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Obesity Treatment Overview

Treatment goals

Regardless of the type or combination of obesity treatment, goal setting is an important part of any obesity treatment plan. Someone may want to lose a large amount of weight. But it's important to realize that setting and achieving a realistic goal of reducing weight by as little as 3% to 5% of body weight will result in important, positive health gains.

Treatment goals work best if they are tailored to a person's needs. For instance, it's safe to lose 1 or 2 pounds per week. But a person may be more comfortable losing at a lower rate of half a pound per week. Over 1 year, that is a 26-pound loss. If that rate is maintained over 3 years, it will lead to a significant weight loss of 78 pounds over time. Whatever treatment plan a person follows, losing weight slowly will be more effective and healthier over the long term. Quick weight loss often spurs weight regain.

Treatment for obesity

Treatment for obesity may include a combination of different types of treatment. Always talk with your healthcare provider for a diagnosis and treatment advice.

There are many ways to treat obesity. It's helpful to use more than 1 method. For instance, you can try making diet changes as well as adding exercise.

Diet

Diet plans high in protein and fat and low in carbohydrates are popular. But some of these diets may pose serious health risks in the long run because of the emphasis on saturated fat. Successful weight loss that is maintained over a long period of time depends more on limiting energy consumed (calories) and increasing energy expenditure (exercise and daily activity) than just the composition of the diet.

Fasting may result in rapid weight loss. But lean muscle mass may be lost as well as fat. All-liquid diets must be medically supervised. They may be used for a short time in people who are obese. These liquid diets may be effective in the short term. But they are not the long-term answer to weight loss.

Fads, fasting, and popular diets in which health effects have not been found by rigorous clinical trials may not be healthy choices for weight loss. But there are dietary recommendations that, if followed, will lead to weight loss:

  • To lose weight and keep it off for a lifetime, think about an individualized eating plan instead of a diet. A plan tailored to your personal likes and dislikes will have a better chance of resulting in lasting weight loss. A balanced diet that is restricted in calories—1,200 to 1,400 calories a day for women and 1,500 to 1,800 calories a day for men—may work well. A registered dietitian can help to make an individualized diet plan based on a person's particular situation.

  • Include a variety of foods in the diet.

  • All fats are not bad. It's now known that polyunsaturated and monounsaturated fats provide health benefits, such as helping to keep the heart healthy. This means that nuts, seeds, and some types of oils, such as olive, safflower, and canola, have a place in a healthy eating plan.

  • Choose whole grains, such as brown rice and whole-wheat bread, rather than white rice and white bread. Whole grain foods are rich in nutrients compared to more processed products. They are higher in fiber and therefore absorbed by the body more slowly so they don't cause a rapid spike in insulin, which can set off hunger and cravings.

  • Choose at least 5 servings daily of fruits and vegetables. Pick a variety of fruits and vegetables. Different fruits and vegetables have varying amounts and types of nutrients.

  • When dining out or ordering take-out food, ask for a take-home box (and use it). Stay away from super-size selections when you order. Many restaurant portions are too large for 1 person. Think about sharing an entree or ordering an appetizer instead of a main dish.

  • Read food labels carefully. Pay close attention to the number of servings contained in the product and the serving size. For instance, a label may say that 1 serving is 150 calories and there are 3 servings per container. But if you eat the entire package, the calories are triple, or 450 calories.

Exercise

A regular exercise program helps people who are obese by helping keep and add lean body mass, or muscle tissue, while losing fat. It also helps to increase the rate at which weight is lost if a person is eating healthy food according to a meal plan. This is because muscle tissue burns calories faster.

Walking is an excellent choice of exercise for people who are obese. A walking program should start slowly by walking 30 minutes a day a few days a week. Increase gradually to the goal of walking for longer periods most days of the week. If you have severe arthritis and walking is hard, water walking in a swimming pool is a very effective means of exercise. There is minimal weight bearing on the knees with this exercise. Some fitness centers also offer water aerobics.

Exercise lowers blood pressure and can help prevent type 2 diabetes. Exercise also helps improve mood, reduce appetite, improve sleep, improve flexibility, and lowers LDL cholesterol (the bad cholesterol).

Check with your healthcare provider before starting any exercise program.

Environmental factors

Many U.S. adults have a sedentary lifestyle. Becoming active takes effort on your part. Use of the car and working at a desk restrict activity. Watching TV is a sedentary activity that can contribute to an inactive lifestyle.

There are simple steps that can be taken to increase daily activity:

  • Take the stairs instead of the elevator or escalator.

  • Park the car at the far end of the parking lot and walk to the store or the office if safe.

  • Get off the bus 1 stop early if you are in an area safe for walking.

  • Turn off the TV or video game and head for the garden, rake the leaves, wash the car, or take a walk.

  • Walk on a treadmill or ride a stationary bike when you watch TV.

  • Find activities that the whole family will enjoy, such as tennis, skating, biking, or hiking.

By looking at your daily routine, it may be easier than you think to find ways to work more activity into the day in addition to exercising.

The workplace may be challenging when trying to stick to a weight loss plan. But there are strategies that may help to keep a weight loss plan on track at work. Bring healthy snacks, such as cut-up fruits and vegetables, to keep on hand when the pastry cart rolls by. Don't go to office social gatherings hungry. Plan ahead to prevent being tempted by treats that are high in sugar and fat. Ask your employer if they can allow an exercise program to be built into your work schedule. You may be able to use a treadmill while you work. Some people also benefit from working at a standing desk instead of sitting all day.

Support groups

Join a support group for encouragement and reinforcement of changing lifestyle behaviors. Some groups meet weekly. They are run by volunteers, psychologists, nutritionists, or exercise therapists. There are also online communities that can help provide support and information to strengthen efforts to lose weight and make lifestyle changes. Friends and family can also provide important support when making lifestyle changes. Commercial weight loss programs can be expensive. But many of them offer the convenience of prepared food. Some of these programs also provide professional consultation to help a person to tailor their weight loss efforts to their needs.

Medical treatment

Some people may need to see a healthcare provider for treatment. This may be the case if they have not been able to lose weight, but they have other medical conditions that make it vital to lose weight. Medicine may be needed for those with obesity-related health problems. But while medicines may help, they alone are not the answer. Behavioral methods play an even more important part in any weight loss regimen. Behavioral methods can be used to help change dietary habits. They can also help increase activity levels. Eating disorders need treatment by a therapist and may also need medicine.

Surgical treatment

Weight-loss surgery (bariatric surgery) is the only choice today that effectively treats morbid obesity in people who have already tried diet, exercise, and medicine. Possible candidates for this surgery include:

  • People with a body mass index (BMI) greater than 40

  • Men who are 100 pounds over their ideal body weight or women who are 80 pounds over their ideal body weight

  • People with a BMI between 35 and 40 who have another serious weight-related condition, such as obesity-related type 2 diabetes, asthma, sleep apnea, arthritis, or heart disease

There are a few different types of bariatric surgery. But all procedures are either malabsorptive, restrictive, or a combination of both.

  • Malabsorptive procedures change the way the digestive system works. Food is rerouted past a part of the small intestine that absorbs some calories and nutrients. With some procedures, there is a restrictive part of the procedure as well. These procedures are often called gastric bypass procedures (duodenal switch with biliopancreatic diversion). 

  • Restrictive procedures severely reduce the size of the stomach to hold less food. But the digestive functions remain intact. Examples of this type of procedure are gastric banding or gastric stapling.

Malabsorptive procedures often result in more weight loss than restrictive procedures. They also lead to more nutritional deficiencies over time.

Always talk with your healthcare provider to find out more information.

Medical Reviewers:

  • Jonas DeMuro MD
  • Melinda Murray Ratini DO
  • Raymond Kent Turley BSN MSN RN