundant.[22] A diet high in refined carbohydrates leads to frequent insulin spikes (secretory bursts), increased fat deposition, and lower satiety. A strict low-carbohydrate diet would also be low in fiber and micronutrients. In addition, the higher fat content may increase saturated fat intake, which may lead to adverse cardiovascular outcomes.

A meta-analysis of randomized controlled trials demonstrated greater decreases in body weight, body fat, and triglycerides with a low-carbohydrate diet than with a low-fat diet.[23] The apparent increase in LDL was observed with a low-carbohydrate, high-fat diet, but overall health benefits outweigh the risk associated with the rise in LDL.[24] A low-carbohydrate diet increases LDL levels due to larger LDL particle size. Large LDL-C particles are not associated with increased cardiovascular risk. The short-term benefits of a low-carb, high-fat diet regarding weight loss are significant. On a short-term basis, a low-carbohydrate diet improves glycemic control with favorable weight loss in type 2 diabetes, prediabetes, and metabolic syndrome.

On the contrary, low fiber content and high fat in a low-carbohydrate, high-fat diet may adversely impact bowel health and the gut microbiome. For patients concurrently receiving pharmacotherapy with GLP-1 receptor agonists or dual GIP/GLP-1 agonists (eg, semaglutide, tirzepatide), dietary pattern continues to modulate outcomes independently of medication; high-quality, fiber-rich carbohydrate sources may optimize medication tolerability and mitigate gastrointestinal adverse effects, whereas strict ketogenic diets may require closer monitoring of glycemic status given the altered appetite and gastric emptying physiology induced by these agents.[25]

Mediterranean diet

The Mediterranean diet is based on the dietary practices of the Mediterranean region. The Mediterranean diet contains fruits, vegetables, nuts, seeds, seafood, fish, and olive oil. The primary source of nutrients is plant-based, rich in fiber, lower in glycemic load, and high in antioxidants and micronutrients. Additionally, the Mediterranean diet is lower in saturated fat and omega-6 polyunsaturated fatty acids (n-6 PUFAs) and higher in monounsaturated fatty acids and omega-3 polyunsaturated fatty acids (n-3 PUFAs).

The Mediterranean diet has been advocated for its cardioprotective and health-promoting benefits, but numerous studies have also shown weight-loss benefits.[26] A recent meta-analysis demonstrated that the Mediterranean diet, combined with energy restriction and physical activity, resulted in significant weight loss compared to the control diet.[26] A meta-analysis of randomized controlled trials also demonstrated an improved metabolic profile with a Mediterranean diet, resulting in a reduced risk of developing type 2 diabetes and metabolic syndrome compared with the control diet.[27] After 12 months, the traditional Mediterranean diet resulted in an average weight loss of 8.7%, and the low-carbohydrate Mediterranean diet resulted in an average weight loss of 10%.[28][29]

The PREDIMED-Plus trial, a multicenter randomized controlled trial conducted across 23 Spanish centers with 6,874 participants with overweight/obesity and metabolic syndrome, demonstrated that an energy-reduced Mediterranean diet combined with increased physical activity significantly reduced total fat mass and visceral fat over 3 years compared to an ad libitum Mediterranean diet, while also attenuating lean mass loss.[30] This provides important long-term RCT evidence supporting the energy-restricted Mediterranean dietary pattern as a sustainable, evidence-based framework for obesity management.

The DASH diet

The Dietary Approaches to Stop Hypertension (DASH) diet was originally developed and validated for hypertension management but has accumulated robust evidence for weight loss and cardiometabolic risk reduction, making it highly relevant to obesity medicine. The DASH dietary pattern emphasizes fruits, vegetables, whole grains, low-fat dairy, legumes, nuts, and lean protein, while limiting saturated fats, red meats, sweets, and sodium. Multiple randomized controlled trials and systematic reviews have demonstrated that the DASH diet, when combined with energy restriction, produces clinically meaningful weight loss and improvements in blood pressure, insulin sensitivity, and lipid profiles.[31] 

The DASH diet consistently scores among the highest on validated dietary quality indices, is nutritionally complete, and is endorsed by the American Heart Association. Given that hypertension is among the most prevalent and clinically significant comorbidities of obesity, the DASH diet represents a particularly rational dietary choice for patients with co-existing hypertension and obesity. Clinicians should consider incorporating DASH-based dietary counseling, potentially combined with a Mediterranean dietary pattern, when both weight reduction and blood pressure control are treatment objectives.

The Ornish diet 

The Ornish diet is named after Dr. Dean Ornish, who created the diet in 1977. The Ornish diet is rich in complex carbohydrates and fiber, low in fat, and extremely low in saturated fat. This diet emphasizes whole foods, plant-based whole grains, fruits, vegetables, legumes, and minimally processed foods. Based on the limited clinical trials available for the Ornish diet in obese subjects, it produced an average weight loss of 3.5% after 6 months and 3.2% after 12 months.[28] The Ornish diet is typically practiced as part of a lifestyle intervention that includes aerobic exercise, resistance training, flexibility activities (eg, yoga), and stress management. 

The Atkins diet 

Dr. Robert Atkins originally promoted the Atkins diet, which is low in carbohydrates and has no restrictions on fat or protein. Because of its low-carbohydrate, high-protein, high-fat content, the Atkins diet leads to greater satiety, improved glycemic control, and improved triglyceride and HDL levels. A low-carbohydrate diet is also associated with a rise in LDL.[32] The Atkins diet is high in protein, with 20% to 35% of energy coming from protein.

High protein content increases satiety and heightens total energy expenditure.[33][34] Dietary protein has a greater thermogenic effect than carbohydrates, thereby increasing total energy expenditure with a high-protein diet.[35] The high protein content of the diet can lead to the browning of white adipose tissue. Vegetarian protein sources produce a more efficient thermogenic effect than animal-source protein.[36] The long-term benefits of a high-protein, high-fat diet should be weighed against the risks of increased LDL and cardiovascular disease associated with higher saturated fat intake.

A high-protein diet, especially from animal sources, can increase the acid load on the kidneys as sulfates and phosphates, which can affect renal function. When protein is obtained from animal sources, a high-protein diet leads to a high level of saturated fat.[37] The Atkins diet produced clinically significant short- and long-term weight loss in a meta-analysis of 10 clinical trials with durations ranging from 3 to 24 months.[28] The Atkins diet resulted in weight loss of 3.5% to 11.8% after 6 months and 2.1% to 10.5% after 12 months.[28]

The Paleolithic diet

The Paleolithic diet mimics our ancestors' dietary patterns before the advent of agriculture. The Paleolithic diet refers to the diet of the hunting-and-gathering lifestyle. No single Paleolithic diet varied by geographical region, depending on climate and food availability.[38] This difference accounts for the varied composition of macronutrients and their sources, whether plant or animal. The Paleolithic diet relied primarily on plant-based foods as a source of energy. The Paleolithic diet consisted of whole foods, fruits, nuts, seeds, legumes, vegetables, and protein and fat from meat and fish. The carbohydrate consumed was low-glycemic and high in fiber.[39] 

The Paleolithic diet involved no food processing other than heating. The significant difference between the Paleolithic and modern diets is that the Paleolithic diet excludes cereal grains, dairy, and ultra-processed foods. The Paleolithic diet has gained considerable attention and popularity in current culture. This diet is rich in whole foods, fruits, and fiber. The plant source provides phytochemicals, micronutrients, antioxidants, and fibers. The diet is high in protein (25% to 35% of energy), moderate in fat and carbohydrates, low glycemic, and minimally processed. Paleolithic diet improves insulin sensitivity, reduces the risk of cardiovascular disease, and helps achieve short- and long-term weight loss. The long-term sustainability of the Paleolithic diet is questionable due to its high cost.[28] A clinical trial reported weight losses of 9% after 6 months and 10.6% after 12 months.[28][40]

The Vegetarian diet 

The vegetarian diet is gaining popularity as a means of promoting overall health, though different types exist. A vegan diet includes only plant-based foods and excludes meat, fish, dairy, and eggs. A lacto–ovo vegetarian diet includes eggs and dairy, plus a plant-based diet. A pescatarian diet allows the use of fish along with plant-based nutrients. A recent meta-analysis of 12 clinical trials shows that individuals assigned to a vegetarian diet lost more weight than those assigned to a nonvegetarian diet. Subgroup analysis of vegetarian subjects showed that subjects assigned to the vegan diet lost more weight than those assigned to the lacto-ovo-vegetarian diet. Significantly more weight loss was detected in subjects on an energy-restricted vegetarian diet than in those without any energy restriction in the diet.[41]

Intermittent Fasting (Time-based Energy Restriction) 

Intermittent fasting is a dietary approach that involves timed fasting periods without restricting any particular macronutrient. The overall rationale for weight loss based on intermittent fasting relies on broad caloric restriction. Few randomized controlled trials provide evidence of weight loss with intermittent fasting. Intermittent fasting can involve alternate-day fasting or time-restricted eating, in which nutritional intake occurs only during a fixed time window.[42] Caloric restriction promotes weight loss, increases insulin sensitivity, improves blood pressure control, and reduces overall cardiovascular risk. 

The beneficial effect of intermittent fasting rests on the same premise as caloric restriction. Intermittent fasting leads to better glucose control.[43] However, 2 landmark randomized controlled trials now challenge the hypothesis that circadian meal timing confers metabolic benefit independent of total caloric restriction. The TREAT trial found that 16:8 time-restricted eating produced no significantly greater weight loss than unrestricted eating over 12 weeks in adults with overweight or obesity.[44] Similarly, demonstrated in a larger, 12-month RCT, caloric restriction with time-restricted eating produced no significantly greater weight loss than caloric restriction alone.[45] These findings suggest that, when caloric restriction is controlled for, the independent contribution of meal timing to weight loss is limited.

Intermittent fasting may be more sustainable over time than caloric restriction alone. Intermittent fasting and caloric restriction also have the added benefit of reducing oxidative stress. Intermittent fasting has the potential to slow the progression of neurodegenerative diseases (eg, Alzheimer and Parkinson disease).[46][47] Intermittent fasting may also have additional benefits from optimizing circadian rhythm and ketogenesis. Disturbance in circadian rhythm, for example, from shift work, leads to metabolic disturbances, increasing the risk of obesity, diabetes, metabolic syndrome, and cardiovascular disease.[48] 

Caloric restriction leads to decreased energy intake, decreased mitochondrial free radical production, and reduced oxidative stress.[49] Caloric restriction also reduces inflammatory markers. In a study of obese individuals with asthma, inflammatory markers, eg, TNF-alpha and brain-derived neurotrophic factors, were significantly reduced after caloric restriction.[50] After 42 hours of fasting, glycogen stores are depleted, and fatty oxidation predominates, leading to ketosis. The ketogenic diet is also trendy, consisting of high-fat intake, much of which comes from animal fat. Excessive animal fat intake can be associated with higher levels of trimethylamine N-oxide, which can be associated with higher cardiovascular risk from a ketogenic diet. Long-term weight loss benefits of the ketogenic diet are not consistent, and the diet is challenging to adhere to in the long term.[51]

In a study of overweight men with type 2 diabetes, caloric restriction and intermittent fasting resulted in a 1% loss of body fat and a mean weight loss of 6.5% after 12 weeks.[52] A 2023 randomized controlled trial at the University of Illinois Chicago demonstrated that an 8-hour time-restricted eating window (without calorie counting) reduced body weight and HbA1c significantly more than a control group at 6 months in adults with obesity and type 2 diabetes, suggesting that TRE (Time Restricted Eating) may offer particular benefit in this subpopulation even in the absence of explicit caloric restriction.[53] Intermittent fasting lowers blood pressure by decreasing sympathetic tone and increasing parasympathetic tone. Increasing parasympathetic tone also reduces levels of inflammatory cytokines.[54] Intermittent fasting also had a positive impact on lipid levels.[55] In a study of nonobese individuals, subjects who fasted for 20-hour intervals and then ate without restriction on alternate days showed increased insulin-mediated glucose uptake after 2 weeks. 

Caloric restriction may alter the pace of aging by modulating Sirtuin 1 (SIRT1). Sirtuins are recently discovered molecules that may be important in aging. Sirtuins are a family of signaling proteins involved in metabolic regulation. SIRT1 is an enzyme in the cell nucleus that deacetylates transcription factors, contributing to cellular regulation (reaction to stressors, longevity). SIRT1 increases in response to caloric restriction. Upregulation of SIRT1 by caloric restriction contributes to increased insulin sensitivity and reduced inflammation, potentially through modulation of the NF-kB (nuclear factor "kappa-light-chain-enhancer" of activated B cells)/TNF (tumor necrosis factor) alpha pathway.[56] 

PPAR-gamma (peroxisome proliferator-activated receptor gamma) is a nuclear transcription factor that regulates multiple genes involved in cell survival and responses to metabolic alterations. One PPAR-gamma gene targets the aP2 gene and encodes a protein involved in fat storage. SIRT1 can act as a repressor of PPAR gamma. Caloric restriction activates SIRT1 in adipose tissue, reducing fat storage and likely resetting hormonal levels to alter the pace of aging.[46] Mild caloric restriction with alteration of feeding frequency may improve compliance among subjects.

Diets Based on a Calorie Deficit 

Low-calorie diet and very low-calorie diet

These diets are based on the "calories in, calories out" model. Physiological adaptive mechanisms resist weight loss by decreasing energy expenditure when the dietary approach is purely based on a negative energy deficit. A low-calorie diet consists of 1,000 to 1,500 kcal/day. A very low-calorie diet consists of less than 800 kcal/day. Low-calorie diets restrict carbohydrate or fat intake to create a negative energy balance. However, a low-calorie diet may not be sustainable over the long term. A very low-calorie diet should not be recommended without medical supervision.

A recent study demonstrated greater weight-loss benefit from a very low-calorie diet when combined with behavioral programs than from behavioral programs alone.[57] A variation of a very low-calorie diet is known as a very-low-calorie ketogenic diet (VLCKD). A VLCKD consists of 600 to 800 kcal/ day, low carbohydrate (less than 30 to 50 g per day), and adequate protein intake (0.8 to 1.2 g/day/kg of ideal body weight ). A VLCKD is used briefly, followed by a transition to a low-calorie diet. A recent meta-analysis of a VLCKD demonstrated improvement in weight, body mass index, HbA1c, blood pressure, total cholesterol, and triglycerides over a short period. The weight-loss benefit of VLCKD was demonstrable over 2 years. No changes in LDL and HDL were observed with VLCKD.[58]

Meal replacements

Meal replacements are used to create a negative energy deficit. People tend to overestimate or underestimate the calorie content of the food. Meal replacements can replace 1 or more meals. They are convenient. Multiple commercial products are available; additionally, their costs vary by product. A systematic review studying meal replacements demonstrated a mean weight loss of -2.2 to -6.13 kg compared with other diets involving support alone.[59] Meal replacements are ineffective for long-term weight loss due to physiologic adaptations that reduce energy expenditure. These adaptations lead to a plateau effect in the weight loss trajectory.

Enhancing Healthcare Team Outcomes

Obesity is a chronic, relapsing, multifactorial disease characterized by excess adiposity that increases the risk of metabolic syndrome, prediabetes, type 2 diabetes mellitus, hypertension, cardiovascular disease, obstructive sleep apnea, certain cancers, and adverse infectious disease outcomes. Contemporary evidence recognizes obesity as a biologically regulated condition driven by complex interactions among neurohormonal, metabolic, genetic, behavioral, and environmental factors rather than solely by excessive caloric intake. Recent frameworks distinguish clinical obesity, in which excess adiposity causes organ or tissue dysfunction, from preclinical obesity, which carries elevated future risk despite the absence of current impairment. Evaluation requires assessment of adiposity-related complications, cardiometabolic risk factors, dietary patterns, physical activity, sleep, psychosocial factors, and readiness for change. Management emphasizes sustainable lifestyle modifications, including dietary quality, physical activity, sleep optimization, stress reduction, and individualized weight-loss goals, with a target of at least 5% to 10% weight reduction to improve health outcomes and reduce disease risk.

Optimal obesity management requires coordinated interprofessional collaboration to support comprehensive, patient-centered care. Physicians, primary care clinicians, and advanced practitioners are responsible for diagnosis, risk stratification, treatment planning, monitoring outcomes, and coordinating referrals when indicated. Registered nurses reinforce education, assess adherence, identify barriers to treatment, and facilitate ongoing follow-up. Pharmacists support medication selection, monitoring, adherence, and management of obesity-related comorbidities and treatment-related adverse effects. Registered dietitians provide individualized nutrition counseling and help patients implement sustainable dietary strategies, while behavioral health professionals address psychological factors, stress, emotional eating, and behavior change. Exercise specialists may assist with individualized physical activity programs. Patients must be guided in navigating data and reading food labels and nutritional information, as empowering them with this information and giving them control over their health is vital.[60] Effective communication among team members promotes shared decision-making, consistent messaging, timely intervention, and coordinated follow-up, reducing complications, improving long-term adherence, enhancing quality of care, and supporting sustainable weight management and overall health improvement.

Nursing, Allied Health, and Interprofessional Team Interventions

Weight management has to be approached from a holistic point of view, and it can not be addressed by physicians alone. Weight management requires an interprofessional approach, including physicians, nurse practitioners, physician assistants, nurses, dieticians, health educators, health coaches, and patients' families. The interprofessional approach is an integrated model. In inpatient and outpatient settings, nurses can act as educators, monitor patients' diet, physical activity, and compliance, and alert them to watch for any complications. This approach can improve patient insight, understanding, and adherence to dietary intervention.[61]

Nursing, Allied Health, and Interprofessional Team Monitoring

Obesity treatment is delivered in various settings, but usually starts with self-management based on information from print and digital media. This information may not be 100% validated scientifically and may not be accurate. Clinical settings for delivering obesity treatment range from primary care to specialized settings, including weight loss clinics and endocrinology practices. Digital healthcare delivery and monitoring treatment outcomes for obesity should be integrated into the conventional healthcare delivery model.

After the COVID-19 epidemic, digital healthcare delivery has become more common. An integrated model for obesity treatment in general and dietary intervention in particular should include self-monitoring via mobile apps, with feedback from a dietitian, nurse educator, clinician, or health coach. Digital health care delivery can also be used to provide counseling for behavioral modification in obesity treatment. A recent randomized controlled trial involving application-based (app-based, cellular phone application) self-monitoring and clinician counseling for obesity treatment in primary care settings demonstrated that participants were more likely to lose more than 5% of their baseline weight with app-based self-monitoring and clinician counseling.[62]