The goal of obesity treatment is to achieve and maintain a healthier weight to reduce your risk of serious health problems and enhance your quality of life. You may need to work with a team of health professionals, including a nutritionist, dietitian, therapist or an obesity specialist, to help you understand and make changes in your eating and activity habits. Together, you can determine a healthy goal weight and how to achieve it. Your initial goal may be to lose 5 to 10 percent of your body weight within six months.
You can start feeling better and seeing improvements in your health with just minor weight loss, though — 5 to 15 percent of your total weight. That means that if you weigh 200 pounds (91 kilograms) and are obese by BMI standards, you would need to lose only about 10 to 30 pounds (4.5 to 13.6 kilograms) to start seeing benefits.
Specific treatment methods
There are many ways to treat obesity and reach a healthier weight. The treatment methods that are right for you depend on your level of obesity, your overall health, and your willingness to participate in your weight-loss plan. Think of your treatment plan as a way to make changes that you can stick with for a lifetime, so that you keep the weight off.
Treatment methods include:
• Dietary changes
• Exercise and activity
• Behavior change
• Prescription weight-loss medications
• Weight-loss surgery
Achieving a healthy weight is usually done by making changes in your lifestyle — dietary changes, increased activity and behavior change. Prescription medication or weight-loss surgery is typically used in addition to lifestyle changes in more serious cases.
Reducing your daily calorie intake and eating healthier are vital to overcoming obesity. Slow and steady weight loss of 1 or 2 pounds (1/2 to 1 kilogram) a week is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term. There are a number of different dietary strategies to choose from, all of which can lower your calorie intake.
Dietary ways to overcome obesity include:
• Reducing your calorie intake. The key to weight loss is reducing how many calories you consume. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You may be eating larger portions than you thought, or realize that your diet includes lots of fast food, sweets or sugary drinks. You and your doctor can decide how many calories you need to take in each day to achieve weight loss, but a typical amount is 1,000 to 1,600 calories.
• Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods, such as desserts, candies and processed foods, are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have low energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods less packed with calories, you squelch hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
• Adopting a healthy eating plan, such as the Mayo Clinic Healthy Weight Pyramid. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole grains. Also emphasize plant sources of protein, such as beans, lentils and soy, choose lean meats, and try to include seafood twice a week. Limit salt and added sugar. Stick with low-fat dairy products. And make sure fats come from healthier sources, such as nuts and olive, canola and nut oils. When you adopt an overall healthier diet, rather than trying a crash diet, you're more likely to follow it for the long term. The Mayo Clinic Healthy Weight Pyramid is one way to adopt a healthy, lifelong eating plan. This means no severe restrictions on the foods you eat and no extreme hunger. The base of the pyramid focuses on generous amounts of healthy foods that contain a small number of calories in a large volume of food, particularly fruits and vegetables. Healthy choices in moderate amounts make up the rest of the pyramid, which focuses on whole-grain carbohydrates, lean sources of protein such as legumes, fish and low-fat dairy, and heart-healthy unsaturated fats.
• Following a very low calorie liquid diet if medically recommended. These mainly liquid diets are meant to provide rapid weight loss over the short term. They provide only about 600 to 800 calories a day. Your doctor may recommend a very low calorie diet if you need to lose weight quickly before a medical procedure or if you have serious health problems. Don't try it on your own. You need close monitoring by your health care providers to avoid complications. You also may need to take vitamin or nutritional supplements. While you may be able to lose weight quickly on a very low calorie diet, you're also likely to regain it quickly once you stop the diet. To prevent weight regain after a very low calorie diet, you must make changes in your overall diet, activity level and behavior.
• Meal replacements. These plans suggest that you replace one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight, and they may be a good option if they help you control portion size, limit calories and encourage healthy eating. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though. So while they may work for some, you might find it hard to maintain your weight loss over the long term.
Be wary of quick fixes
You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Special diets such as low-carbohydrate diets may produce weight loss in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight — and keep it off — you have to adopt healthy eating habits that you can maintain over time.
Increased physical activity or exercise is also an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking. The goal of activity and exercise for weight loss is to burn more calories, although exercise offers many other health benefits as well. How many calories you burn depends on the frequency, duration and intensity of your activity.
To boost your activity level:
• Exercise. One of the best ways to lose body fat is through regular aerobic exercise, such as walking, cycling, stair climbing or swimming. The American College of Sports Medicine recommends that people who are overweight or obese get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to lose a modest amount of weight. But to achieve significant weight loss, you may need to get as much as 250 to 300 minutes of exercise a week, it says. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. To make your own exercise goal more doable, break it up into several sessions throughout the day, doing just five or six minutes at a time. Don't set your goals unrealistically high, or you may give up. Your doctor can help you create an exercise plan that's appropriate for your specific situation and abilities.
• Increase your daily activity. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day.
To lose weight and keep it off, you need to make changes in your behavior and attitudes toward food and exercise.
A behavior modification program 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 obesity. 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.
There are a number of ways to help you change unhealthy behavior and thoughts. Behavior modification, sometimes called behavior therapy, can include:
• Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers and cope with food cravings. Counseling may be available by telephone, e-mail or Internet-based programs if travel is difficult. Cognitive behavioral therapy is a type of therapy frequently used for weight loss. Therapy can take place on both an individual and group basis.
• Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers.
Prescription weight-loss medication
It's best to lose weight through a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may be an option. Keep in mind, though, that these medications are meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work.
Your doctor may recommend a weight-loss medication if:
• Other methods of weight loss haven't worked for you.
• Your body mass index (BMI) is greater than 27 and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea.
Two prescription medications have been approved by the Food and Drug Administration (FDA) for long-term weight loss. These medications work in different ways and have different side effects.
• Sibutramine (Meridia). This medication changes your brain chemistry, making you feel full more quickly and reducing your hunger. Average weight loss is about 5 to 10 percent of your starting body weight after taking the medication for one year. Side effects can include increased blood pressure, rapid heartbeat, headache, dry mouth, constipation and insomnia.
• Orlistat (Xenical). This medication blocks the digestion and absorption of fat in your stomach and intestines. Unabsorbed fat is eliminated in the stool. Average weight loss with orlistat is also about 5 to 10 percent of your initial body weight after one year of taking the medication. Side effects associated with orlistat include oily and frequent bowel movements, bowel urgency and flatulence with discharge. These side effects can be minimized as you reduce fat in your diet. Because orlistat blocks absorption of some nutrients, take a multivitamin while taking orlistat to prevent nutritional deficiencies. The FDA has approved orlistat for use in adults, children and adolescents. The FDA also has approved a reduced-strength version of orlistat (Alli) to be sold over the counter, 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.
You need close medical monitoring while taking these medications. Also, keep in mind that these medications don't work for everyone. And if they do work, their effects tend to level off after six months of use. You may need to take weight-loss medication for the rest of your life. When you stop taking these medications, you're likely to regain much or all of the weight you lost.
In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery offers the best chance of losing the most weight, but it can pose serious risks. Weight-loss surgery limits the amount of food you're able to comfortably eat or inhibits the absorption of food and calories, or both.
Weight-loss surgery for obesity may be considered if:
• You have extreme obesity, with a body mass index (BMI) of 40 or higher
• Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure
• You're committed to making the lifestyle changes that are necessary for surgery to work
Weight-loss surgery can often help you lose as much as 50 percent of your excess body weight. Just over half of those who undergo weight-loss surgery keep the weight off at the 5-year mark. But weight-loss surgery isn't a miracle obesity cure. 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.
There are numerous types of weight-loss surgery. Some types are restrictive, causing weight loss by restricting how much your stomach can hold. Others are malabsorptive, because they prevent your body from absorbing calories and nutrients. Others are a combination of these two types. More common weight-loss surgeries include:
• Gastric bypass surgery. This is the favored weight-loss surgery in the United States because it has shown relatively good long-term results. It combines both restriction and malabsorption to produce weight loss. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your 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 your stomach.
• Laparoscopic adjustable gastric banding (LAGB). In this restrictive-type procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. LAGB is gaining popularity because it generally causes slow, steady weight loss and the band can be adjusted if needed. However, as with other procedures, this won't work without changes in your behavior.
• Biliopancreatic diversion with duodenal switch. In this malabsorption-type procedure, most of your stomach is surgically removed. This weight-loss surgery offers sustained weight loss, but it poses a greater risk of malnutrition and vitamin deficiencies, and you require close monitoring for health problems. It's generally used for people who have a body mass index of 50 or more.
Complications of weight-loss surgery
Weight-loss surgery poses a threat of numerous serious health problems related to the surgery and your reduced food intake, including:
• Blood clots
• Nutritional deficiencies
Preventing weight regain after obesity treatment
Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. But that doesn't mean your weight loss efforts are futile.
One of the best ways to prevent regaining the weight you've lost is getting regular physical activity. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost.
You may always have to remain vigilant about your weight. Combining a healthier diet and more activity is the best way to lose weight and keep it off for the long term. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or eat foods laden with fat and calories.
Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term.