Obesity pandemic – searching for the most effective treatments

Abstract Obesity develops as a result of excessive fat tissue accumulation caused by a chronic state of positive energy balance. The increased accumulation of fat in the muscles, heart and liver leads to the development of type 2 diabetes, cardiovascular disease and a wide range of metabolic disorders. In this literature review, we would like to elucidate the methods used in the treatment of overweight/obesity and demonstrate the most effective strategy. A balanced diet with an appropriate calorie deficit is a critical element in obesity management. Diets recommended for reducing cardiovascular risk include the Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) and vegetarian diets. Weight loss also depends on total daily energy expenditure. Regular physical activity induces body weight reduction, declines cardiovascular risk and alleviates chronic diseases. Meta-analyses pertinent to weight loss programs showed that there is greater weight loss as a result of a combination of diet and physical activity compared to only one of these methods. Obesity treatment should also include appropriate psychological support, including psychoeducation, social support and behavioral intervention. If there are no effects of non-pharmacological treatment, pharmacological therapy should be implemented to treatment. The following drugs are registered for obesity treatment in the European Union: orlistat, extended-release naltrexone (ER)/bupropion (ER) and glucagon-like peptide-1 (GLP-1 RA) receptor agonists – liraglutide and semaglutide. It should be emphasized that pharmacotherapy significantly increases the effectiveness of the treatment in people previously treated non-pharmacologically previuosly. In recent years, there has been a gradual increase in the number of bariatric surgeries performed for obesity management. However, bariatric procedures are associated with numerous serious complications and high treatment costs. To sum up, the most effective strategy with relatively few side effects includes combined therapy based on dietary intervention, lifestyle modification and pharmacotherapy.