Lifestyle change as therapy for obesity

Lifestyle change (comprising adequate diet, physical activity, and behavior therapy) represents the cornerstone of obesitytherapy. Dietary intervention consists primarily in reducing the energy content of the diet and secondarily in altering the relativemacronutrient composition. It is recommended to ingest low-calorie diets rather than very-low-calorie diets, because they aresafer and better accepted and provide at least similar long-term results. Low-fat diets have traditionally been prescribed forweight loss, because they facilitate energy restriction. Low-carbohydrate diets are helpful because they favor energy restriction,as well. Physical activity has favorable effects in obese patients: it prevents the decline in resting energy expenditure thataccompanies diet-induced weight loss, reduces the amount of free-fat mass lost, decreases the risk of developing type 2diabetes mellitus and of dying from cardiovascular disease, increases the rate of weight loss, and helps maintaining the resultson long term. Behavior therapy aims at altering eating and activity habits that promote obesity. It usually involves multiplestrategies, including stimulus control, self-monitoring, problem solving skills, cognitive restructuring, social support, andrelapse prevention. Many obese persons can achieve short-term weight loss by dieting alone. However, successful log-termresults are much more difficult to obtain and require a more complex strategy, including physical activity and behavior therapy.