Treatments For Obesity

Exercise

Caloric restriction alone will not produce long-term weight loss. While the data from studies on the effect of exercise for short-term weight loss are contradictory, research clearly indicates that regular exercise is the single best predictor for achieving long-term weight control. Regular exercise will also improve some of the medical conditions associated with obesity including elevated blood cholesterol, high blood pressure, and diabetes.

Behavior Modification

Many eating and exercise habits combine to promote weight gain. Certain times, places, activities, and emotions may be linked to periods of overeating or inactivity. Many obesity treatment programs recommend individuals keep a food diary that records all food or drink consumed, when and with whom it was consumed, and the mood or precipitating events that trigger eating. After one to two weeks, the diary may reveal a pattern of activities or negative emotions that lead to overeating. Once these eating cues are identified, techniques can be developed and practiced to prevent unwanted eating habits.

Weight-Loss Medications

Weight-loss medications of any type are only appropriate for people with a BMI of 30 or above, or a BMI of 27 or above accompanied by weight-related medical conditions such as diabetes or high blood pressure. Amphetamine drugs used to be prescribed to combat obesity, but their well-documented side effects, including insomnia, anxiety, and tolerance (the need to take higher and higher doses to continue to produce the same effect), made them less popular by the late 1970s. A renewed scientific and commercial interest in weight-loss medications was prompted by the Food and Drug Administration’s (FDA) approval of the appetite suppressant dexfenfluramine (sold under the brand name Redux) in 1996, the first weight-loss medication approved in the United States in over 20 years and the first ever approved for maintaining weight loss.

Although never approved for long-term use by the FDA, a combination of two other drugs, phentermine and fenfluramine, popularly known as phen-fen, was used by millions of Americans to promote weight loss. Fenfluramine and dexfenfluramine were eventually associated with valvular heart disease, and the manufacturer withdrew these medications from the marketplace in 1997. A new medication, sibutramine (sold under the brand name Meridia), was approved by the FDA for weight loss and the maintenance of weight loss in 1997. Unlike dexfenfluramine and fenfluramine, sibutramine does not appear to be associated with valvular heart disease, although a small number of patients may develop significant increases in blood pressure. This medication seems to increase fullness, making the required dietary changes for weight loss and the maintenance of weight loss easier to accomplish.

Other weight loss medications are currently in development. The FDA is evaluating orlistat, for example, a weight loss medication that works by blocking the absorption of fat. Over a six-month period, weight-loss medications may result in an approximately 10-percent body weight reduction. Weight loss slows or stops after six months, but discontinuing medication usually causes weight regain. The continued use of medications keeps most of the lost weight from returning for two years. Many experts recommend that medications for weight control be used chronically, like medications for diabetes and high blood pressure. Unfortunately, few studies have examined the consequences of long-term use of weight-control medications.

Surgery

Surgery may be a viable option for patients who are extremely obese (with a BMI greater than 40) and suffer from serious medical complications due to weight. Among all obese persons in the United States, less than 2 percent meet weight criteria for surgery. There are two accepted surgical procedures for reducing body weight: gastroplasty and gastric bypass. Although these two procedures use different methods, they both reduce the stomach to a pouch that is smaller than a chicken’s egg, drastically limiting the amount of food that can be consumed at one time.

Surgery produces 25 to 35 percent reductions in weight over the first year and most of this weight loss is maintained five years after surgery. More importantly, the serious medical conditions that accompany extreme obesity improve significantly. Surgery is not without risk and should be performed by skilled surgeons who provide patients with a comprehensive program for long-term weight control.

NEW DIRECTIONS IN WEIGHT CONTROL

The weight-loss goal of most dieters is typically to achieve an ideal weight as defined by a weight-height chart. More recently, however, the recommended goals for obesity treatment have become more modest: reduce body weight by about 10 percent. Research over the last decade indicates that 5- to 10-percent reductions in body weight are sufficient to improve medical conditions associated with obesity such as high blood pressure, diabetes, and elevated cholesterol levels. These significant health improvements occur even though patients may still be overweight.

These new weight-loss goals may be difficult for obese people to accept. Obese people often seek weights that may be biologically impossible to achieve or, if achieved, cannot be maintained. One study of overweight women found that the average weight goal was a 30 percent reduction in body weight. Clearly, seeking ideal weights is unrealistic—virtually no obesity treatment produces long-term, maintainable weight losses significant enough for patients to reach their ideal weights. Physicians and commercial weight-loss programs need to help obese people feel successful when more modest reductions in weight and significant improvements in health are achieved.