Obesity Center and Weight Control

Abstract

Obesity is a multifactorial disease resulting from the complex interaction of genetic, metabolic, behavioral, and environmental factors. Obesity centers, which provide a multidisciplinary approach, play an important role in the implementation of appropriate and sustainable obesity management. The primary objective of obesity centers is to help individuals develop healthy lifestyle skills, achieve, and maintain their target weight, and change their environmental and social habits.

1. Introduction

The World Health Organization (WHO) defines obesity as the abnormal and excessive accumulation of fat in the body to such an extent that it may present a risk to and impair human health [1]. Body mass index (BMI), calculated as body weight in kilograms divided by the square of height in meters, is a simple index commonly used to classify overweight and obesity. For adults, current guidelines issued by the United States Center for Disease Control and Prevention (CDC) and WHO define a normal BMI range as 18.5–24.9, indicating BMI ≥25 kg/m² as overweight, BMI ≥30 kg/m² as obesity, and BMI ≥40 kg/m² as severe obesity [1, 2]. According to this simple definition, obesity is a multifactorial disease that results from a chronic positive energy balance, i.e., when dietary energy intake exceeds energy expenditure. It results from the complex interaction of multiple genetic, metabolic, behavioral, and environmental factors, which are thought to be the primary reasons for the significant increase in the prevalence of obesity [3, 4]. Excess energy is converted into triglycerides, which are stored in adipose tissue, which expands, increasing body fat and causing weight gain. The globalization of food systems, which encourages passive overconsumption of more processed and affordable foods and energy-dense, nutrient-poor foods and beverages, has been identified as a major contributor to the epidemic of obesity [5]. Reduced physical activity associated with modernized lifestyles is also a significant factor [6, 7].

2. The prevalence of obesity

Obesity can occur at any age. Previous studies assessing trends in obesity have reported that the prevalence of obesity is increasing in both adults and children of all ages, regardless of geographic region, ethnicity, or socioeconomic status [8]. In low-income countries, obesity is particularly prevalent among middle-aged adults (especially women) from wealthy and urban backgrounds, whereas in high-income countries it affects both sexes and all age groups [5]. The global prevalence of overweight and obesity has doubled since 1980, with around a third of the world’s population now classified as overweight or obese [8]. According to the World Health Organization’s 2019 data, Turkey is the 17th most obese country in the world, with 32.1% of the population in Turkey scoring a BMI above 30 [1]. The increasing prevalence of obesity not only affects individuals but also places a significant burden on healthcare systems. In the USA, the healthcare costs incurred by a single obese individual were estimated at USD 1901 per year in 2014, with a national estimate of USD 149.4 billion [9]. The total direct and indirect costs attributable to overweight and obesity in Europe are equivalent to 0.47–0.61% of gross domestic product (GDP) [10].

3. Approach to treatment of obesity

Obesity, which has evolved into a major public health problem affecting physical and mental health, is the second leading cause of preventable death after smoking [11]. Approximately 3 million people die from obesity every year [12]. Obesity is a risk factor for a wide range of medical conditions, including type 2 diabetes, some types of cancer, cardiovascular diseases, and musculoskeletal disorders [12, 13, 14]. In addition to these health risks, adverse effects on quality of life and impaired quality of life have been reported to be associated with the degree of obesity [15]. Obese patients have an elevated risk of body image disturbance, low self-esteem, depression, and anxiety [16, 17]. Obese patients cannot lose weight effectively because they do not make diet and exercise indispensable habits of their lifestyles, and even if they manage to lose weight, they cannot maintain their weight. Throughout this long process, patients have a greater chance of success thanks to a multidisciplinary team [18].

Lifestyle intervention and weight loss programs for adults often report disappointing results and diminishing effectiveness associated with low participation and compliance rates [19]. Obese people have been demonstrated to adopt inhibited attitudes toward behavioral change [20]. Therefore, the implementation of lifestyle changes necessary to achieve treatment goals can be extremely challenging [19].

One of the most common behavioral strategies used in weight loss interventions is to help patients identify barriers to behavior change and generate solutions [21]. Perri et al. defined a problem-solving model that recommends active problem-solving for everyday problems for obese people and reported that people who completed problem-solving training lost more weight in the long term [22]. In addition to studies reporting that patients with improved or enhanced problem-solving skills are more likely to adhere to treatment and lose weight, recent meta-analysis reports show that such interventions have significant effects on session attendance and physical activity [19, 23].

Treatment of obesity can be planned according to the clinical characteristics of the patient and may include diet, exercise, medical and surgical treatment [2]. For the diagnosis and assessment of obesity in clinical practice, new approaches have been proposed [3, 4, 24]. Although BMI is commonly used to assess and classify obesity, it has not been proven to be an accurate tool for identifying complications associated with adiposity [4]. Waist circumference is independently associated with increased cardiovascular risk but is not a strong indicator of visceral adipose tissue on an individual basis [25]. Incorporating both BMI and waist circumference into the clinical assessment may identify a higher-risk phenotype. In addition to BMI and waist circumference measurements, a thorough history, appropriate physical examination, and relevant laboratory investigations to identify the root causes of obesity will help identify those who will benefit from treatment [26].

4. Obesity centers and weight control

Obesity centers have been in operation in Turkey to implement appropriate and sustainable obesity management and to treat obese patients using a multidisciplinary approach model [27]. These centers are mission-driven centers that help people who are overweight or obese to reach and maintain their ideal weight [7, 28, 29]. Patients with a BMI of 30 kg/m² and above are admitted to obesity centers. Obesity centers have experienced teams that offer a holistic approach to patients. These teams include doctors, dieticians, physiotherapists, psychologists, and nurses [17, 18].

Age, sex, educational level, social and marital status, reading culture, work and adaptation to the center, economic status, residential and daily life status data, attendance at the center, and additional disease information of the patients applying to the obesity center are being collected and recorded. Laboratory tests include complete blood cell count parameters, fasting plasma glucose (FPG), electrolytes, kidney and liver function tests, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), and thyroid function tests. Patients receive a total of twelve training sessions at the center at least 3 days a week during the first month, a total of at least six sessions during the second month, and a total of at least three sessions during the third month. Patients who are required to attend training sessions will be categorized according to whether they attend these sessions. Patients who do not attend half of the twelve training sessions during the first month, those who do not attend half of at least six training sessions during the second month, and those who do not attend at least one of the three training sessions during the third month are considered as not attending training [29]. Individualized diet and exercise programs and a medical approach under the supervision of a doctor are planned to achieve the target weight. The aim is to ensure that people who have reached their target weight maintain their healthy lifestyle and weight, change their environmental and social habits, and maintain their weight permanently. If the target weight is lower than the weight to be lost, the program is repeated and the target weight is reset and the time to start losing weight again is planned [28]. Studies have revealed that patients who regularly attend obesity centers lose weight more easily and exhibit significant improvements in serum lipid parameters [29].