How Obesity is Treated

Weight Loss, Exercise, and Other Obesity Treatment Modalities

Two women smiling and working out

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The overall goal of successful obesity treatment is for a person to get to a healthy weight and stay there long-term. Obesity treatment is very complex. There are several areas that need to be addressed before an effective obesity treatment plan can be formulated. These include dietary changes, exercise and activity plan, and behavior changes (such as developing willpower and addressing emotional eating). Other obesity treatment modalities may include prescription drugs aimed at lowering the appetite, and bariatric surgery such as gastric bypass.

There is no one-size-fits-all treatment protocol. But everyone with obesity who ends up losing weight will need to follow two basic protocols: a calorie-reduced diet and a physical fitness routine.

Creating a Multidisciplinary Weight Loss Team

Although there is a high rate of failure in the first five years of obesity treatment, a multifaceted treatment plan approach has been identified as the most successful long-term plan.

Many people who have been diagnosed with obesity find that working with a team of professionals helps them to stay on track in the long-term. 

Effective obesity treatment may require a team of professionals called a "multidisciplinary team." Examples of healthcare professionals who can help with weight loss include:

  • A dietician to help with nutrition and meal planning
  • A behavioral counselor to address emotional issues linked to overeating
  • A life coach to enable a person to set and reach regular weight loss goals
  • A fitness coach to help design a safe and effective exercise plan
  • An obesity specialist: A healthcare provider, such as a doctor, nurse practitioner or other professional, who is a member of the Obesity Medicine Association (OMA) and has received special training in treating obesity

To increase the likeliness of permanent weight loss, the length of the weight loss program usually involves an initial weight loss phase followed by a maintenance phase.

The complete weight loss program, led by a team of experts (including a counselor or coach, physician, dietician and more) should last at least six months; the maintenance phase is implemented for at least 12 additional months.

Home Remedies and Lifestyle

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

The diet and activity plan for a person with obesity will vary depending on several factors, including:

  • A person’s eating habits
  • The amount of weight needed to lose
  • Overall health status
  • Willingness to participate in plan

When it comes to weight loss, slow and steady progress wins the race.

A person with obesity should aim for slow, steady weight loss over an extended time span. This is considered the safest and most effective way to keep the weight off.

A person with obesity does not have to lose a lot of weight before an improvement in health is seen. 

With modest weight loss of only 3% to 5% percent of a person’s total weight, some improvement usually starts to occur. For example, a person who weighs 250 pounds would only need to lose around 12 pounds to begin feeling better and to notice an improvement in health.

The benefits of modest weight loss are noted by the National Institutes of Health; these include lowering blood sugar, blood pressure, triglycerides, and more.

Diet

There is no one size fits all weight loss diet. Everyone is different. The important thing is to select a diet that one can live with on a long-term basis. Crash diets and other extreme eating plans are unlikely to work on a long-term basis.

Reducing your food intake to lower the number of calories that are consumed is the primary dietary recommendation for most obesity treatment plans.

According to a 2017 study published in Contemporary Clinical Trials, it was not the type of diet, but rather the reduction in food intake (calories) that resulted in weight loss. In fact, there were 2 groups in the study, one ate a low-fat diet and one ate a low carbohydrate diet. Both groups restricted their diet by around 500 calories per day, and both groups lost the exact same amount of weight.

Your healthcare provider, dietician, or nutrition coach may suggest a diet to help with weight loss. Typically, a 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, but the number of calories varies from person to person. The physician, dietician, or other healthcare provider will suggest how many calories are best on an individual basis.  

Although there is no definitive diet that has been deemed the best diet for obesity treatment, there are some general guidelines for healthy weight loss, these include:

  • Substituting foods that are high in energy density (such as doughnuts, candies, fried foods, and processed foods) for others that have fewer calories (like vegetables and fruits) 
  • Filling up on high fiber, low-fat foods, such as oatmeal, quinoa, beans, and legumes as these foods take a long time to digest, satisfy hunger and help a dieter to avoid eating extra snacks or meals that are not on the daily weight loss menu
  • Restricting the amount of simple carbohydrates (like white bread, white pasta, sugar, candies, cakes, and other processed foods) and replacing them with whole grains such as whole wheat and multi-grain bread, whole-wheat pasta, quinoa, barley, etc.
  • Increasing the intake of plant-based foods like fresh vegetables and fruits, while restricting the amount of saturated fats (such as those from animal products)
  • Eating smaller portions and substituting several small meals and snacks for large meals
  • Avoiding sugar-laden drinks such as soda pop and shakes (check the labels because most commercially sold drinks are loaded with sugar)
  • Avoiding saturated and trans-fats (a very unhealthy source of fats) and eating heart-healthy fats instead (such as those that come from plant sources, like avocados, olive oil, and nuts)

Be suspicious of any diet that proclaims to be a quick or easy fix. Taking off weight and keeping it off takes time.

Crash diets and other fad diets (such as the Maple Syrup Diet and more) may promote short term weight loss, but they don’t promote long-term healthy eating habits, necessary for effective obesity treatment.

Physical Activity

A regular exercise routine is an essential part of obesity treatment. Not only does exercise help to strengthen the body and promote weight loss, it also lends itself to providing benefits to those who are at risk for common comorbidities of obesity, such as diabetes and cardiovascular disease.

According to a 2014 study published by Progress in Cardiovascular Disease, “Exercise training, regardless of weight loss, provides numerous health benefits especially for overweight and obese individuals at risk for CV diseases or with current CV conditions.” 

An effective exercise regime should start slow and progressively build up to be more strenuous with time. This helps to gradually increase a person’s strength and endurance.

Initially, a simple routine such as daily walking may be enough activity. 

People who have been diagnosed with obesity should follow their physician’s protocol regarding how much time is required for exercise each week. A general rule of thumb for starting out usually involves at least 150 minutes per week of moderate-intensity physical activity, but your healthcare professional should make a specific recommendation about physical activity.

There are many factors that impact exactly how much and what type of exercise a person with obesity should do. These factors include the type of comorbidities and other limitations in physical movement and endurance.

In most instances, the goal is to get as much activity as can be tolerated. Performing a strenuous cardiovascular workout regularly (such as aerobic exercise) may lend itself to burning the most calories, but other types of activities can help too. Working in the yard, swimming, playing sports, or going for brisk walks, are all beneficial to the overall success of the treatment plan.

Behavioral Issues

For most people who are obese, losing weight is not just about shedding some pounds by incorporating a healthy diet and exercise routine. There’s usually an emotional and behavioral aspect of the disease that needs to be addressed as well.

Overeating can be the result of many different factors. A behavior modification program, led by a professional counselor, can help a person with obesity to identify some of the stressors and other factors that may be fueling the overeating habit.

Addressing behavioral issues may include:

  • One-on-one individual therapy or counseling
  • Attending support groups, such as Overeaters Anonymous or Weight Watchers)
  • Participating in coaching sessions to identify blocks and set goals and action steps

Prescriptions

If treatment modalities such as a change in diet and lifestyle are not successful, some healthcare providers will also prescribe weight loss medications. There are specific parameters that must be met before a person with obesity can be considered a candidate for prescription drugs.

  • Fastin (beta-methyl-phenylethylamine) is a stimulant known to increase fat metabolism.
  • Xenical (orlistat) blocks approximately 30% of dietary fat from being absorbed. A lower dose over-the-counter formula of the same medication is called “Alli.”
  • Phentermine is an appetite suppressant which was historically part of the “fen-phen” (fenfluramine and/or dexfenfluramine) combination medication. The use of the isolated form of phentermine is NOT associated with the severe side effects caused by fen-phen (such as heart valve problems).
  • Meridia (sibutramine) is an appetite suppressant prescribed for long-term use.

Factors that are considered for eligibility to be prescribed weight loss medication may include:

  • Your health history (some medications are not given with specific health conditions)
  • Side effects of the medication
  • Contraindications (such as pregnancy)
  • A body mass index (BMI) of over 30, or a BMI of over 27 with other complications from obesity (such as diabetes or high blood pressure)

Close monitoring by the healthcare provider is required when a person is taking prescription weight loss medication.

Surgeries and Specialist-Driven Procedures

Weight loss surgery (AKA bariatric surgery) is a common treatment option for those with obesity who do not respond to diet and exercise, or behavioral and lifestyle changes.

Weight loss surgery can pose several risks, and so there are criteria for surgery, which may include:

  • Morbid obesity involving a BMI of 40 or higher, or a BMI of 35 or higher with a weight loss linked to a serious medical disorder (comorbidity) such as diabetes or high blood pressure
  • A high commitment level to making lifestyle changes needed for the success of the surgery (such as exercise and eating habits)

There are several types of surgical procedures for weight loss aimed at reducing the space of the stomach to help control the appetite.

Gastric Bypass Surgery

Gastric bypass surgery involves creating a small pouch at the top of the stomach which is connected to the small intestine. This allows food and liquid to travel from the pouch to the intestine, bypassing most of the stomach.

With this procedure, food intake is restricted to a very small amount at a time. Gastric bypass surgery is known for having some side effects such as nutritional deficiencies resulting from re-routing of the intestines.

Laparoscopic Adjustable Gastric Banding (LAGB)

Laparoscopic adjustable gastric banding (LAGB) involves an adjustable band that is pulled tight to create two separate pouches in the stomach. The band results in an increase in the time it takes for food to be emptied from the stomach, as well as a restriction in the amount of food a person can eat before feeling full. 

Gastric Sleeve

Gastric sleeve is a simpler surgery compared to the gastric bypass, involving the removal of part of the stomach creating a smaller reservoir for food and providing a feeling of fullness. The gastric sleeve dramatically decreases the amount of food that can be eaten before a person feels full.

This procedure does not involve re-routing the intestines and is considered safer, with a lower risk of resulting nutritional deficiencies.

Vagal Nerve Blockage

Vagal nerve blockade is newer technology, approved by the U.S. Food and Drug Administration (FDA) in 2014. It involves a device, that is implanted in the skin of the abdomen, which sends electric impulses aimed at giving the brain a message that the stomach is full.

A person must have a BMI of 35 to 45 with at least one obesity-related (comorbidity) condition to qualify for this treatment.

AspireAssist Device

The AspireAssist device is another relatively new weight loss treatment, approved by the FDA in 2016. A gastronomy tube is surgically placed, allowing the user 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 those who haven't been able to lose weight with non-surgical means.

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Article Sources

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  2. Stanton MV, Robinson JL, Kirkpatrick SM, et al. DIETFITS study (diet intervention examining the factors interacting with treatment success) - Study design and methods. Contemp Clin Trials. 2017 Feb;53:151-161. doi:10.1016/j.cct.2016.12.021.

  3. Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The Role of Exercise and Physical Activity in Weight Loss and Maintenance. Prog Cardiovasc Dis. 2014 Jan-Feb; 56(4): 441–447. doi:10.1016/j.pcad.2013.09.012

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