Obesity : Treatments and drugs

The goal of obesity treatment is to achieve and maintain a healthier weight. The amount of weight you need to lose to improve your health may be much less than what you feel you need to lose.

Just a 5 percent to 10 percent weight loss can bring health improvements. That means that if you weigh 200 pounds and are obese by BMI standards, you would need to lose about 10 to 20 pounds. You don't have to stop there, but it's a place to start. Slow and steady weight loss of 1 or 2 pounds a week is considered the safest way to lose weight and the best way to keep it off.

Achieving a healthy weight is usually done through dietary changes, increased activity and behavior modification. Depending on your situation, your doctor may suggest prescription medication or weight-loss surgery to supplement these efforts.

Dietary changes
Adopting a new eating style that promotes weight loss must include lowering your total calorie intake. One way you can lower your calorie intake is by eating more plant-based foods — fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without giving up taste or nutrition. Cutting back on calories is easier if you focus on limiting sugar and other refined carbohydrates and some types of fat.

Ask your doctor to help you determine your calorie goals to lose weight. He or she may recommend that you also work with a dietitian or a reputable weight-loss program.

Crash diets to reduce calories aren't recommended because they can cut so many calories and nutrients that they lead to other health problems, such as vitamin deficiencies. Fasting isn't the answer, either. Most of the weight you initially lose is from water, and it's not good for your body to go without food for extended periods.

Very low calorie liquid diets are sometimes prescribed as an intervention for seriously obese people. These mainly liquid diets, such as Medifast or Optifast, provide about 800 calories a day — most adults consume roughly 2,000 to 2,500 calories a day. While people are usually able to lose weight on these very low calorie diets, most people regain the weight just as quickly when they stop following these diets.

Over-the-counter liquid meal replacements, such as Slim-Fast, also cut calories. These plans suggest that you replace one or two meals with their products — low-calorie shakes — then eat snacks of vegetables and fruits and a healthy, balanced third meal that is low in fat and calories. This can be as effective as a traditional calorie-controlled diet.

Increased physical activity
Cutting 250 calories from your daily diet can help you lose about half a pound a week: 3,500 calories equals 1 pound of fat. But add a 30-minute brisk walk four days a week, and you can double your rate of weight loss.

The goal of exercise for weight loss is to burn more calories, although exercise offers many other benefits as well. How many calories you burn depends on the frequency, duration and intensity of your activities. One of the best ways to lose body fat is through steady aerobic exercise — such as walking — for more than 30 minutes most days of the week.

Even though regularly scheduled aerobic exercise is most efficient for losing fat, any extra movement helps burn calories. Lifestyle activities may be easier to fit into your day. Think about ways you can increase your physical activity throughout the day. For example, make several trips up and down stairs instead of using the elevator, or park at the far end of the lot.

If you're obese, particularly if you're unfit and have health problems, check with your doctor before starting an exercise program.

Behavior modification
To lose weight and keep it off, you need to make changes in your lifestyle. But there's more to changing your lifestyle than choosing different foods and putting more activity into your day. It also involves changing your approach to eating and activity, which means changing how you think, feel and act.

A behavior modification program — led by a psychologist, therapist or other trained professional — can help you make these lifestyle changes. Behavior modification programs may include examining your current habits to find out what factors or situations may have contributed to your excess weight. Exploring your current eating and exercise habits gives you a place to start when changing your behaviors.

Once you understand which habits are undermining your weight-loss efforts, you can take steps to create a new, healthier lifestyle. These tips can help:

* Have a plan. Work out a strategy that will gradually change your habits and attitudes. Consider how often and how long you will exercise. Determine a realistic eating plan that includes plenty of water, fruits and vegetables. Write it down and choose a start date.
* Set realistic goals. Weight-loss goals can be process goals, such as exercising regularly, or outcome goals, such as losing 20 pounds. Make sure process goals are realistic, specific and measurable. For example, you'll walk for 30 minutes a day, five days a week. For outcome goals, aim to lose weight at a safe pace of 1 or 2 pounds a week. Losing weight more rapidly means losing water weight or muscle tissue, rather than fat.
* Avoid food triggers. Distract yourself from your desire to eat with something positive, such as calling a friend. Practice saying no to unhealthy foods and big portions. Eat when you're actually hungry — not when the clock says it's time to eat.
* Keep a record. Keep a food and activity diary, so you can reinforce good habits and discover any behaviors that you may need to improve. Be sure to track other important health parameters such as blood pressure, cholesterol levels and overall fitness.

Prescription weight-loss medication
It's best to lose weight through a healthy diet and regular exercise. But if you're among those who struggle to lose weight and the excess weight has produced medical problems, prescription weight-loss drugs may be able to help you.

Your doctor may consider you a candidate for medication treatment if these criteria apply:

* Other methods of weight loss haven't worked for you.
* Your body mass index (BMI) is greater than 27 and you have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea.
* Your BMI is greater than 30.

Two prescription drugs have been approved by the Food and Drug Administration (FDA) for long-term weight loss. These drugs work in different ways and cause different side effects.

* Sibutramine (Meridia). This drug changes your brain chemistry, making you feel full more quickly. Though sibutramine generally helps you lose more weight than you could through diet and exercise alone, it's no magic bullet. Studies have shown that after a year, sibutramine users lost an average of about 10 pounds more than did people simply following a low-calorie diet and taking a placebo. Side effects can include increased blood pressure, headache, dry mouth, constipation and insomnia.
* Orlistat (Xenical). This drug prevents the absorption of fat in your intestines. Unabsorbed fat is eliminated in the stool. Average weight loss with orlistat is modest — about 6 pounds after one year. Side effects associated with the drug include oily and frequent bowel movements. Because orlistat blocks absorption of some nutrients, your doctor will recommend that you also take a multivitamin. The FDA has approved a reduced-strength version of orlistat (Alli) to be sold without a prescription. This medication works the same as prescription-strength orlistat and is meant only to supplement — not replace — a healthy diet and regular exercise.

If you're among those who can benefit from weight-loss medication, you'll likely need to take it indefinitely. When drug treatment is stopped, much or all of the excess weight generally returns.

Even if you qualify for weight-loss drug therapy, the drugs might not work for you. And, if they do work, their effects tend to level off after six months of use.

Weight-loss surgery
If you're among those who have tried and can't lose the excess weight that's causing your health problems, weight-loss (bariatric) surgery may be an option. Weight-loss surgery may be considered if:

* Your body mass index (BMI) is 40 or higher
* Your BMI is 35 to 39.9, and you have a serious weight-related health problem such as diabetes or high blood pressure

Gastric bypass surgery, which changes the anatomy of your digestive system to limit the amount of food you can eat and digest, is the favored weight-loss surgery in the United States.

In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of the stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of the stomach. The stomach continues to make digestive juices to help break down food. So the portion of the intestines still attached to the stomach is reattached farther down. This allows the digestive juices to flow to the small intestine. Weight loss is achieved by restricting the amount of food that the stomach can hold and to a lesser extent by reducing the amount of calories that are absorbed.

When appropriate, weight-loss surgery can result in dramatic improvements in weight and health. Within the first two years, you can expect to lose 50 percent to 60 percent of your excess weight. Those people who follow dietary and exercise recommendations tend to keep most of that weight off long term.

Weight-loss surgery does have side effects, however. Complications such as pneumonia, blood clots and infection can occur with any type of surgery. Rapid weight loss can result in gallstones; a hernia or weakness, which may require surgery to correct, may develop at the site of your incision. Gastric bypass can also cause dumping syndrome, a condition in which stomach contents move too quickly through the small intestine, causing nausea, vomiting, diarrhea, dizziness and sweating.

Surgery for weight reduction isn't a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after gastric bypass surgery depends on your commitment to making lifelong changes in your eating and exercise habits.
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