Obesity is a chronic disease that requires long-term therapy for successful long-term weight management. The cornerstone of obesity treatment involves consuming less calories that are expended to mobilize and oxidize endogenous triglycerides as fuel. Appeoximately 75%–85% of weight that is lost by dieting is composed of fat, and 15%–25% is fat-free mass. Often, patients who are able to lose weight with obesity therapy regain their lost weight after therapy is discontinued. Maintenance therapy is therefore important for long-term weight management success after initial weight loss is achieved by diet and behavior therapy.
The clinical approach to obesity can be viewed as a pyramid consisting of several levels of therapeutic options. All patients should be involved in an effort to change their lifestyle behaviors to decrease energy intake and increase physical activity. Lifestyle modification also should be a component of all other levels of therapy. Behavioral therapy for obesity should involve (1) developing specific and realistic goals that can be easily measured (eg, walking for 20 minutes, three times per week), (2) developing a reasonable plan for reaching those goals and to prevent relapse, and (3) making incremental changes rather than large changes, so patients can have successful experiences that can be used as a foundation for additional lifestyle alterations. Pharmacotherapy can be a useful adjunctive measure for properly selected patients. Bariatric surgery is an option for patients with severe obesity, who have not responded to less-intensive interventions.

　　Evidence revealed that successful long-term weight loss is associated with specific behaviors: (1) self-monitoring of food intake and body weight ; (2) consuming a low-calorie (1300–1400 kcal/d) and low-fat diet (20%–25% of daily energy intake from fat), (3) eating breakfast every day, and (4) performing regular physical activity that expends 2500 to 3000 kcal per week. Physicians can incorporate several important aspects of behavioral therapy in their office practice to enhance their weight management treatment approach. The most important principle is to provide a treatment plan that involves short-term and achievable goals. These goals should be adjusted as needed based on the patient’s response. Frequent patient contact, particularly during the initial 6 months of therapy, enhances motivation and provides the opportunity to assess progress, give support, and establish goals for the next visit. However, contact does not need to be with the physician only, and other office staff can be used to provide effective patient interactions. The use of written materials and manuals, and appropriate websites also provide educational support but reduces the burden on office manpower.