Weight Loss Options

Treatment for Morbid Obesity

A statistic frequently used about obesity treatment is that 95 percent of people who lose weight gain it all back. That statistic, based on a small study from 1959, is no longer valid. Much has changed in the way of obesity treatment since then. Thousands of people have succeeded in losing weight and keeping it off -- an encouraging fact for many that are discouraged by outdated information. There are several different types of effective treatment options to manage weight including: dietary therapy, physical activity, behavior therapy, drug therapy, combined therapy and surgery.

Weight loss of about 10 percent of excess body weight is proven to benefit health by reducing many obesity-related risk factors. Recommendations for treatment are now focusing on 10 percent weight loss to help patients with long-term maintenance of weight loss. Health professionals including physicians, nutritionists, exercise physiologists, psychologists and bariatric surgeons help persons with overweight and obesity to determine the most appropriate treatment.

Dietary Therapy

• Dietary therapy involves instruction on how to adjust a diet to reduce the number of calories eaten.

• Reducing calories moderately is essential to achieve a slow but steady weight loss, which is also important for maintenance of weight loss.

• Strategies of dietary therapy include teaching about calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods.

• Some diets for weight loss include low-calorie, very-low calorie, and low-fat.

Physical Activity

• A decrease in the amount of daily activity related to work, transportation and personal chores is believed to contribute to the high percentage of overweight and obesity today.

• Moderate physical activity, progressing to 30 minutes or more on most or preferably all days of the week is recommended for weight loss.

• Physical activity is reported to be a key part of maintaining weight loss.

• Abdominal fat, and in some cases waist circumference can be modestly reduced through physical activity.

• Strategies of physical activity include: the use of aerobic exercise (such as aerobic dancing, brisk walking, jogging, cycling, and swimming), beginning slowly and gradually increasing intensity, and selecting enjoyable activities that can be scheduled into a regular routine.

Behavior Therapy

• Behavior therapy involves changing diet and physical activity patterns and habits to new behaviors that promote weight loss.

• Behavioral therapy strategies for weight loss and maintenance include:

  • Recording diet and exercise patterns in a diary.

  • Identifying high-risk situations (such as having high-calorie foods in the house), and consciously avoiding them.

  • Rewarding specific actions, such as exercising for a longer time or eating less of a certain type of food.

  • Changing unrealistic goals and false beliefs about weight loss and body image to realistic and positive ones.

  • Developing a social support network (family, friends or colleagues) or joining a support group that can encourage weight loss in a positive and motivating manner.

Drug Therapy

• Drug therapy is recommended as a treatment option for persons with: 1) a Body Mass Index (BMI) > 30 with no obesity-related conditions or 2) a BMI of > 27 with two or more obesity-related conditions.

• Drug treatment should be used with appropriate lifestyle modifications.

• Drug therapy may be used for weight loss and weight maintenance.

• Patients should be regularly assessed to determine the effect and continuing safety of a drug.

• Three weight loss drugs, approved by the US Food and Drug Administration (FDA) for treating obesity, are Orlistat (Xenical), Phentermine, and Sibutramine (Meridia).

1. Orlistat works by blocking about 30 percent of dietary fat from being absorbed, and is the most recently approved weight loss drug.

2. Phentermine, an appetite suppressant, has been available for many years. It is half of the “fen-phen” combination that remains available for use. The use of phentermine alone has not been associated with the adverse health effects of the fenfluramine-phentermine combination.

3. Sibutramine is an appetite suppressant approved for long-term use.

Combined Therapy

• A combination of a diet (with lower calories) and increased physical activity is reported to produce more weight loss than diet alone or physical activity alone.

• A combination of behavior therapy and drug therapy could prove to be an effective treatment for obesity.

• Drug therapy appears to assist in the adherence to dietary therapy (low-fat, low-calorie diet), and may improve maintenance of weight loss.

Bariatric Surgery

• Obesity surgery is recommended as a treatment option for persons with obesity that have: 1) a BMI > 40 or 2) a BMI of 35 to 39.9 with serious medical conditions.

• Obesity surgery is used to modify the stomach and or intestines to reduce the amount of food that can be eaten.

• Surgery is a well-established method for long-term weight control for persons with severe obesity.

• Much progress has been made to develop safer and more effective procedures used in obesity surgery today.

• Before surgery, patients should be informed about the risks and benefits.

• Patients should be motivated and committed to making a lifestyle change after surgery.

• A medical team, including behavioral and nutritional professionals, should be part of a life-long follow-up plan.

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