Weight and Obesity

Weight loss

Treatment of obesity

People who are obese usually can gain significant health benefits by losing weight. The key is to change the person’s energy balance so that energy output exceeds the energy intake. When this occurs the size of the person’s fat cells shrinks, leading to modest but significant weight loss.

Even losing as little as 5 percent to 7 percent of total body weight can result in a dramatic decrease in risk for health conditions such as diabetes, cardiovascular disease and stroke. A relatively small weight loss can also lower blood pressure, total and low-density lipoprotein (LDL, so-called “bad”) cholesterol levels, triglyceride levels and blood sugar. In addition, modest weight loss may cause high-density lipoprotein (HDLs, so-called “good”) cholesterol to increase.

It is important to note that people who are obese often have trouble losing significant amounts of weight and keeping the weight off. When an obese person loses weight, the size of fat cells shrinks, but the number of fat cells does not diminish. Over time, many of the shrunken fat cells may fill again, leading to weight gain. It is for this reason that people with an average number of fat cells tend to have a better chance of maintaining weight loss than those who have higher numbers of fat cells.

In addition, research indicates that each person has an inner mechanism that establishes an individual’s weight or body composition at a “set point.” When a person gains or loses weight, the body’s metabolism adjusts to restore the person’s weight to its original level.

Still, people who are obese can often maintain modest weight loss by adhering to a healthier diet and engaging in regular physical activity. Modest weight loss of one-half to 2 pounds a week (0.23 to 0.91 kilograms) is often easier to maintain over time than sudden and massive weight loss. And even people who have trouble losing weight can often prevent further weight gain by adopting healthier lifestyle habits. These habits can reduce the disease risks associated with obesity.

Most physicians agree that management and treatment of obesity requires permanent changes to the diet. In order to lose weight, numerous options are available, including:A well-balanced diet For weight loss to occur, people must take in less energy (the calories taken in from the diet) than they use or burn (the calories used in daily activities and exercise). To get rid of one pound of body fat requires using or burning an additional 3,500 calories.

For example, a deficit of 500 calories a day can result in losing a pound a week. For most people, a balanced diet containing no more than 2,000 calories a day for women and 2,500 for men is recommended. Crash diets are not recommended as they can end up leading to additional health problems including nutrition deficiencies.Regular exercise Exercise without an associated change in diet will likely reduce weight by only a few pounds. However, people who exercise regularly are more likely to adhere to a change in diet, both of which help to prevent further weight gain.

Physical exercise of at least 150 minutes a week along with a balanced diet is crucial for long-term weight loss. Aerobic exercise, such as walking, swimming or stair climbing, can help to keep weight off while at the same time providing many other benefits to an individual’s overall health and well-being. Even if people exercise regularly and do not lose weight, they can reduce abdominal obesity and the chances of developing cardiovascular disease, insulin resistance and high blood pressure.Counseling Several studies have confirmed that obese patients who receive nutritional counseling from a dietitian achieve better weight-loss outcomes, including better metabolic control and reduced waist circumferences. In addition, some people have trouble controlling food intake not because of hunger, but because of emotional needs.

People who use food to fill a feeling of emptiness, to comfort themselves or to gain a sense of control may benefit from speaking to a qualified counselor about the situation. Inpatient programs are available, in which people stay overnight as they relearn to eat only when hungry and to satisfy emotional needs through other means.Diet pills Some diet pills are available over the counter, and others require a physician’s prescription. Over-the-counter medications may contain ingredients that increase the heart rate and/or blood pressure or cause other side effects. In addition, their ability to help reduce body weight has not been proven. Anyone considering use of these drugs should discuss the potential risks with a physician.

To date, benzocaine is the only over-the-counter diet pill approved by the U.S. Food and Drug Administration (FDA) for weight loss. It anesthetizes the tongue, reducing taste sensations. Herbal supplements that claim to promote weight loss also appear to be largely ineffective. Prescription diet pills may be recommended for some patients. However, most people who use them regain the weight when they stop taking the medication. Also, the long-term effects of taking these drugs are not known.Other medications If a healthy diet, exercise, stress management and counseling are ineffective in managing weight, medications may be prescribed.

One drug (sibutramine) used to treat obesity affects levels of certain hormones (e.g., serotonin and noradrenaline) in areas of the brain associated with food intake and satisfaction. This temporarily decreases the urge to eat and, with appropriate diet and exercise, supports weight loss efforts. The prescription medication orlistat is used in combination with a low-fat diet to help lose weight and maintain the loss by blocking the absorption of dietary fat.

There are some drawbacks to obesity medications. These drugs can produce serious side effects, such as high blood pressure in the blood vessels of the lungs and valvular heart disease. The medications should be used by patients whose treatments are closely monitored by a qualified physician.Surgical intervention In certain cases, surgery may be used to treat people with clinically severe obesity who have not lost weight by other medical therapies. One surgical technique is gastric bypass surgery, in which part of the small intestine is bypassed as food passes out of the stomach.

The gastric bypass involves significant changes in how much food and drink can be consumed, and people are encouraged to learn all about the surgery before having it done. For all surgical candidates, an integrated medical program must be in place to provide guidance on diet, physical activity and support before and after the surgery. Not all people are good candidates for surgery.Avoiding smoking and alcohol use These unhealthy strategies are often used to relieve stress. They do not solve whatever problem is at hand, and often make situations worse (e.g., by causing new health problems). By using healthy stress management techniques instead of using alcohol excessively or smoking, individuals can reach weight loss goals more quickly.

People who are trying to shed the excess weight associated with obesity are encouraged to avoid crash diets and fasting. Crash diets that suddenly and dramatically reduce calorie intake deprive the body of important nutrients that can cause health problems. Meanwhile, fasting tends to cause weight loss that is mostly water-based and also deprives the body of important nutrients.

Treatments & Supplements

We all need a little help sometimes.If you or someone you love is seriously obese, medical treatment may help. Prescription drugs and surgical procedures are available, and can even be lifesaving in some cases. But these approaches come with risks, too. The articles here give you the facts you need to make an informed decision about medical weight-loss treatment.

If medical treatment isn't appropriate, over-the-counter weight-loss aids are available. But nonprescription drugs and herbal supplements carry some health cautions and need to be taken seriously and with care. Even meal replacements — convenient and readily available as they are — work best when used wisely. Get the information you need here.

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