Obesity/Overweight

Treatment

Generally, the first goal in treating obesity and overweight is to achieve a healthier weight. Losing 5–10% of the excess weight is often enough for the patient to start experiencing health benefits. On average, the safest pace for weight loss is 1 or 2 pounds a week.

A healthier diet, increased exercise, and lifestyle changes are often the first steps. Patients can work with doctors, nutritionists, and fitness experts to work out a program that best suits their needs and always consult with a doctor before beginning any weight loss program.

In some cases, medication (prescription or over-the-counter) and surgery are recommended.

Diet

Doctors and dieticians can recommend a daily calorie intake and make suggestions for healthy meals that include fruits and vegetables, protein-rich foods, and complex high-fiber carbohydrates found in whole grains and brown rice (as opposed to complex carbohydrates found in table sugar and fruit juices).

Patients are also advised to reduce fat intake, control portion sizes, examine food labels for calorie counts, and cut back on junk food.

Over-the-counter meal replacements are another way to reduce calorie intake. While most adults consume 2,000 to 2,500 calories each day, seriously obese patients are sometimes given very low-calorie liquid diets of 800 calories a day.

Specialized diets, often called "fad" diets, vary considerably and range from high-protein, low-carbohydrate diets, to the grapefruit diet, and the cabbage soup diet. Fad diets can help patients lose weight quickly, but most doctors do not endorse them, noting that the results usually are not permanent, and the methods are not healthy.

Fad diets often eliminate important nutrients or cause patients to lose too much weight too quickly. Diets that allow only a very low calorie intake are especially dangerous, as they increase the risk for developing heart murmurs.

Exercise

Increasing physical activity and exercise is a highly recommended weight loss strategy. Exercise can take many forms—a structured program at a local gym, an informal program at home (e.g., working with an exercise video), or just adding activity throughout the day.

Some patients choose to park far from a store entrance to take advantage of the extra walk, some ride a stationary bike while watching television, and others choose stairs instead of elevators.

Doctors recommend exercise programs that combine aerobic exercise (e.g., walking, participating in an aerobics class) and strength training (e.g., lifting weights). The key is for patients to burn more calories than they consume.

Weight Loss Programs

Many patients find group weight loss programs helpful for the extra support and camaraderie they can provide. For a membership fee, participants can get advice from weight-loss practitioners, learn more about healthy diets and exercise programs, and share their challenges and successes with other members who have the same goals.

Other patients prefer individual weight loss programs; particularly busy patients who do not have time to prepare healthy meals and track progress. Some of these programs prepare and deliver meals for patients. However, these programs usually are more expensive than the group programs.

Life Style Changes

Losing weight often requires lifestyle changes, as well as changes in diet and exercise habits. Ways that patients can lose weight more effectively include the following:

• Avoiding situations that promote overeating
• Finding support when needed
• Goal-setting
• Planning
• Staying positive and motivated

Medication

Doctors sometimes prescribe medications that must be taken indefinitely. These prescription medications include sibutramine (Meridia®) and orlistat (Xenical®). In February 2007, the Food and Drug Administration (FDA) approved a reduced-strength version of orlistat (alli™) for over-the-counter use in people over the age of 18.

Sibutramine (Meridia®) alters brain chemistry so that the patient does not feel the urge to overeat. However, this medication has not been proven to be more effective than changes in diet and exercise. Side effects include insomnia, headache, constipation, dry mouth, and increased blood pressure.

Orlistat (Xenical®) causes the intestines to absorb less fat. This medication can affect the way the body absorbs nutrients, so doctors often recommend that patients take a multivitamin as well. The main side effect, an increased number of bowel movements (which can be oily), can be managed by decreasing fat intake.

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The safety and effectiveness of many over-the-counter remedies are often disputed. These products include St. John's Wort, herbal laxatives, chitosan, and garcinia. Patients are advised to research these remedies carefully and consult with a physician before taking them.

In many cases, the products are labeled "natural" or "herbal," but they often are not scientifically tested for safety or effectiveness and they can interfere with other medications or conditions.

Follow-up

It is important for any patient who is trying to lose weight to see a doctor regularly to monitor progress, make suggestions, interpret changes, and provide extra support.

Prognosis

With support from physicians and medical staff, family, and friends, patients who maintain healthy habits often can keep their weight under control. Doing so improves their prognoses for health conditions complicated by obesity and overweight.

Diabetes, heart disease, cancer, and many other illnesses can be easier to treat when obesity and overweight are no longer issues.

Prevention

In some cases (e.g., genetic causes, thyroid conditions, medications), obesity and overweight are not preventable, but may be controlled and managed. For patients who do not have a medical cause, the best way to prevent obesity and overweight is to burn more calories than are consumed. Patients should eat responsibly, control portion sizes, exercise regularly, and prioritize weight control.

Obesity/Overweight, Weight Loss reprinted with permission from healthinfo.healthcommunities.com
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