How Obesity Is Treated

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.

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.

This article discusses the treatments for obesity, including lifestyle changes with diet and exercise. It also discusses prescriptions that lower appetite as well as bariatric surgeries, such as gastric bypass.

Assembling a Weight Loss Team

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 long term.

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.

Home Remedies 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 that you undertake will vary depending on several factors, including:

• Your current dietary needs
• The amount of weight you need to lose
• Your overall health status and other medical conditions
• How willing you are to commit to and participate in the plan

You may begin to see improvements in your health before you've lost a lot of weight. According to the National Institutes of Health, a modest weight loss of 3% to 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.

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. However, there are some general guidelines for healthy weight loss, including:

• Eat fruits and veggies: Try to avoid foods that are high in energy density but low in nutrition (such as doughnuts, candy, and fast or processed food). Instead, choose those with fewer calories but more nutrition (like vegetables and fruits). 
• Get lots of 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.
• Choose 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.
• Control 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.
• Pick healthy fats: Avoid saturated fat, found in red meat, 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 long term.

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. However, they aren't sustainable, effective, or safe to use as a long-term 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, exercise can especially benefit those at risk for common comorbidities of obesity, such as diabetes and cardiovascular disease.

People with obesity should follow their physician’s recommendations for the amount of exercise they should aim for each week. The goal for most people will be to do as much physical activity as they can tolerate. However, 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 an exercise you like and can stick to, it's more likely to support your long-term 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. 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. They can also help them find ways to cope with them.

Addressing behaviors as part of obesity treatment can also include:

• One-on-one individual or cognitive behavioral therapy
• Coaching sessions to identify challenges and set goals
• Support groups such as Overeaters Anonymous

Prescriptions

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

Examples of commonly prescribed weight-loss medications include:

• Xenical (orlistat) blocks approximately 30% of dietary fat from being absorbed. A lower dose formula of the same medication is sold over-the-counter 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.
• Wegovy (semaglutide) is the first and only once-weekly GLP-1 RA injectable for chronic weight management. It targets areas of the brain that regulate appetite and food intake.

It's important to note that Belviq (lorcaserin), a previously prescribed weight-loss medication, was withdrawn from the market in February 2020 due to concerns regarding an increased occurrence of cancer in those taking the drug.

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), which affects eligibility for weight loss medication (in general, a person must have a BMI of over 30 or a BMI of over 27 with complications from obesity, such as type 2 diabetes or high blood pressure, to be considered)

Surgeries and Specialist-Driven Procedures

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 long-term changes to their diet and lifestyle. This helps ensure the outcomes of the surgery are successful.

There are several types of surgical procedures that can aid weight loss. 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. It also 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. These include indigestion, gallstones, and stomach ulcers.

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 to 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 and 55 who haven't been able to lose weight using non-surgical means.

Summary

A treatment plan for obesity involves various approaches to reach a healthy weight and maintain it. Your healthcare provider will likely suggest making lifestyle changes first. This includes healthy eating, increased exercise, and addressing overeating habits.

If lifestyle changes don't help with reducing weight, your healthcare provider may also suggest prescription medications or surgical procedures. These are only suggested when you meet certain criteria, such as a certain BMI or obesity-related health conditions.

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. It's important to talk with your healthcare team about your nutritional, physical, and emotional needs. They can help evaluate the risks and benefits of each treatment before deciding which approach will best help with long-term weight loss.