Section 3.1 Lifestyle Intervention

Key Points

  • Lifestyle interventions effectively prevent physical and metabolic complications of obesity
    • Lifestyle alone is less effective in populations with more severe obesity
  • Weight loss with lifestyle change is difficult to maintain
    • Behavioral support may need to be intensified to assist with weight loss and maintenance
    • Initial weight loss benefits are sustained even with weight regain
  • Support groups, including healthcare professional teams and community groups, should help patients set realistic goals and encourage adherence to healthy weight loss and maintenance behaviors

AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity Recommendation1

Overall

  • R64. A structured lifestyle intervention program designed for weight loss (lifestyle therapy) and consisting of a healthy meal plan, physical activity, and behavioral interventions should be available to patients who are being treated for overweight or obesity.

Reduced-Calorie Meal Plan and Macronutrient Composition

  • R65. Reducing total energy (caloric) intake should be the main component of any weight-loss intervention.
  • R66. Even though the macronutrient composition of meals has less impact on weight loss than adherence rates in most patients, in certain patient populations, modifying macronutrient composition may be considered to optimize adherence, eating patterns, weight loss, metabolic profiles, risk factor reduction, and/or clinical outcomes.

Physical Activity

  • R67. Aerobic physical activity training should be prescribed to patients with overweight or obesity as a component of lifestyle intervention; the initial prescription may require a progressive increase in the volume and intensity of exercise, and the ultimate goal should be ≥ 150 min/week of moderate exercise performed during 3 to 5 daily sessions per week.
  • R68. Resistance training should be prescribed to patients with overweight or obesity undergoing weight-loss therapy to help promote fat loss while preserving fat-free mass; the goal should be resistance training 2 to 3 times per week consisting of single-set exercises that use the major muscle groups.
  • R69. An increase in nonexercise and active leisure activity should be encouraged to reduce sedentary behavior in all patients with overweight or obesity.
  • R70. The prescription for physical activity should be individualized to include activities and exercise regimens within the capabilities and preferences of the patient, taking into account health-related and physical limitations.
  • R71. Involvement of an exercise physiologist or certified fitness professional in the care plan should be considered to individualize the physical activity prescription and improve outcomes.

Behavior Interventions

  • R72. Lifestyle therapy in patients with overweight or obesity should include behavioral interventions that enhance adherence to prescriptions for a reduced-calorie meal plan and increased physical activity (behavioral interventions can include: self-monitoring of weight, food intake, and physical activity; clear and reasonable goal-setting; education pertaining to obesity, nutrition, and physical activity; face-to-face and group meetings; stimulus control; systematic approaches for problem solving; stress reduction; cognitive restructuring [i.e., cognitive behavioral therapy], motivational interviewing; behavioral contracting; psychological counseling; and mobilization of social support structures).
  • R73. The behavior intervention package is effectively executed by a multidisciplinary team that includes dietitians, nurses, educators, physical activity trainers or coaches, and clinical psychologists. Psychologists and psychiatrists should participate in the treatment of eating disorders, depression, anxiety, psychoses, and other psychological problems that can impair the effectiveness of lifestyle intervention programs.
  • R74. Behavioral lifestyle intervention and support should be intensified if patients do not achieve a 2.5% weight loss in the first month of treatment, as early weight reduction is a key predictor of long-term weight-loss success. A stepped-care behavior approach should teach skills for problem solving and should evaluate outcomes.
  • R75. Behavioral lifestyle intervention should be tailored to a patient’s ethnic, cultural, socioeconomic, and educational background.

Reference

  1. Garvey WT, Mechanick JL, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients With Obesity. Endocr Pract. 2016;22(suppl 3);1-205.