European Journal of Cardiovascular Medicine

Obesity is a complex, multifactorial condition that has reached epidemic proportions worldwide, with significant implications for public health. According to the World Health Organization (WHO), more than 650 million adults globally are classified as obese, and this number is steadily rising. Obesity is a major risk factor for numerous chronic diseases, including cardiovascular disease, type 2 diabetes, hypertension, and certain cancers, contributing to increased morbidity, mortality, and healthcare costs (1). Despite widespread recognition of the health risks associated with obesity, traditional weight-loss approaches focusing solely on caloric restriction and physical activity often fail to deliver sustainable results. This is because obesity is not merely a consequence of poor lifestyle choices but is influenced by a complex interplay of genetic, hormonal, psychological, behavioural, and environmental factors (2, 3).

Critique of the traditional biomedical paradigm approach of obesity management focused on individual responsibility for weight loss and health behaviour change as the most viable options for weight management. There has been a strong interest in multidisciplinary approaches, where healthcare professionals from different fields work together such as dietitians, exercise physiologists, psychologists, primary care physicians, endocrinologists, and bariatric surgeons (4). Multidisciplinary approaches acknowledge that obesity management must encompass more than dietary and exercise recommendations, but rather must be conducted in a holistic manner that includes psychological, behavioural, social, and medical management of the disease (5).

Lifestyle changes include improvement in diet and exercise which are still essential in treating obesity. However, behaviour therapy is key to getting patients to adopt and stick with healthy lifestyle changes. Emotional eating and disordered eating patterns with psychological blockage from losing weight can block many people with obesity from success. Behavioral therapies like cognitive-behavioral therapy (CBT) and motivational interviewing can assist patients in building better eating habits and coping skills (6).

In addition to lifestyle interventions (which are the cornerstone of managing obesity), pharmacological treatments, and bariatric surgery are also important components of multidisciplinary obesity management, especially in cases of severe obesity or failure to achieve adequate weight loss with lifestyle alone. Pharmaceutical options, like those that regulate appetite and metabolism, are available for obesity treatment, but bariatric surgery — which is an option for patients with a body mass index (BMI) of 40 or higher, or a BMI of 35 and higher with associated comorbidities linked to obesity — might provide a more direct approach for some patients.

Finding ways in which disciplines can complement one another to enhance patient care is the focus of multidisciplinary approaches, as well as developing individualized care plans to serve a patient better. Obesity patients often have different contributors, co-existing diseases, and psychologies behind their disease that lead to different and tailored treatment plans. Multidisciplinary approaches seek to address multidimensional factors driving obesity using a comprehensive support system to promote long-term weight management and enhance health outcomes.

This systematic review aims to evaluate the effectiveness of multidisciplinary approaches in managing obesity, highlighting the importance of combining dietary, behavioural, pharmacological, and surgical interventions. The review also explores the challenges and limitations of these approaches, including issues related to patient adherence, accessibility, and long-term sustainability.

Literature Search Strategy

A comprehensive and systematic literature search was conducted across major medical and scientific databases, including PubMed, MEDLINE, Scopus, Web of Science, and Cochrane Library, to identify relevant peer-reviewed studies published between January 2000 and October 2023. The search aimed to capture a broad range of evidence related to multidisciplinary approaches to obesity management, including clinical trials, cohort studies, systematic reviews, and meta-analyses. The following search terms were used:

• “Obesity management”
• “Multidisciplinary approaches”
• “Behavioral therapy for obesity”
• “Dietary interventions”
• “Pharmacological treatments for obesity”
• “Bariatric surgery”
• “Integrated healthcare models”

Boolean operators (AND, OR) were employed to refine the search results, ensuring that all relevant studies covering different aspects of multidisciplinary care were included. The reference lists of selected articles were manually screened to identify additional studies that met the inclusion criteria. Duplicates were removed, and studies were screened by title and abstract before full-text assessment.

Inclusion and Exclusion Criteria

Inclusion Criteria:

1. Peer-reviewed studies focusing on multidisciplinary approaches to obesity management.
2. Studies evaluating the effectiveness of dietary, physical activity, behavioral, pharmacological, or surgical interventions as part of a multidisciplinary care model.
3. Randomized controlled trials (RCTs), observational studies, systematic reviews, and meta-analyses.
4. Studies reporting on measurable outcomes such as weight loss, reduction in comorbidities, improvement in psychological well-being, and long-term health benefits.

Exclusion Criteria:

1. Studies focusing solely on single-modality interventions (e.g., diet-only or exercise-only programs).
2. Case reports, editorials, commentaries, and opinion pieces.
3. Studies with insufficient methodological rigor, unclear outcomes, or incomplete data.
4. Non-English language studies were excluded unless a high-quality translation was available.

The inclusion and exclusion criteria were applied to ensure that the review focused on high-quality evidence from diverse healthcare settings and populations.

Extracting Data and Assessing Quality

A standard template was utilized to extract data. Data was extracted from each of the included studies as follows:

Study design (RCT, cohort, or systematic review)

• Characteristics of the population (age, gender, BMI, comorbidities)
• Mode of intervention (dietary, physical activity, behavioral, pharmacological, surgical)
• Primary and secondary outcomes (weight loss, metabolic improvements, psychological well-being, adherence rates)
• Follow-up (short-term vs long-term outcomes)
• Quality assessment of the included studies was conducted using appropriate tools according to the study type:
• Cochrane Risk of Bias Tool was used (for RCTs) to evaluate the risk of bias in domains including randomization, blinding, and outcome reporting.
• The Newcastle-Ottawa Scale (NOS) score was used to assess the quality of the observational studies concerning selection, comparability, and outcome assessment (6).
• AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) checklist was used to ensure methodological rigor for systematic reviews and meta-analyses

The quality of the studies was independently assessed by two reviewers and discrepancies were discussed or resolved by a third reviewer for accuracy and objectivity in this assessment process.

PRISMA Flow Diagram

The study selection process followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The PRISMA flow diagram below provides a detailed summary of the identification, screening, eligibility, and inclusion stages of the review process.

Data Synthesis

The data synthesis process involved both qualitative and quantitative analyses to provide a comprehensive overview of the effectiveness of multidisciplinary approaches to obesity management.

Qualitative Analysis:

Thematic analysis was used to categorize the included studies into key domains, including dietary interventions, physical activity programs, behavioural therapy, pharmacological treatments, and bariatric surgery. The analysis focused on identifying common themes, patterns, and variations in the effectiveness of these interventions when used in a multidisciplinary context.

Quantitative Analysis:

For studies reporting numerical outcomes, descriptive statistics were used to summarize the data, including mean weight loss, percentage reduction in BMI, and improvements in metabolic markers such as blood pressure, blood glucose, and cholesterol levels. Due to the heterogeneity of the included studies in terms of population, intervention type, and outcome measures, a meta-analysis was not performed.

Ethical Considerations

Ethical approval was not required for this systematic review, as it involved the synthesis of publicly available data from previously published studies. However, the review adhered to ethical principles by accurately reporting the findings and acknowledging the limitations of the included studies.        

Dietary Interventions

Dietary manipulation forms a core approach in the management of obesity. Personalized meal strategies designed by registered dietitians for the specific individual patient are common in multidisciplinary approaches. Low-carbohydrate, Mediterranean, and ketogenic diets have been known to help with those goals, according to studies. Nonetheless, maintenance of dietary changes over longer periods has proved difficult, further underscoring the necessity of continued support and behavioural counselling (6, 7).

Physical Activity

Physical activity is a key part of weight control protocols. Incorporating exercise physiologists in multidisciplinary approaches helps create individualized physical activity plans that consider the patient’s fitness level and preferences. Exercise not only helps with weight loss but also increases cardiovascular health, insulin sensitivity, and mental health. Research also suggests that the more you exercise in combination with dietary changes, the more you will lose weight and maintain a healthy weight long-term than with either of the two (8, 9).

Psychological & Behavioural Therapy

Third, behavioural and psychological therapies are important to address emotional and psychological barriers to weight loss. Interventions that have had the most positive impact on helping patients improve their lifestyle and manage emotional eating are cognitive-behavioural therapy (CBT), motivational interviewing, and mindfulness-based interventions. Psychological support is especially vital for people with trauma, anxiety, or depression history — conditions that can compromise efforts to lose weight (10, 11).

Pharmacological Interventions

Pharmacotherapy during weight gain is an add-on to lifestyle management. Comparator: Adjunct pharmacotherapy (e.g. orlistat, metformin) to weight loss (diet/exercise) (GBD 2015 Obesity Collaborators, 2017). Drugs like liraglutide, orlistat, and semifluid work by suppressing appetite, fat absorption, or insulin levels, which can all lead to weight loss. Endocrinologists are often part of such multidisciplinary teams, to ensure the safe use of these medications and monitor patients for adverse effects (12, 13).

Bariatric Surgery

Bariatric surgery is a highly effective option for people with severe obesity, or for those who have not had success with other options. Gastric bypass, sleeve gastrectomy, and adjustable gastric banding procedures lead to substantial and lasting weight loss. Multidisciplinary teams are essential in providing appropriate patient preparation for surgery, as well as providing post-operative care including nutritional and psychological needs (14, 15).

Managing obesity requires a comprehensive and multidisciplinary approach that addresses the multifactorial nature of the condition. Traditional weight-loss programs that focus solely on reducing caloric intake and increasing physical activity often fail to achieve long-term success because they do not address the underlying factors contributing to obesity. Multidisciplinary approaches, which integrate dietary modifications, physical activity, behavioural therapy, pharmacological treatments, and bariatric surgery, have been shown to produce more sustainable weight loss and better health outcomes (11, 12).

Dietary Modifications and Physical Activity

Dietary interventions remain a cornerstone of obesity management, but they must be tailored to each patient's needs and preferences to achieve long-term success. Multidisciplinary teams often include dietitians who work with patients to develop personalized meal plans that promote healthy eating habits. Low-carbohydrate diets, Mediterranean diets, and ketogenic diets have all been shown to be effective in promoting weight loss and improving metabolic health. However, the success of dietary interventions depends heavily on patient adherence, which can be challenging to maintain without ongoing support (13).

Exercise is another critical component of obesity management. Physical activity not only helps patients lose weight but also improves cardiovascular health, insulin sensitivity, and mental well-being. Exercise physiologists play a key role in developing individualized exercise programs that are safe and effective for patients with obesity. Studies have shown that combining dietary modifications with regular physical activity leads to more significant and sustainable weight loss than either intervention alone (14, 15).

Behavioural and Psychological Interventions

Behavioural and psychological interventions are essential components of multidisciplinary obesity management. Many individuals with obesity struggle with emotional eating, disordered eating patterns, and psychological barriers to weight loss. Cognitive-behavioural therapy (CBT), motivational interviewing, and mindfulness-based interventions have been shown to be effective in helping patients develop healthier eating habits and coping strategies (16).

Addressing psychological factors is particularly important for individuals with a history of trauma, anxiety, or depression, which can hinder weight loss efforts. Multidisciplinary teams often include psychologists or behavioural therapists who work with patients to identify and address these barriers. Behavioural interventions can also help patients set realistic goals, develop self-monitoring skills, and build a supportive social network, all of which are critical for long-term success (17, 18).

Pharmacological Treatments

Pharmacological treatments can be an important adjunct to lifestyle interventions for patients with obesity. Medications such as liraglutide, orlistat, and semaglutide have been shown to promote weight loss by suppressing appetite, reducing fat absorption, or regulating insulin levels. However, these medications must be used under the supervision of a healthcare professional to monitor for potential side effects (19, 20).

Pharmacological treatments are particularly beneficial for individuals with obesity-related comorbidities, such as type 2 diabetes or hypertension, who may require additional support to achieve significant weight loss. Endocrinologists play a key role in managing these treatments as part of a multidisciplinary team (21).

Bariatric Surgery

For individuals with severe obesity, bariatric surgery offers a highly effective solution for achieving significant and sustained weight loss. Procedures such as gastric bypass, sleeve gastrectomy, and adjustable gastric banding can result in dramatic weight loss and improvements in obesity-related comorbidities. However, bariatric surgery is not without risks, and it requires careful patient selection, pre-operative preparation, and post-operative support (22, 23).

Multidisciplinary teams play a critical role in ensuring the success of bariatric surgery by providing comprehensive care before, during, and after the procedure. This includes addressing nutritional needs, managing psychological health, and helping patients develop healthy lifestyle habits to maintain their weight loss (24).

Obesity management requires a comprehensive, multidisciplinary approach that addresses the underlying causes of the condition and provides tailored interventions for each patient. By integrating dietary changes, physical activity, behavioural therapy, psychological support, pharmacological treatments, and surgical options, multidisciplinary teams can achieve more sustainable weight loss and improved health outcomes. While challenges remain in implementing these approaches on a larger scale, the evidence suggests that patient-centred care models hold the key to tackling the global obesity epidemic.

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