How Are Overweight and Obesity Treated?
Successful treatments for weight loss include
setting goals and making lifestyle changes such as eating fewer calories and
being more physically active. Drug therapy and weight loss surgery are also
options for some people if lifestyle changes dont work.
Set Realistic (Do-able) Goals
Setting the right weight loss goals is an important
first step to losing and maintaining weight.
For Adults
- Lose just 5 to 10 percent of your current weight
over 6 months. This will lower your risk for
heart
disease and other conditions.
- The best way to lose weight is slowly. A weight
loss of 1 to 2 pounds a week is do-able, safe, and will help you keep off the
weight. It also will give you the time to make new, healthy lifestyle
changes.
- If youve lost 10 percent of your body
weight, have kept it off for 6 months, and are still overweight or obese, you
may want to consider further weight loss.
For Children and Teens
- If your child is overweight or at risk of
overweight, the goal is to maintain his or her current weight and to focus on
eating healthy and being physically active. This should be part of a family
effort to make lifestyle changes.
- If your child is overweight and has a health
condition related to overweight or obesity, your doctor should refer you to a
pediatric obesity treatment center.
Lifestyle Changes
For long-term weight loss success, its
important for you and your family to make lifestyle changes:
- Focus on energy IN (calories from food and
drinks) and energy OUT (physical activity)
- Follow a healthy eating plan
- Learn how to adopt more healthful lifestyle
habits
Over time, these changes will become part of your
everyday life.
Calories
Cutting back on calories (energy IN) will help you
lose weight. To lose 1 to 2 pounds a week, adults should cut back their calorie
intake by 500 to 1,000 calories a day.
- In general, 1,000 to 1,200 calories a day will
help most women lose weight safely.
- In general, 1,200 to 1,600 calories a day will
help most men lose weight safely. This calorie range is also suitable for women
who weigh 165 pounds or more or who exercise routinely.
These calorie levels are a guide and may need to be
adjusted. If you eat 1,600 calories a day but dont lose weight, then you
may want to cut back to 1,200 calories. If youre hungry on either diet,
then you may want to boost your calories by 100 to 200 a day. Very low-calorie
diets of less than 800 calories a day shouldnt be used unless your doctor
is monitoring you.
For overweight children or teens, its
important to slow the rate of weight gain; however, reduced-calorie diets
arent advised before you talk to a health care provider.
Healthy Eating Plan
A healthy eating plan gives your body the nutrients
it needs every day. It has enough calories for good health, but not so many
that you gain weight.
A healthy eating plan also will lower your risk for
heart disease and other conditions. A plan low in total, saturated, and
trans fat; cholesterol; and sodium (salt) will help to lower your risk
for heart disease. Cutting down on fats and added sugars also can help you eat
fewer calories and lose weight. Healthful foods include:
- Fat-free and low-fat milk and milk products such
as low-fat yogurt, cheese, and milk.
- Lean meat, fish, poultry, cooked beans, and
peas.
- Whole grain foods such as whole wheat bread,
oatmeal, and brown rice. Other grain foods like pasta, cereal, bagels, bread,
tortillas, couscous, and crackers.
- Fruits, which can be canned (in juice or water),
fresh, frozen, or dried.
- Vegetables, which can be canned (without salt),
fresh, frozen, or dried.
Canola or olive oils and soft margarines made from
these oils are heart healthy. They should be used in small amounts because
theyre high in calories. Unsalted nuts, like walnuts and almonds, also
can be built into a healthful diet as long as you watch the amount you eat,
because nuts are high in calories.
The National Heart, Lung, and Blood Institutes
Aim for
a Healthy Weight patient booklet provides more information on
following a healthy eating plan.
Foods to limit. Foods that are high
in saturated and trans fats and cholesterol raise blood cholesterol
levels and also may be high in calories. These fats raise the risk of heart
disease, so they should be limited.
Saturated fat is found mainly in:
- Fatty cuts of meat such as ground beef, sausage,
and processed meats such as bologna, hot dogs, and deli meats
- Poultry with the skin
- High-fat milk and milk products like whole-milk
cheeses, whole milk, cream, butter, and ice cream
- Lard, coconut, and palm oils found in many
processed foods
Trans fat is found mainly in:
- Foods with partially hydrogenated oils such as
many hard margarines and shortening
- Baked products and snack foods such as crackers,
cookies, doughnuts, and breads
- Food fried in hydrogenated shortening such as
french fries and chicken
Cholesterol is found mainly in:
- Egg yolks
- Organ meats such as liver
- Shrimp
- Whole milk or whole-milk products, including
butter, cream, and cheese
Limiting foods and drinks with added sugars, like
high-fructose corn syrup, is important. Added sugars will give you extra
calories without nutrients like vitamins and minerals. Added sugars are found
in many desserts, canned fruit packed in syrup, fruit drinks, and nondiet
drinks. Check the nutrition label on food packages for added sugars like
high-fructose corn syrup. Drinks with alcohol also will add calories, so it's a
good idea to watch alcohol intake.
Portion size. A portion is the
amount of food that you choose to eat for a meal or snack. It's different from
a serving, which is a measured amount of food and is noted on the nutrition
label on food packages.
Anyone who has eaten out lately is likely to notice
how big the portions are. In fact, theyre oversized. These ever-larger
portions have changed what we think of as normal.
Cutting back on portion size is a good way to help
you eat fewer calories and balance your energy IN. To quiz yourself on how
today's portions compare to those from 20 years ago, visit the National Heart,
Lung, and Blood Institute's
Portion Distortion Web
pages.
Food weight. Studies have shown
that we all tend to eat a constant weight of food. Ounce for ounce,
our food intake is fairly constant. Knowing this, you can lose weight if you
eat foods that are lower in calories and fat for a given measure of food. For
example, replacing a full-fat food product that weighs 2 ounces with one that's
the same weight but lower in fat helps you cut back on calories. Another
helpful practice is to eat foods that contain a lot of water like vegetables,
fruits, and soups.
Physical Activity
Staying active and eating fewer calories will help
you lose weight and keep the weight off over time. Physical activity also will
benefit you in other ways. It will:
- Lower the risk of heart disease, diabetes, and
cancers (such as breast, uterus, and colon)
- Strengthen your lungs and help them to work
better
- Strengthen your muscles and keep your joints in
good condition
- Slow bone loss
- Give you more energy
- Help you to relax and cope better with
stress
- Allow you to fall asleep more quickly and sleep
more soundly
- Give you an enjoyable way to share time with
friends and family
In general, adults should follow these guidelines in
relation to physical activity.
- For overall health and to lower the risk of
disease, aim for at least 30 minutes of moderate-intensity physical activity
most days of the week.
- To help manage body weight and prevent gradual
weight gain, aim for 60 minutes of moderate-to-vigorous intensity physical
activity most days of the week.
- To maintain weight loss, aim for at least 60 to
90 minutes of daily moderate-intensity physical activity.
In general, children and teens should aim for at
least 60 minutes of physical activity on most, if not all, days of the
week.
Many people lead inactive lives and may not be
motivated to do more physical activity. Some people may need help and
supervision when they start a physical activity program to avoid injury.
If you're obese, or if you haven't been active in
the past, start physical activity slowly and build up the intensity a little at
a time. When starting out, one way to be active is to do more "everyday"
activities such as taking the stairs instead of the elevator and doing
household chores and yard work. The next step is to start walking, biking, or
swimming at a slow pace, and then build up the amount of time you exercise or
the intensity level of the activity.
To lose weight and gain better health, it's
important to get moderate-intensity physical activity. Choose activities that
you enjoy and that fit into your daily life. A daily, brisk walk is an easy way
to be more active and improve your health. Use a pedometer to count your daily
steps and keep track of how much you're walking. Try to increase the number of
steps you take each day.
Other examples of moderate-intensity physical
activity include dancing, bicycling, gardening, and swimming. For greater
health benefits, try to step up your level of activity or the length of time
you're active. For example, start walking for 10 to 15 minutes three times a
week, and then build up to brisk walking for 60 minutes, 5 days a week. You
also can break up the amount of time that you're physically active into shorter
amounts such as 15 minutes at a time.
Behavioral Changes
Changing your behaviors or habits around food and
physical activity is important for losing weight. The first step is to
understand the things that lead you to overeat or have an inactive lifestyle.
The next step is to change these habits.
The list below gives you some simple tips to help
build healthier habits.
Change your surroundings. You may
be more likely to overeat when watching TV, when treats are available in the
office break room, or when you're with a certain friend. You also may not be
motivated to take the exercise class you signed up for. But you can change
these habits.
- Instead of watching TV, dance to music in your
living room or go for a walk.
- Leave the office break room right after you get a
cup of coffee.
- Bring a change of clothes to work. Head straight
to the exercise class on the way home from work.
- Put a note on your calendar to remind yourself to
take a walk or go to your activity class.
Keep a record. A record of your
food intake and the amount of physical activity that you do each day will help
to inspire you. You also can keep track of your weight. For example, when the
record shows that you've been meeting your goal to be more active, you'll want
to keep it up. A record is also an easy way to track how you're doing,
especially if you're working with a registered dietitian or nutritionist.
Seek support. Ask for help or
encouragement from your friends, family, and health care provider. You can get
support in person, through e-mail, or by talking on the phone. You also can
join a support group.
Reward success. Reward your success
for meeting your weight loss goals or other achievements with something you
would like to do, not with food. Choose rewards that you'll enjoy, such as a
movie, music CD, an afternoon off from work, a massage, or personal time.
Weight Loss Medicines
Weight loss medicines approved by the Food and Drug
Administration (FDA) may be an option for some people. If you're not successful
at losing 1 pound a week after 6 months of using lifestyle changes, medicines
may help. These medicines should be used only as part of a program that
includes diet, physical activity, and behavioral changes.
Weight loss medicines may be suitable for adults who
are obese (a BMI of 30 or greater). People who have BMIs of 27 or greater and a
risk for heart disease and other health conditions also may benefit from
medicines.
The FDA has approved two prescription weight loss
medicines for long-term use: sibutramine (Meridia®) and orlistat
(Xenical®). These medicines cause a weight loss between 4 and 22
pounds, although some people lose more weight. Most of the weight loss occurs
within the first 6 months of taking the medicine.
- Sibutramine (Meridia). This medicine sends
signals to your brain to curb your appetite. Sibutramine raises blood pressure
and pulse. You shouldn't take it if you have
high
blood pressure or a history of heart disease or stroke.
- Orlistat (Xenical). This medicine reduces the
absorption of fats, fat calories, and vitamins A, D, E, and K by the body.
Orlistat can result in mild side effects such as oily and loose stools.
The FDA also has approved Alli™, an
over-the-counter weight loss aid for adults. Alli is the lower dose form of
orlistat. It's meant to be used along with a reduced-calorie, low-fat diet and
physical activity. In studies, most people taking Alli lost 5 to 10 pounds over
6 months.
Like orlistat, Alli reduces the absorption of fats,
fat calories, and vitamins A, D, E, and K to promote weight loss. It also has
similar side effects to orlistat. If you're taking orlistat or Alli, you should
take a multivitamin at bedtime due to the possible loss of some vitamins. You
also should talk to your doctor before starting Alli if you're taking
blood-thinning medicines or being treated for diabetes or thyroid disease.
Combined with healthy eating and physical activity,
these medicines can help people lose weight. If you think you would benefit
from the prescription medicines, sibutramine or orlistat, talk to your doctor.
People taking these medicines need regular checkups with their doctors,
especially in the first year after starting the medicine. During checkups, your
doctor will check your weight, blood pressure, and pulse and order laboratory
tests. He or she also will discuss any medicine side effects and answer your
questions.
Other Medicines
Some prescription medicines are used to treat weight
loss, but aren't FDA-approved for treating obesity. They include:
- Drugs to treat depression. Some medicines for
depression cause an initial weight loss and then a regain of weight while
taking the medicine.
- Drugs to treat seizures. Two drugs used for
seizures, topiramate and zonisamide, have been shown to cause weight loss.
These drugs are being studied to see whether they will be useful in treating
obesity.
- Drugs to treat diabetes. Metformin may cause
small amounts of weight loss in people with obesity and diabetes. It's not
known how this drug causes weight loss, but it has been shown to reduce hunger
and food intake.
Over-the-Counter Products
Over-the-counter (OTC) products often claim that a
person taking them will lose weight. The FDA doesn't regulate these products
because they're considered dietary supplements, not medicines. However, many of
these products have serious side effects and aren't generally recommended. A
few OTC products include:
- Ephedra (also called ma-huang). Ephedra comes
from plants and has been sold as a dietary supplement. The active ingredient in
the plant is called ephedrine. Ephedra can cause short-term weight loss. It
also has serious side effects. It causes high blood pressure and stresses the
heart. In fact, because ephedra poses a serious health risk, the FDA has
advised people to stop using dietary supplements that contain it.
- Chromium. This is a mineral that's sold as a
dietary supplement to reduce body fat. While studies haven't found any weight
loss benefit from chromium, there are few serious side effects from taking
it.
- Diuretics and herbal laxatives. These products
cause you to lose water weight, not fat. They also can lower your body's
potassium levels, which may cause heart and muscle problems.
- Hoodia. Hoodia is a cactus that is native to
Africa. It's sold in pill form as an appetite suppressant. However, there is no
firm evidence that hoodia works. No large-scale research has been done on
humans to show whether hoodia is effective or safe.
Weight Loss Surgery
Weight loss surgery may be an option for people with
extreme obesity (BMI of 40 or greater) when other treatments have failed. It's
also an option for people with a BMI of 35 or greater who have life-threatening
conditions such as:
- Severe
sleep
apnea (a condition in which your breathing stops or gets very shallow while
you're sleeping)
- Obesity-related
cardiomyopathy
(diseases of the heart muscle)
- Severe type 2 diabetes
Two common weight loss surgeries include:
- Banded gastroplasty. For this surgery, a band or
staples are used to create a small pouch at the top of your stomach. This
surgery limits the amount of food and liquids the stomach can hold.
- Roux-en-Y gastric bypass. For this surgery, a
small stomach pouch is created with a bypass around part of the small intestine
where most of the calories you eat are absorbed. This surgery limits food
intake and reduces the calories your body absorbs.
Weight loss surgery can improve your health and
weight. However, the surgery can be risky depending on your overall health.
There are few long-term side effects with gastroplasty; however, you must limit
your food intake dramatically. Roux-en-Y gastric bypass has more side effects.
These include nausea, bloating, diarrhea, and faintness (which are all part of
a condition called dumping syndrome). After Roux-en-Y gastric bypass,
multivitamins and minerals may be needed to prevent nutrient deficiencies.
Lifelong medical followup is needed after both
surgeries. A monitoring program both before and after surgery also is advised
to help you with diet, physical activity, and coping skills.
If you think you would benefit from weight loss
surgery, talk to your doctor. Ask whether you're a candidate for the surgery
and discuss the risks, benefits, and what to expect.
Weight Loss Maintenance
Maintaining your weight loss over time can be a
challenge. For adults, weight loss is a success if you lose at least 10 percent
of your initial weight and you don't regain more than 6 or 7 pounds in 2 years.
You also must keep a lower waist circumferenceat least 2 inches lower
than your waist circumference before you lost weight.
After 6 months of keeping off the weight, you can
think about losing more if:
- You've already lost 5 to 10 percent of your body
weight
- You're still overweight or obese
The key to further weight loss or to maintain your
weight loss is to continue with lifestyle changes. Adopt these changes as a new
way of life. However, if you want to lose more weight, you may need to eat
fewer calories and increase your activity level. For example, if you eat 1,600
calories a day but don't lose weight, you may want to cut back to 1,200
calories.
Adults should aim for 60 to 90 minutes of daily
moderate-intensity physical activity. Children and teens should aim for 60
minutes of physical activity a day. |