Toward a New Paradigm for the Management of Obesity

Reduced calorie regimens lead to an adaptive response that reduces the body's daily energy needs, and to hormone and enzyme changes that lead to enhanced rates of fat storage following caloric restriction. There is no sound evidence to support a causal relationship between excess caloric intake and development of obesity, yet virtually all outpatient treatments for obesity are based on strategies to reduce caloric intake. The programs subsequently fail at long-term weight control, while at the same time exposing participants to substantial psychological and physiological dangers. It is time for a new paradigm in weight management that focuses primarily on reducing the percentage of calories in the diet from fat, and on increasing the level of physical activity. It has been shown that many individuals can lose weight at a satisfactory rate (one pound per week) by combining physical activity with a change in the composition of the diet that involves less fat. In working toward the goal of dietary fat reduction and increased activity, health education programs need to be comprehensive in nature and include behavior therapy, cognitive interventions, social support, and nutrition education.