Exercise Treatment of Obesity

Surveillance data from the general US population indicate a continued increase in the prevalence of overweight and obesity that is consistent with weight gain trends observed globally among industrialized countries. Physical inactivity and obesity are closely linked conditions and they account for a large burden of chronic disease and impaired function. The underlying agent in the etiology of obesity is a long-term positive energy balance; however, the pathways determining the rate and extent of weight gain due to a positive energy are complex. Engaging in regular, moderate-intensity physical activity for at least 150 min/week can help maintain energy balance and prevent excessive weight gain; however, this minimum requirement may not be sufficient for reversing already-existing obesity and chronic disease. In fact, physical activity closer to 300 min/week may be necessary for successful weight loss and weight loss maintenance. Regimented exercise programs alone may not be the most effective treatment for people with obesity, however. Rather, lifestyle changes that increase total daily energy expenditure need to be accompanied by dietary counseling for reducing daily caloric intake. Also, accumulating the necessary exercise and lifestyle physical activity in intermittent bouts, rather than one long continuous bout, can improve adherence and the success of weight loss regimens. It is also important for both clinicians and patients to understand that a simple solution to obesity treatment does not exist due to the constellation of underlying mechanisms that drive energy balance. Indeed, physiological, behavioral, environmental, and genetic factors play both independent and interrelated roles that contribute to the complex etiology of obesity. Research from numerous scientific disciplines has shaped our understanding of obesity. While the relative contributions of insufficient energy expenditure versus excessive energy intake to obesity development continue to be debated, there is general agreement that exercise is a key element for both prevention and treatment. Future research should focus on the prevention of excess weight gain over the life course. In addition to the behavioral and intervention studies of the past several decades, an understanding of the regulatory processes governing energy intake, energy storage, and energy expenditure and how the reinstatement of exercise can correct the disruption of neural pathways is vital to the future of obesity research. Finally, public health science needs to link with public health practice to better enable the translation of this knowledge into policies that can alter the environment in a way that promotes an active lifestyle for all. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.