A prudent and practical approach to the treatment of obesity.

Although obesity is difficult to treat, the only effective long-term strategy is an emphasis on adoption of a healthy lifestyle, including exercise, and prudent control over eating habits. Such modifications in behavior can be implemented by some patients with the help and encouragement of their physician, whereas other patients need professional, psychological intervention. VLCDs are useful to attain initial weight loss, but are not (nor were ever intended to be) a substitute for the development of a prudent lifestyle. Thus, for patients with major obesity (BMI > 30), the combination of a VLCD with behavior modification offers the best medical approach to obesity. Surgery has a role in the treatment of obesity, but only in patients with morbid obesity that have repeatedly failed other treatments, including treatments involving a serious effort at behavior modification.