A more recent article has been published on this subject: Weight loss: the options and the evidence
The mainstays of obesity management are simple and well known to health professionals: reduce sugar and saturated fat intake, eat more fresh vegetables and whole grain fibre and increase physical activity. The complexity lies in the psychosocial, cultural and economic barriers that people need to overcome in order to sustain the lifestyle changes required to achieve long-term weight-loss. “Fad” diets, myths and misinformation about weight-loss, and the difficulties of discussing obesity with patients, add to this challenge. Patients who do manage to lose weight should be followed-up regularly in primary care to encourage them to maintain their lifestyle changes. Currently no anti-obesity medicines are funded in New Zealand and there is a very limited role for their use in obesity management, although several new medicines have recently been licensed overseas. Bariatric surgery is the most effective and sustainable weight-loss treatment for select patients who are morbidly obese.