"If you think losing a meaningful amount of weight is so monumentally difficult that hardly anyone succeeds think again. About  percent of patients lose  percent or more of their weight  enough to improve blood pressure and risk factors for diabetes  within six months of the triedandtrue approach of diet exercise and counseling according to a review of obesity research published Wednesday in the New England Journal of Medicine. The counseling piece is crucial  and should include at least  sessions over six months with a trained professional such as a dietitian or exercise specialist. That kind of handholding is readily available the review said not only at medical centers but through YMCA diabetesprevention programs commercial weightloss plans such as Weight Watchers or Jenny Craig and even through call centers that provide tailored guidance. With intensive counseling patients get a lot of instruction but equally important they get a lot of support said psychologist Thomas Wadden director of the Center for Weight and Eating Disorders at the University of Pennsylvania. Partly its the accountability that makes the difference. If youre reviewing your progress every week with a counselor youre going to try harder than if youre just recording your weight on a phone app. For the paper Wadden teamed with Steven B. Heymsfield an obesity researcher at Louisiana State University to sum up what is known about the causes of the obesity epidemic and how to battle it. Some parts of their scholarly review come as no surprise.  Twothirds of the U.S.  adult population http is overweight a Body Mass Index of  to . or obese a BMI of  or more a result of increasingly sedentary lifestyles and eating too much highcalorie food in supersize portions. The girth of the nation has led to soaring rates of diabetes heart disease and other chronic illnesses. But less wellknown is the fact that research has uncovered  uncommon genetic forms of obesity including a type that is found in about  percent of severely obese children. Moreover studies suggest that when fat people slim down they continue to suffer metabolic and psychological effects such as increased appetite and a preoccupation with food. The implication is that persons who are no longer obese may not be physiologically identical to their counterparts who were never obese the authors wrote. If obesity permanently changes how the body functions then that helps explain why so many who lose weight regain it. The authors say it also supports the concept of obesity as a chronic disease that requires longterm vigilance and management. Because of the chronic nature of the problem professional guidelines httponlinelibrary.wiley.comdoi.oby.full recommend that antiobesity medications be considered to supplement intensive counseling and lifestyle changes. Six drugs have been approved http_Will_new_diet_drug_prove_safe__effective__and_affordable_.html for short or longterm use and research by Wadden and others has shown that adding a medication leads to greater weight loss and better maintenance. Nonetheless studies suggest the medications are underused given the scale of the obesity epidemic. Wadden and his coauthor cite the reasons Diet drugs have a history of being barely effective or unsafe insurance usually doesnt cover them and patients are often disappointed that pills are no panacea  their losses are modest. Its clear that these medications are beneficial said Wadden who has been a paid consultant to pharmaceutical companies as well as Weight Watchers. Unfortunately theres a sense that they must not work if you have to take them indefinitely. But I think obesity medications should be used on a longterm basis for chronic weight management just as I take a cholesterollowering statin and a bloodpressure medication for the long term."