Obesity Treatment Overview

Treatment goals

Regardless of the type or combination of obesity treatment, goal setting is an important part of any obesity treatment plan. While a person may want to lose a large amount of weight because of societal or fashion reasons, it is important to realize that setting and achieving a goal of reducing weight by as little as 5 to 10 percent of body weight will yield important, positive gains in health.

Treatment goals work best if they are individualized. For example, it is safe to lose one to two pounds per week, but a person may be more comfortable losing at the rate of one-half pound per week. Over one year, that is a 24-pound loss and, if that rate is maintained over three years, will lead to a significant 78-pound loss. Whatever treatment plan a person follows, losing weight slowly will be more effective and healthy over the long term because quick weight loss often spurs weight regain.

Treatment for obesity

Specific treatment for obesity will be determined by your health care provider based on:

• Your age, overall health, and medical history

• Extent of overweight or obesity

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

In addition, treatment for obesity may include a combination of treatment types. Always consult your health care provider for a diagnosis and treatment recommendations.

There are a variety of methods used to treat obesity. Incorporating multiple methods, such as making diet changes as well as adding exercise, may be beneficial. These methods include, but are not limited to, the following:

• Diet. Although diet plans high in protein and fat and low in carbohydrates are popular, some of them may pose serious health risks in the long run because of the emphasis on saturated fat. Successful weight loss that is maintained over a long period of time depends more on limiting energy consumed (calories) and increasing energy expenditure (exercise and daily activity) than the composition of the diet. Fasting may result in rapid weight loss, but lean muscle mass is lost as well as fat. All-liquid diets must be medically supervised and may be used for a short period of time in people who are obese, but these diets are not the long-term answer to weight loss. Fads, fasting, and popular diets in which health effects have not been determined by rigorous clinical trials may not be healthy options for weight loss. However, there are dietary recommendations that, if followed, will lead to weight loss:

  • To lose weight and keep it off for a lifetime, begin thinking about an individualized eating plan instead of a "diet." A plan tailored to personal likes and dislikes will have a better chance of producing sustainable weight loss. A balanced diet that is restricted in calories--1,200 to 1,400 calories a day for women and 1,500 to 1,800 calories a day for men--may work well. A registered dietitian can help to make an individualized diet plan based on a person's particular situation.

  • Include a variety of foods in the diet.

  • All fats are not bad. It is now known that polyunsaturated and monosaturated fats provide health benefits, such as helping to keep the heart healthy. This means that nuts, seeds, and some types of oils, such as olive, safflower, and canola, have a place in a healthy eating plan.

  • Choose whole grains such as brown rice and whole wheat bread rather than white rice and white bread. Whole grain foods are rich in nutrients compared to more processed products. They are higher in fiber and therefore absorbed by the body more slowly and do not cause a rapid spike in insulin, which can trigger hunger and cravings.

  • Choose at least five servings daily of fruits and vegetables. Be sure to choose a variety of fruits and vegetables, as different fruits and vegetables contain varying amounts and types of nutrients.

  • When dining out or ordering take-out food, ask for a take-home box or avoid super-size selections when you order. Many restaurant portions are too large for one person, so consider sharing an entree or ordering an appetizer instead of a main dish from the entree menu.

  • Read food labels carefully, paying particular attention to the number of servings contained in the product and the serving size. If the label says a serving is 150 calories but the number of servings per container is three and the contents of the entire container are consumed, the calories consumed is triple, or 450 calories.

• Exercise. Exercise benefits people who are obese by helping to keep and add lean body mass, or muscle tissue, while losing fat. It also helps to increase the rate at which weight is lost if a person is eating healthy food according to a meal plan, because muscle tissue has a higher rate of metabolism, thus burning calories faster. Walking is an excellent choice of exercise for people who are obese. A walking program should start slowly by walking 30 minutes a day a few days a week and increase gradually to the goal of walking for longer periods most days of the week. Exercise lowers blood pressure and can help prevent type 2 diabetes. Exercise also helps to improve emotional well-being, reduce appetite, improve sleeping ability, improve flexibility, and lower LDL cholesterol. Consult your health care provider before starting any exercise program.

• Environmental factors. A typical day for most U.S. adults encourages a sedentary lifestyle, and becoming active takes some effort. Use of the automobile and working at a desk restrict activity. Watching television is a sedentary activity that can contribute to an inactive lifestyle. There are simple steps that can be taken to increase daily activity:

  • Take the stairs instead of the elevator or escalator

  • Park the car at the far end of the parking lot and walk to the store or the office

  • Get off the bus one stop early if you are in an area safe for walking

  • Turn off the television or video game and head for the garden, rake the leaves, wash the car, or take a walk

  • Find activities that the whole family will enjoy, such as tennis, in-line skating, or hiking

  By looking at a person's daily routine, it may be easier than first imagined to find ways to pack more activity into the day in addition to exercising.

  The workplace may be part of a person's environment that is not helpful to a weight loss plan. However, there are strategies that may help to keep a weight loss plan on track at work. Bring healthy snacks, such as cut-up fruits and vegetables, to keep on hand when the pastry cart rolls by. Avoid going to office social gatherings hungry--plan ahead to avoid the temptation of treats that are high in sugar and fat.

• Support groups. Join a support group of people for encouragement and reinforcement of efforts to help with success in changing lifestyle behaviors. Some groups meet weekly and are run by volunteers. There are also online communities that can help provide support and information to strengthen efforts to lose weight and make lifestyle changes. Friends and family can also provide important support when making lifestyle changes. Although commercial weight loss programs can be expensive, many of them offer the convenience of preprepared food. Some of these programs also provide consultation to help a person to individualize his or her weight loss efforts.

• Medical treatment. Treatment by a doctor may be necessary when an individual's own efforts to lose weight have failed and/or when coexisting medical conditions make it crucial for a person to lose weight. Medication may be necessary for those having obesity-related health problems, while behavioral measures can play an important part in any weight loss regimen. Behavioral strategies can be used to help change dietary habits and increase activity levels. Eating disorders require treatment by a therapist, and may also require medication.

• Surgical treatment. Weight-loss surgery (bariatric surgery) is the only option today that effectively treats morbid obesity in people for whom more conservative measures, such as diet, exercise, and medication have failed. Potential candidates include:

  • Persons with a Body Mass Index (BMI) greater than 40

  • Men who are 100 pounds over their ideal body weight or women who are 80 pounds over their ideal body weight

  • Persons with a BMI between 35 and 40 who have another condition, such as obesity-related type 2 diabetes, sleep apnea, or heart disease

  There are several approaches to bariatric surgery, but all procedures are either malabsorptive, restrictive, or a combination of the two. Malabsorptive procedures change the way the digestive system works. Food is rerouted past a large portion of the stomach and part of the small intestine that absorbs some calories and nutrients. With some procedures, a portion of the stomach is removed. These procedures are commonly referred to as "gastric bypass" procedures.

  Restrictive procedures severely reduce the size of the stomach to hold less food, but the digestive functions remain intact. This type of procedure may be referred to as a "gastric stapling" or a "gastric banding" procedure.

  Typically, malabsorptive procedures result in more weight loss than restrictive procedures, but lead to more nutritional deficiencies.

  Always consult your doctor for more information.