Exercise and Obesity: Lifestyle Modification as a Means in Prevention and Treatment

摘要

The ongoing battle against the obesity epidemic has been fought for almost eight decades. The first attempt to summarize the effectiveness of the treatment methods used by the scientific community during the previous 30 years was by Stunkard [1] in 1958. The failure of the initial efforts to control obesity by dietary manipulations alone was dramatically expressed by the following two sentences expressed by Stunkard, 'Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it'[1,2]. The discouraging outcomes forced the scientific community to start trying various dietary combinations, thus developing an array of dietary proposals, including the reduction of calorie intake in the range of 400-1,500 kcal/day in an effort to meet the individual's daily nutrient and caloric needs on the one hand, and at the same time achieve loss of a considerable amount of fat [3, 4]. To overcome the failureof dietary treatment alone, behavior modification was introduced in the 1960s. The addition of this method supplied new arrows to the practitioner's arsenal, but although for quite some time this seemed to produce promising solutions to the problem [5,6], the final results were not up to expectations. Weight loss, as expressed on the scale, is not the solution to obesity. The objectives of a weight control program are focused, on the one hand, to accelerate fat loss, while at the same time to achievelong-term maintenance after the completion of the treatment. When qualitative assessment of weight loss was taken into consideration, dietary manipulation and behavior modification methods alone, or in combination, did not seem to assure adequate fat loss, protection of the individual's lean tissue during the weight loss phase, and most importantly, maintenance of the achieved body weight after the completion of the intervention program [7]. Only during the early 1980s, when exercise treatment was for the first time introduced alone, but most remarkably in combination with diet and/or behavior modification, did we start to see promising results, not only in fat weight loss but in long-term maintenance as well [8, 9]. The orthologic use of the combination of a nutrient adequate, but energy-deficit diet, increased physical activity, and behavior modification therapy constitutes the so-called lifestyle intervention approach, a method which, if appropriately applied, is promising encouraging results in the prevention and treatment of obesity.