Open Access
Feature Article

Managing obesity: focus on lifestyle approaches



© new africa/ model used for illustrative purposes only
© new africa/ model used for illustrative purposes only
Dr Gibson is a Research Fellow In the Boden Collaboration, Charles Perkins Centre, The University of Sydney. Dr Franklin is a Senior Dietitian at Metabolism and Obesity Services, Royal Prince Alfred Hospital. Dr Sim is a Senior Dietitian and Manager of Obesity Prevention and Management, Sydney Local Health District. Dr Partridge is a Dietitian at the Westmead Applied Research Centre, The University of Sydney. Professor Caterson is the Boden Professor of Human Nutrition and Director of the Boden Collaboration, The University of Sydney, Sydney, NSW.


Most of us eat several times a day, most days of our lives. In our modern environment, food is plentiful, energy-dense, highly visible, convenient and a major part of our social lives. In contrast, being physically active is a choice and not a necessity for survival. It is therefore not surprising that it is hard for people to lose weight and keep that weight off.

Key Points

  • The majority of patients who have obesity are interested and motivated to lose weight; they want their healthcare practitioner to discuss it with them.
  • The most important factor determining the success of any weight loss attempt is the ability to adhere in the long term to the new lifestyle changes.
  • A quick and practical approach to offering dietary advice is to think quality (eating more for less kilojoules by choosing healthier whole-food options) and quantity (applying caution with portions).
  • Simply telling patients they need to eat less and move more is unlikely to be effective. They need help to do this – it takes ‘skill power’ not just ‘will power’ to lose weight.
  • Taking a detailed weight history and representing this visually is a useful starting point for providing individualised advice that is more likely to resonate with the patient.

Obesity is the result of a long-term positive energy balance and although an energy deficit must be created to achieve weight loss, attributing obesity to eating too much and not exercising enough is an oversimplification. It is evident in the real world and from scientific studies that people struggle to lose weight and keep it off. Unfortunately this failure is usually attributed to the individual, with the person often considered weak-willed, lazy and even stupid.

The factors contributing to obesity are complex due to an interaction between varying genetic and biological tendencies, and to environmental, cultural and socioeconomic drivers of weight gain. Factors may act alone or in combination to modulate energy intake and/or expenditure and hence determine the likelihood of an individual developing obesity. The current ‘obesogenic’ environment is propelling the epidemic by providing an unfavourable situation that overwhelms the sophisticated regulatory systems of the body controlling appetite and maintaining energy balance. In today’s world it can be argued that weight gain is a natural response for humans endowed with an ‘ancient metabolism’. Consuming excess energy was important in our evolutionary past to last us through the times of shortage, now it is a health hazard.


The primary care setting is the obvious choice for tackling the obesity epidemic because of the long-term nature of the clinician–patient relationship. However, due to a range of factors, including lack of time, perception the patient is not interested or motivated, that there are more important health issues to discuss, and the social and personal prejudices about the individual with obesity, many GPs find it challenging or feel ill equipped to tackle the problem.1


This article aims to help practitioners start a conversation with their patients regarding weight loss and better health using simple practical suggestions. It is in line with the current National Health and Medical Research Council (NHMRC) guidelines that recommend lifestyle change as the cornerstone of all interventions. The reader is also referred to the NHMRC Clinical Practice Guidelines for Managing Overweight and Obesity in Adults, Adolescents and Children for more information.2