Exercise for the Overweight and Obese

The development of new phamacological treatments for obesity has been challenging. In part, the lack of early diagnosis, early detection, early intervention and treatment has meant that more cases progress to life-threatening co-morbidities and surgical options. Pharmacological treatment of obesity has been limited. Self medication with drugs of abuse and tobacco has been successful for some patients, but abuse and addiction make this approach quite dangerous. The advent of trendy 'diets du jour' has apparently made obesity and eating disorders more likely rather than less likely. Trials of novel anti-obesity compounds have generally compared the new medication and placebo to a dietary counseling intervention. Interventions for patients who are not obese enough for gastric banding or bariatric surgery are quite similar to those given to alcoholics in the 1970s, "drink less or stop drinking". We need to consume less in a modern life of desk and computer work, driving, and even internet shopping. However, we are driven and reinforced to consume and easily fall prey to television and other cues and messages driving this relationship to eating. This paper, after briefly reviewing the consensus on consumption and exercising suggests that new treatments may be developed by increasing exercise adherence and even increasing the reinforcing value or power of exercise itself. Food, sex, and drugs of abuse are highly valued and reinforced in our brains, so why not exercise?