Lifestyle interventions for the treatment of class III obesity: a primary target for nutrition medicine in the obesity epidemic.

Although rates of obesity have increased universally in the United States over the past 30 y, it is clear that certain individuals are more susceptible to weight gain than others. Extreme obesity [body mass index (in kg/m(2)) > 40] is increasing at rates greater than any other class of obesity in the United States. Severely obese patients often suffer from a wide variety of comorbidities. Although weight-loss surgery is the most effective treatment, it offers little in the way of large-scale containment due to its costly and invasive nature. Lifestyle interventions that induce modest weight loss and improve fitness can significantly lower disease risk. As medical professionals in the field of nutrition, we must focus first on the patient cohort that suffers most from the modern obesogenic environment. Lifestyle interventions specifically targeted toward the class III obese cohort should be a high priority in nutrition medicine.