Bariatric treatments for adult obesity - Institute of Health Economics

Additional benefits of exercise over dietary therapyA negative energy balance can be attained through either eating less, or exercising more or both. 8 Adeficiency of 500 kcal per day is recommended to achieve a weight loss rate of approximately 0.5kilograms per week. 8 The same energy deficit obtained through either increased exercise or throughdietary restriction may yield similar changes in body weight, but the composition of the lost tissuediffers. On average, the composition of weight loss is approximately 70% fat and 30% lean bodymass, whereas loss of the latter causes a decrease in the resting metabolic rate. 8 Exercise aids inminimizing the loss of lean body mass, thereby reducing the decrease in metabolic rate (for increasedefficiency) that accompanies any loss in body weight.To obtain the desired energy deficit for weight loss under normal circumstances, caloric intake mustbe reduced; it is much easier to reduce caloric intake by 500 kcal per day, for example, than toincrease expenditure by that magnitude. Examples of activities that use approximately 500 kcal ofenergy, for a person weighting approximately 80 kilograms, are an hour of jogging at 5 kilometersper hour, or 35 minutes of jumping rope. 8In addition to increasing energy expenditure and promoting fat loss, physical exercise has additionalbenefits including:reducing abdominal fat and increasing lean mass;reducing blood pressure and improving glucose tolerance, insulin sensitivity and the lipidprofile;improving physical fitness;improving compliance to the dietary regimen;improving feelings of well-being and self esteem; reducing anxiety and depression. 11Behavioural therapyDefinitionBehavioural therapy, an important component of weight management, refers to the principles andtechniques used to change a patient’s behaviour and habits. 5 The goal of behavioural therapy is toalter learned eating and activity habits in overweight and obese individuals. 11Although behavioural modification recognizes the role of genetics and cultural influences on weight,it focuses on current behaviour, with a particular focus on increasing energy expenditure andreducing energy intake to achieve weight loss. 14 Behavioural therapy provides the individual withcoping skills to handle various cues to overeat and to manage lapses in diet and physical activitywhen they occur. 15 Behavioural therapy also provides the motivation essential to maintainingadherence to a healthier lifestyle over a long period of time. 15TypesKey features of typical behavioural therapy include self-monitoring, goal setting, nutrition, exercise,stimulus control, problem solving, social support, cognitive restructuring, and relapse prevention(see Table T.2). 5,13,14Brief history and developmentBariatric treatments for adult obesity 66