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Obesity: Ways of Management Through Diet, Exercise,

Medication and Bariatric Surgery

Mason Suchora, Michael Martin, Aaron Williams and Ryan

Thompson

Centofanti School of Nursing, Youngstown State University

NURS 3749: Nursing Research

Ms. Randi Heasley

April 6, 2022
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Introduction 

At this point in time, it is no secret that not only the United States, but the world is in a

battle against obesity. Frankly it is not a battle many people win and causes many deaths

throughout the world. Obesity can lead to hyperlipidemia, hypertension, congestive heart failure,

coronary artery diseases, diabetes, or being put at an increased risk of heart attack; however,

there are several ways to treat obesity that we are now discovering that are fairly effective if

followed properly they can change these people's lives. While researching these treatments we

found several articles covering diet, exercise, bariatric surgery, and medication that can cause

weight loss. Many people firmly believe that with the right diet and exercises that anyone can

lose weight while maintaining the weight lost; however, this is not the case for everyone. Obesity

is a mental illness that some people cannot find their way out of. Not everyone is able to go to a

gym and lose the weight that they need to due to a multitude of reasons. The articles discussed

will show that there are other ways that can work for those that cannot do just diet and exercise.

These two methods are not bad, but for someone that needs to lose 200 pounds and change their

whole lifestyle around is an extremely daunting task. Our articles will discuss how diet and

exercise can help some people, but we will also look at how surgical or pharmacological

management can be very helpful for some individuals as well. These patients just want to feel

comfortable in their own skin and there is more than one way to do this that is effective. Using

EBSCO host and PubMed, the search strategy included obesity, diet, exercise, bariatric surgery,

for peer review scholarly articles from 2016 to the present.  The literature search was narrowed

down to these eight articles by reviewing article abstracts and titles for relevancy to the topic.  
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Managing obesity with diet 

Obesity is a disease that many people throughout the world are currently struggling with.

According to Christensen et al. (2021), “As of 2016, almost 40% of adults worldwide had

overweight or obesity” (p.1). Christensen's (2021) study has shown that excess weight can

contribute to the development of chronic diseases such as diabetes or cardiovascular disease.

This study looked at three groups that tried different diets in order to lose weight. The first group

was given calorie deficient diets while eating low carbohydrates with high fats without a time

restraint. The second group had the same diet but with a time restraint being eighteen hours

fasting and six hours of eating time. The last group did just a standard low-calorie diet. While

making a diet modification is not easy according to Christensen et al. (2021), “The primary mode

of intervention for weight loss is behavioral intervention, which involves changing one’s diet to

decrease calorie intake” (p. 1). This would involve sticking to a proper diet along with a change

in lifestyle for the patient.

Christensen et al. (2021) found that no matter the type of diet the vast majority of

participants lost 5% of their body weight. It really seems that if you are willing to stick to a diet

then you will be able to lose some weight and maintain the weight loss. Christensen et al. (2021),

found “that trying multiple different diets, with the supervision of medical weight management

clinic, may help patients lose more weight and improve their likelihood of achieving a clinically

significant weight loss” (p. 5). This means that as long as the subjects that are taking part of the

study are willing to try, then they have a high chance of losing weight. 

In a similar article, the use of a few different diets is compared against one another to find

the optimal diet. The diets being examined were commercial diets, meal replacements and very-

low-calorie-diets, intermittent energy restriction, continuous energy restriction, intermittent

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energy restriction / fasting diets, Mediterranean Diet, and low-fat and low-carbohydrate diets.

This is very important because according to Thom and Lean (2017), “Obesity rates are at an all-

time high, with over two thirds of adults classified as overweight (BMI>25kg/m2) or obese

(BMI>30 kg/m2) in most of the Western world” (p. 4). The researchers wanted to see if there

was a set way that works for everyone to lose weight with the goal being to find the single best

diet that would succeed.

  Thom and Lean (2017) describe the benefits and downfalls of each diet and come to the

conclusion that no diet is the ideal diet. Thom and Lean (2017) state that “There is no optimal

macronutrient distribution for weight management, no ‘one size fits all’

strategy that will suit everyone” (p. 20). However, the researchers do believe that “the era

of personalized nutrition is drawing closer, and there may at some point be a time when

we can make recommendations based on genotype” (p. 20). The key that they found was to just

be consistent when it comes to dieting. According to Thom and Lean, (2017) medical

professionals need to realize it is not the diet; rather, the ability to adhere to the diet that leads to

success. The findings were that as long as the participants found consistency in the path that they

chose while dieting that they would be successful in some sort of weight loss. 

Managing Obesity with Exercise

In obese patients losing weight with caloric restrictions, weight loss surgery, or even

medication this can become very easy for them to lose control of their path to losing weight.

Exercise interventions have shown to interest even shorter attention spanned individuals such as

adolescents to continue their journey of weight loss. According to Staino et al. (2017) “Wearable

activity trackers like pedometers are inexpensive, objective ways for children to self-monitor
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physical activity, and are suggested as a way to increase children's awareness and regulation of

their physical activity” (p.284). This is a very important tool used in the study because not only

was it used to track how well the adolescents were adhering to their step goals, but it also kept

them focused on a goal. Adolescents are hard to keep focused on one thing, so by wearing the

pedometers this keeps them focused. Staiano et al. (2017) backed up this statement by saying,

“the addition of pedometers to interventions has demonstrated moderately increased physical

activity, but findings are equivalent for weight loss” (p. 285). The pedometers used killed two

birds with one stone. It kept the adolescents focused and kept them on a path to losing weight

with exercise.

  In this study, Staiano et. al. (2017) helped conduct a study on whether or not pedometer

only with adolescents, pedometers with step goals, or no pedometer at all made a difference in

adolescent weight loss attainability. The outcome of this study was that children who received

the pedometers and individualized step goals reduced weight and BMI z-score to a greater extent

than children who did not receive a pedometer or step goals. As Mantzor et al. (2018) goes

further to point out, “Both pedometer groups significantly improved in subjective health and

health-related quality of life, without a difference between the two groups'' (p. 286). This showed

that pedometers were a huge factor in losing weight that the obese adolescents needed to lose

weight and a goal set on top of the use of pedometer use only further increased chances of weight

loss. 

In another article that used exercise intervention the participants used were on the other

side of the age spectrum, older adults. This study was heavily due to older adults with

inflammation being more susceptible to being diagnosed with chronic diseases.  According to

Rejeski et al. (2020) “Chronic low-grade inflammation is a consequence of aging and is

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associated with the risk of developing several age-associated chronic health conditions such as

ischemic heart disease, diabetes, kidney disease, and Alzheimer’s disease” (p. 1805). These are

diseases that no one wants to see their loved one go through, so this study was done to see if

exercise intervention would help lower weight loss, inflammation, and risk of chronic diseases

that come with it. In the study 222 older adults were put into three different groups, weight loss

with no activity, weight loss plus aerobic training, and weight loss plus resistance training. It was

important to perform this study because according to Marsh, et. al (2020), “Although state-of-

the-art weight loss interventions include physical activity, many commercial programs rely on

diet alone” (p. 1807). Now, diet can be a great way to lose weight, there is no denying that.

However, researchers in this article used this study to determine if the use of physical exercise

would help aid in weight loss of the older adults and lower risk of chronic conditions.

The article goes on further to investigate whether or not the addition of certain physical

exercise, any exercise, or no exercise would help aid in weight loss and chronic condition

reduction. The researchers came to the conclusion that not only does physical activity improve

weight loss, but it also improves inflammatory profile in older adults. As stated by Marsh, et al

(2020), “The results of this study reinforce a central role for physical activity in weight

management, particularly for older adults with chronic health conditions such as MetS and

CVD” (p. 1809).  What researchers found with this study is that physical activity should not be

left out of any type of weight loss intervention and that it is a staple of weight loss management

especially for older adults who rarely get any type of exercise in the first place. 

Management of Obesity with Medications

Initially for patients diagnosed with obesity, there was no other way of helping

themselves other than diet, exercise and inevitably bariatric surgery. Medication for weight loss
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is still a treatment that is not very widely used in practice, only becoming an option when the

normal ways of weight loss are not attainable. Medications do seem to be a growing theme with

the rates of obesity going up especially in the United States. Khalil states, “When application of

comprehensive lifestyle interventions has failed to result in clinically significant and sustained

weight loss and bariatric surgery is not appropriate, pharmacological intervention should be

considered.” (Hanan Khalil, 2020). This leads into the studies that were analyzed on the basis of

medications that are used to manage obesity. 

The first initial study observed was the study from Khalil, and parameters were used to

get an obtainable sample population. The patients had to be greater than sixteen years old, have a

BMI greater than or equal to 25 and have a weight-associated comorbidity as well. There were

two groups used. One group consisted of individuals who were on medications such as Orlistat,

Naltrexone and Liraglutide. The second group was placed on a placebo medication, each group

not knowing which is which and that a placebo was being given. Khalil states, “The primary

outcome of this review is weight loss. Secondary outcomes include fasting blood glucose,

HbA1c, total cholesterol, triglycerides, systolic and diastolic blood pressure and adverse events.”

(p. 2) This was also a study that had two initial groups reviewing, and if the two groups

contradicted each other, a third group was used to review to maintain validity of the research. 

Upon reviewing the results of the study, each medication significantly outperformed their

placebo counterpart. A maximum of 4.95 kg was lost in one year with the medication

Naltrexone, with no lifestyle modifications in the participants. The minimum weight loss

observed was Orlistat, with 2.83 kg lost in one year while on 360 mg per day. In comparison to

its placebo counterpart, which only 1.74 kg lost in one year with lifestyle changes in this

particular part of the study. The overall comparison grouped together came out to an average of
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5.24 kg lost with the medication and 1.7 kg lost with a placebo effect used. Similar results were

found in a second research study by Ken Fujikora and Jill Braverman-Panza, using the

medications in a controlled environment and testing them against the placebo effect. This journal

went more into the breakdown of the medications and what the action of the drug is such as,

“The effectiveness of naltrexone/ bupropion appears to be due to a reduced association between

trait-like reward-driven eating and daily food-craving intensity rather than to a reduction in

craving intensity. (Fujikora, Braverman-Panza, 2016)” This study uses the same medications, but

was a landmark study, meaning it is compared over a shorter period of time. The FDA has

approved the use of these medications for long term therapy. When that was first approved in

2015, a landmark study was needed to show the effectiveness. All of the comparisons were done

over 52 weeks or 56 weeks, compared to the study of Khalil, in which some therapies were even

done over 36 months in that study. As mentioned, this is all new, so with more time comes

longer studies, so next the initial studies will be analyzed over the one year or 56 weeks. 

The breakdown of this study is astonishing to see the results of each med after 1 year and

or 56 weeks. Looking at Phentermine/ Topiramate specifically, when taking 7.5/46 mg once a

day for 56 weeks, 50.3% of people who were on that medication had a weight loss of >10%.

Over just 56 weeks if someone can lose over 10% of their body weight, that seems as if it is very

productive. Comparing it to the placebo used in that same test 11.5% of people on the placebo

only reported >10% weight loss. That goes to show that it is still possible to lose weight, but

while on that medication the difference in decreasing your calories can exceed weight loss

expectations. Although it is noted that, “It should be kept in mind that the weight loss observed

in an individual patient with any of these medications may differ from the average weight loss
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observed in the clinical trials.” Essentially saying that these medications are never going to be

100% effective, but that is the same way as any medication for any other person. 

The last point assessed in this article was when should treatment be assessed and what is

a possible endpoint for these medications? “The 2000 National Heart, Lung and Blood institute

threshold for treatment is a 2kg weight loss after 4 weeks.” (p. 22) That is the time period to

monitor to ensure that there is a therapeutic response. Fujikora and Braverman-Panza note in

their article that this is a preventative measure to try to avoid bariatric surgery. Although,

bariatric surgery may be inevitable in some due to their comorbidities. 

Management of Obesity with Bariatric Surgery

Bariatric surgery is known to be one of the most effective ways to combat obesity and the

comorbidities that come with the condition. A study done by Pantelion and Miras, states “Diet,

exercise, cognitive behavioral therapy and pharmacotherapy are some of the means of assisting

patients to lose weight, with bariatric surgery being the most effective.” (p. 97). However, it can

be extremely difficult for patients that undergo these procedures to keep the weight off long-term

and sustain their weight loss due to factors already discussed such as poor management of diet

and exercise post-surgery. “The identification of novel lifestyle behaviors to maintain a reduced

weight would be a crucial step forward in the progression of obesity treatment.”, (Zuraikat et. al,

p. 1769) states that while modifying your diet and exercise is important, it is more important to

pay closer attention to your ways of eating, sticking to a routine scheduled diet.

To be eligible for bariatric surgery, a patient should have a “BMI greater than or equal to

40.0 kg/m2 or a BMI than or equal to 35–39.9 kg/m2 with co-morbidities related to their

obesity.” Not only must the comorbidities be present, they must also be expected to improve

with surgical intervention. Patients that have a BMI lower than 35 kg/m2 may still be considered
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for bariatric surgery given their individual circumstances. When deciding which type of bariatric

procedure is best fitting, many factors are assessed. These factors discussed by Panteliou and

Miras include “the degree of obesity, metabolic comorbidities, target outcomes in terms of

weight loss and improvement of associated conditions, risks of the procedure and patient needs

and concerns” (p. 98). Due to the large number of factors to be assessed, this is usually decided

through a multidisciplinary approach. For patients with a BMI between 30 kg/m2 and 40 kg/m2

with no compelling comorbidities, who express the wanting of a reversible procedure, and will

be accountable for showing up to follow-up appointments, the laparoscopic adjustable gastric

band (LAGB) is the recommended procedure.

Another type of surgery that is reversible and has been commonly used in type 2 diabetes

patients is the Roux-en-Y gastric bypass (RYGB) procedure. Although it is a more demanding

procedure, its positive effectiveness on metabolic disease processes have been proven over time.

The Vertical sleeve gastrectomy (VSG) is similar to the RYGB in its results on weight loss and

metabolic results, however it is not a reversible procedure. The last surgical procedure that my

article mentions is Biliopancreatic Diversion (BPD). This is the most effective procedure

available as far as weight reduction and remission of metabolic complications go. However, this

intervention is typically limited to morbidly obese patients who have a BMI greater than or equal

to 50 kg/m2.

Keeping the weight off post-surgery is a key component to maintaining the effectiveness

of the surgical intervention itself as well the metabolic conditions that were put in remission. One

factor related to maintaining weight loss is sleep. According to Zuraikat et. al, “Sleep is known

to influence food intake and may therefore contribute to sustained reductions in body weight

following surgery.” (p. 1769). In a study done to evaluate the effectiveness of sleep
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quality/duration in post-bariatric surgery and weight loss, body weight was measured at 1 year, 2

years, 6 years, and 9 years post-surgery, while sleep quality and duration was assessed at the 9-

year visit. The PSQI scale was used to assess sleep quality, and weight loss was measured in

mean weight loss (SEM). The results of this study showed that individuals with a PSQI score of

less than or equal to 5 (good sleep quality) had a greater SEM than those with a score of greater

than 5 (poor sleep quality). Given this information, it can be deduced that maintaining good,

adequate quality of sleep may be used as an effective nonpharmacological intervention in

maintaining weight loss post-bariatric surgery.

Conclusion 

Obesity is a common issue that is currently seen all throughout the world. Many people,

groups, and professionals in the medical field have tried to find the best way to lose weight and

keep it off. It is of the utmost importance that studies like this continue to try and see if

something can be done to help these people struggling with obesity, while keeping in mind the

goal of being able to keep the weight off. In the articles looked at in this paper it was found that

when referring to diet, no diet is a magical answer to your problems. The key is consistency

when it comes to losing weight with dieting. A diet must be found that the patient will be able to

stick to and they must be willing to stick to the rules of that diet. 

Exercise has always been a crucial part of helping to lose weight. The articles above

show no matter what age you are, exercise is always key to have with a weight loss program

even if it does include diet, medications, or bariatric surgery with it. Talking with your Dr.,

cardiologist, or even a nurse for more education on how you should go about starting a physical

exercise routine is recommended. Not only will a person lose weight by including exercise, but
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the articles above go to show that it will also improve decreased risk of chronic disease, muscle

growth, and an overall healthier and happier lifestyle. 

Medications are still a constant study when it comes to Obesity and any other disease for

that matter. There is no knowing that it will work for someone specifically, these articles

mentioned above are reasons that it is worth a chance though. Consulting with your primary care

doctor will be necessary, if he or she feels as if they are fit for you, just know that they have

shown progress in helping others. This is a long-term commitment in yourself and anyone that is

looking for some help should consider taking these medications. 

When it comes to bariatric surgery, consistency is also key. If you are a candidate for

bariatric surgery, the odds are that you are struggling with other comorbidities that are affecting

your everyday life and health. To keep the weight off after surgery is to keep your comorbidities

from arising and causing complications once again. Not only has proper diet, exercise, and

pharmacological management been proven to help with this, but also getting adequate, good-

quality sleep can also aid in keeping weight off long-term. 

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