How Obesity Is Treated

Weight Loss, Exercise, and Other Obesity Treatment Modalities

In This Article

The overall goal of successful obesity treatment is for a person to get to a healthy weight and stay there long-term. It seems straightforward, but obesity treatment is complex and variable.

Several areas need to be addressed before an effective obesity treatment plan can be made, including:

In some cases, obesity treatment also involves prescription drugs aimed at lowering appetite and/or bariatric surgery such as gastric bypass.

No single obesity treatment works for everyone, but losing weight and keeping it off essentially boils down to two key components: a calorie-reduced diet and a physical fitness routine.

Multidisciplinary Weight Loss Teams

Research has shown that the most successful long-term approach to managing obesity is a multifaceted treatment plan. This may include working with more than one healthcare professional from different specialties (a "multidisciplinary team").

A complete weight loss program should be led and overseen by a team of experts, including a counselor or coach, physicians, dietitians, and others.

Examples of healthcare professionals who can help with weight loss include:

  • Dietitians to educate on nutrition and help with meal planning
  • Behavioral counselors to address emotional issues linked to overeating
  • Life coaches to support setting and reaching weight loss goals
  • Fitness coaches to design a safe and effective exercise plan
  • Obesity specialists: Doctors, nurse practitioners, and other healthcare providers who have received special training in treating obesity and are members of the Obesity Medicine Association (OMA) 

A weight loss program typically has an initial weight loss phase followed by a maintenance phase to support weight loss in the longterm.

The first phase usually lasts at least six months. After the initial weight loss, the maintenance phase is implemented for another 12 months or longer.

Diet, Activity, and Lifestyle

Successful obesity treatment and weight loss do not occur without making diet and lifestyle changes. Everyone with an obesity diagnosis can expect to make changes to their eating habits and increase their level of physical activity.

The exact diet and activity plan a person undertakes will vary depending on several factors, including:

  • An individual's current dietary needs
  • The amount of weight an individual needs to lose
  • An individual's overall health status and other medical conditions
  • How willing an individual is to commit to and participate in the plan

Slow, steady weight loss over an extended period of time is considered the safest and most effective way to lose weight and keep it off.

A person with obesity may begin to see improvements in their health before they've lost a lot of weight. According to the National Institutes of Health, a modest weight loss of 3-5% of a person's total weight can be enough for positive health changes, such as lowered blood pressure and blood sugar levels, to take place.

For example, a person weighing 250 pounds may begin to notice improved health after losing just 12 pounds.

Diet

There is no one diet plan that will be effective for everyone who is trying to lose weight and improve their health. Everyone's dietary needs and preferences are different, so the nutritional component of an obesity treatment plan will be highly individual.

However, the primary recommendation for most obesity treatment plans is to reduce food intake to lower how many calories are consumed per day.

According to a 2017 study published in Contemporary Clinical Trials, how many calories someone eats per day may have more influence on weight loss than the type of diet they follow.

The study included two groups: one eating a low-fat diet and the other eating a low carbohydrate diet. Both groups restricted their intake by 500 calories per day. Even though they were focusing on reducing different types of food, both groups lost the exact same amount of weight.

According to the National Institute of Health, a typical weight loss diet for obesity is comprised of around 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.

However, the exact number of calories an individual needs to eat per day will be determined by a healthcare provider who has taken their overall health, activity level, and metabolism into account.

There is no definitive diet that has been deemed the best diet for obesity treatment, but there are some general guidelines for healthy weight loss, including:

  • Fruits and veggies. Substitute foods that are high in energy density but low in nutrition (such as doughnuts, candy, and fast or processed food) for those with fewer calories but more nutrition (like vegetables and fruits). 
  • Fiber. Fill up on high fiber, low-fat foods, such as oatmeal, quinoa, beans, and legumes. These foods take a long time to digest, so they satisfy hunger and will help you avoid eating extra snacks or meals.
  • Whole grains. Reduce the simple carbohydrates (like white bread and pasta, cakes and cookies, and other sugary treats) in your diet. Swap them out for whole grains such as whole wheat and multi-grain bread, whole-wheat pasta, quinoa, and barley.
  • Plant-based. Increase your intake of plant-based foods like fresh vegetables and fruits, and eat fewer foods with saturated fat (such as animal products).
  • Portion control. Eat smaller portions. Try eating several small meals and snacks instead of three big meals a day.
  • Skip soda. Avoid sugar-laden drinks such as soda and energy drinks. Be sure to check labels, as many commercially sold beverages are loaded with hidden sugar.
  • Healthy fats. Avoid saturated and trans fats, which are mainly found in processed, packaged, and fast foods. Instead, focus on heart-healthy fats from plant sources like avocados, olive oil, and nuts.

The most important consideration is to select a diet plan that can be used for the longterm.

Be suspicious of any diet that claims to be a quick or easy fix. Losing weight safely (and keeping it off) takes time. "Crash diets," fad diets, and other extreme eating plans might lead to rapid weight loss in the short-term, but they aren't sustainable, effective, or safe to use as a longterm treatment plan.

Physical Activity

A regular exercise routine is an essential part of obesity treatment, but weight loss and a stronger body aren't the only benefits.

According to a 2014 study published in the journal Progress in Cardiovascular Disease, exercise can be especially beneficial for people who are at risk for the common comorbidities of obesity, such as diabetes and cardiovascular disease.

An effective exercise regime starts slow and progressively becomes more strenuous with time, gradually increasing a person's strength and endurance.

People with obesity should follow their physician’s recommendations for the amount of exercise they should aim for each week. While the goal for most people will be to do as much physical activity as they can tolerate, specific factors will determine how much and what type of exercise will be recommended.

For example, a healthcare provider will consider whether a person has health conditions or physical limitations when making recommendations for exercise.

Initially, a simple routine such as daily walking may be enough. The general rule of thumb is at least 150 minutes of moderate-intensity physical activity per week.

Some people prefer aerobic exercise like taking a brisk walk every day, while others like to lift weights. You can even combine both for a full-body workout. If you choose a form of exercise you like and can stick to, it's more likely to support your longterm weight loss goals.

Behaviors

For many people with obesity, losing weight is not as simple as following a healthy diet and getting regular exercise. The emotional and behavioral aspects of obesity also need to be addressed for treatment to be successful.

For example, there are a number of reasons why people overeat, but sometimes a person might not even be aware of what drives them to do so.

Behavior modification programs led by professional counselors can help people with obesity identify stressors and other factors that fuel their overeating habits and learn to cope with them.

Addressing behaviors as part of obesity treatment can also include:

Prescription Medications

If treatment modalities such as a change in diet and lifestyle are not successful, healthcare providers may prescribe medications for weight loss.

  • Xenical (orlistat) blocks approximately 30% of dietary fat from being absorbed. A lower dose over-the-counter formula of the same medication is sold under the brand name Alli.
  • Phentermine is an appetite suppressant. It was a component of an older combination medication called fenfluramine and/or dexfenfluramine (“fen-phen”) that was removed from the market in 1997. It's important to know that the isolated form of phentermine is not associated with the severe side effects of fen-phen (such as heart valve problems).
  • Saxenda (liraglutide) is an injectable drug that, along with diet and exercise, is approved to help manage weight.

A person with obesity must meet specific criteria to be considered a candidate for prescription weight-loss drugs, and they must be closely monitored by a healthcare professional while taking them.

Doctors will consider several factors when determining whether someone is eligible for weight loss medication, such as:

  • Contraindications (such as pregnancy or a history of eating disorders)
  • The potential side effects and risks of the medication compared to its benefits
  • Any other medications you take that could interact with weight-loss drugs (such as antidepressants or migraine medications)
  • Health history (as some medications cannot be given to people with certain health conditions like uncontrolled high blood pressure and glaucoma)
  • Body mass index (BMI). In general, a person must have a BMI of over 30 to be prescribed weight loss medication or a BMI of over 27 with complications from obesity (such as type 2 diabetes or high blood pressure)

Surgery and Devices

Weight loss surgery (also called bariatric surgery) is another treatment option for obesity. However, these procedures are usually reserved for people who have not responded to changes in diet, physical activity, behaviors, and lifestyle.

As with prescription medication, a person must meet specific criteria to be considered for weight loss surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) states that the following criteria must be met to be considered a candidate for bariatric surgery:

  • Morbid obesity (a BMI of 40 or higher) or a BMI of 35 or higher with a serious weight-related medical disorder (comorbidity) such as type 2 diabetes or high blood pressure
  • Unable to lose weight using other methods, such as diet and lifestyle changes, medication, and behavior modification

It's also important that someone seeking bariatric surgery is committed to making longterm changes to their diet and lifestyle to ensure the outcomes of the surgery are successful.

There are several types of surgical procedures that can aid weight loss, but most are designed to physically limit the amount of space in the stomach and reduce appetite.

Gastric Bypass Surgery

During gastric bypass surgery, a small pouch is made where the top of the stomach connects to the small intestine. The opening allows food and liquid to travel from the pouch to the intestine, bypassing most of the stomach.

After the procedure, food intake is restricted to only small amounts at a time. The re-routing of the intestines can contribute to the common side effects of gastric bypass surgery, such as nutritional deficiencies.

Laparoscopic Adjustable Gastric Banding (LAGB)

Laparoscopic adjustable gastric banding (LAGB) uses an adjustable band that is pulled tight to create two separate pouches in the stomach. The procedure restricts how much food a person can eat before they feel full and makes it take longer for food to be emptied from the stomach.

Gastric Sleeve

Compared to gastric bypass, a gastric sleeve is a simpler surgery to remove part of the stomach. By creating a smaller reservoir in the stomach, the amount of food a person can eat before they feel full is dramatically decreased.

Gastric sleeve procedures do not involve re-routing the intestines and are generally considered safer than other surgeries. However, there are short- and long-term complications of gastric sleeve surgery.

Vagal Nerve Blockage

Vagal nerve blockade (or vBloc) was approved by the FDA in 2014. The device is implanted beneath the skin of the abdomen and sends electric impulses to the brain with a "message" that the stomach is full.

To qualify for vagal nerve block treatment, a person must have a BMI of 35-45, at least one obesity-related condition, and have not succeeded with other supervised weight-loss programs within the last five years.

AspireAssist Device

The AspireAssist was approved by the FDA in 2016. The device is a surgically-placed gastronomy tube that allows a person to drain a portion of the stomach's contents into the toilet after eating.

As with other surgical procedures, the AspireAssist device is only recommended for people with a BMI between 35-55 who haven't been able to lose weight using non-surgical means.

A Word From Verywell

For people diagnosed with obesity, treatment options usually begin with diet and lifestyle changes, then progress to behavior modification and prescription weight-loss medication. If these measures aren't successful, bariatric surgery or devices may be considered if specific criteria are met.

There are pros and cons to each approach. What works for one person may not work for someone else. Each person with obesity needs to discuss their nutritional, physical, and emotional needs with their healthcare team, as well as evaluate the risks and benefits of each treatment, before deciding which approach will best help them achieve long-term weight loss.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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