The treatment of Chronic Obesity is with multiple medications.

The treatment for Chronic obesity is multiple diet medications.
Seven simple steps.
ONE
Metformin should be started for pre-diabetics with fasting glucose greater than 95..
TWO
Liraglutide (Victoza) injection should be second drug for obese diabetic type 2.   The new oral  semaglutide will be good for those who don't want to take injections if it works and is tolerable)
THREE
Canagliflozin (Invokana) should then be added for further glucose control for type 2 Diabetes.
FOUR
Hopefully during this period the patient has been on LCHF (low carbohydrate high) or some form of Atkins diet or South Beach Diet.
Check that carbohydrates are low enough to cause nutritional ketosis with urine strips or blood sticks.
FIVE
To lose more weight and then maintain weight loss a patient will eventually need to be on either Qysemia, Contrave or Belviq for the rest of their lives.
SIX
Good news is people only need to walk 20 to 30 minutes a day or achieve 5,000 to  10,000 steps a day.  Exercise is for health not weight loss. 
SEVEN
Drink decaf coffee in morning so that afternoon hunger can be treated with a strong cup of regular coffee.

Insulin and Bariatric surgery should be reserved for those who fail the above and have morbid obesity


Update on my weight maintenance 7-14-19 link

Gardner's new trial on LCHF vs LFHC diets being equally effective.

I have heard Dr. Gardner speak at an Obesity Conference in Orlando.
I like his work.
His latest work from JAMA on February 20, 2018, states LFHC diet vs. HFLC diet are the same at losing weight after one year.

This is a good start but if the LCHF are not in nutritional ketosis most of the time, I think Dr. Gardner misses the main point of an Atkins type diet. 

My new book is all about weight loss maintenance.  
The reason people regain weight is because they never lose the tremendous number of fat cells which when shrunken after weight loss cause a low leptin level.   The low leptin level causes the brain to think the body is starving.  

In my personal experience and research I have discovered that
1- any diet (unless it is 1,000 to 15,000 a day for life, even weekends)
2- any amount of exercise 
3- nutritional ketosis from low calories or LCHF (Atkins type) 

will not prevent slow regain due to the Sponge Syndrome. 

The only way to prevent weight regain is with multiple diet medications.
I go into this in detail in my book, The Chronic Disease of Obesity published iUniverse in Feb. 2018.

My new book is now on sale at:
 iUniverse sales 

Amazon book sales


Also available on kindle or ebook at these two sites for $3.99