As insulan resistance is a central component of the metabolic complications found in dyslipidemic, visceral obese patients, therapeutic approaches aiming at reducing cardiovascular disease risk should focus on improving insulin sensitivity and reducing visceral adipose tissue mass rather than on the normalization of body weight, this latter objective being less relevant from a clinical standpoint. A reduction in fat intake combined with the induction of a negative energy balance by a simple form of endurance exercise such as brisk walking should contribute to rapidly improve the metabolic condition of the visceral obese patient, even in the absence of major changes in body composition. Thus, there is a two-fold increase in the prevalence of obesity between the ages of 20 and 55, and more than twice the prevalence of obesity among women of lower socioeconomic status compared with those of upper socioeconomic status. The prognosis for obesity is poor, untreated, it tends to progress. Attempts to lose weight may cause complications, symptoms of anxiety and depression may appear in as many as half of patients undergoing medical treatment.
Treatment is still only modestly effective but is improving.
The aim of therapy is to establish a caloric deficit by reducing the number of food calories below the number of calories expended as energy. Methods to achieve this deficit vary widely and may seem confusing. Severe obesity is relatively uncommon. The basis of treatment is surgery , which can produce large weight losses that are often well maintained. Such surgery is not without risk, and should be used only in severely obese persons who have repeatedly failed at conservative treatments.