New perspectives on diagnosis and treatment of obesity.

Overview

The alarming increase in the prevalence of obesity in the past decade, as demonstrated by ongoing systematic population-based studies, and increased recognition of the adverse health consequences associated with excess body weight have generated widespread interest in the management of obesity. After an extensive review, the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health issued a consensus statement with comprehensive clinical treatment guidelines in 1998 that is relevant to cardiologists as well as primary care physicians. A new focus on obesity research has advanced our understanding of the complexity of this disorder and provided new molecular targets for intervention, including beta(3)-adrenergic receptor agonists, leptin analogues, and uncoupling proteins (UCPs) that stimulate energy expenditure. Two newly available pharmacotherapeutic agents approved by the United States Food and Drug Administration (FDA) and increasing acceptance of bariatric surgery for specific categories of obese patients have expanded current therapeutic options for the management of obesity. Nonetheless, the cornerstone of lifetime weight regulation and the prevention and treatment of obesity inevitably will remain lifestyle modification and long-term vigilance.