Stephen J. Schueler, M.D.

Obesity Treatment

Treatment for obesity usually requires a weight loss program that often combines a special diet, regular exercise, behavioral therapy, and medications to diminish hunger. Some may benefit from bariatric surgery in the event other measures fail.

Treatment for obesity includes:

Obesity Diet

Long-term success of treating obesity with a diet depends on the type of dietary restriction and the individual's existing diet. In order to lose weight, it is essential to eat fewer calories a day than the body needs to maintain the present weight. This is the only way one can lose weight through dieting. A dietitian can help greatly in this process. A dietitian is a nutrition expert that can design a healthy, low-calorie diet that allows losing weight safely.

Obesity Counting Calories

In order to successfully treat obesity, it's important to understand how the body maintains energy balance: regulating energy intake so that it equals energy output. Consider the following equation:

Energy In (food intake) = Energy Out

When energy intake exceeds energy output, weight gain occurs. When energy output exceeds energy intake, weight loss occurs. Any imbalance in this equation will have direct results on body weight. For instance, the individual who eats regularly, but receives little or no exercise will usually gain weight. The cancer patient with a decreased appetite and a rapidly growing cancer tends to lose weight. This individual is simply unable to keep up with the energy demands the cancer is placing on the body.

Food is essential because the body needs it to function properly. However, eating more food than the body needs leads to the storage of excess body fat. Exercise requires calories and helps consume body fat. These components must be balanced to achieve body weight goals.

The number of calories people need depends on their weight, age, and level of activity. The calculation of total caloric intake necessary to simply maintain a certain body weight is as follows:

Desired Weight (in pounds) multiplied by a level of activity value will equal the number of calories you need each day to maintain your weight.

Desired Weight x (level of activity value) = total calories needed per day

The level of activity value is determined as follows:

10Light physical activity
15Medium physical activity
20Heavy level of physical activity

The total calories needed per day should be adjusted based on your age group. Use the chart provided below:
25-34subtracts 0 from your total calories
35-44subtracts 100 from your total calories
45-54subtracts 200 from your total calories
55-64subtracts 300 from your total calories
65 +subtracts 400 from your total calories

The result obtained after this step should be a closer estimate of the total calories needed per day to maintain a desired weight, based on a commitment to a particular level of activity.

Once total calories are known, it is important to calculate the calories from each food group. Using the example above for a person who is going to consume 1,500 total calories per day:

1,500 total calories per day x 0.30 (30%) fat calories = 450 calories

This shows that 450 calories of the total 1,500 daily calories may be from fat sources. We also know that each gram of fat provides 9 calories, so that the person in our example can eat about 50 grams of fat per day (450 calories divided by 9 calories/gram of fat) and still be following these guidelines.

The same calculations can be performed for protein and carbohydrates. There are also many tables and simple computer calculators that will perform these tasks quickly and accurately.

Obesity Fad Diets

Most fad diets do more harm than good. Most of these diets share the same characteristics:

  • Their rise in popularity is rapid
  • They distort or ignore proven nutrition principles
  • They have a special appeal or prestige
  • They make grand promises of rapid weight loss
  • They promote engineered fasts
  • They promote a particular food or special diet
  • They quote questionable, self-sponsored or biased science
  • They relieve the dieter of all responsibilities and decisions
  • They seldom include the full variety of foods needed by the body
  • They sound easy

There are virtually hundreds of fad diets. Although these diets vary widely in composition, they all have the potential of leading to nutrient deficiencies and dangerous side effects.

The majority of them fall into one of the following categories:
  • Low carbohydrate diets
  • High carbohydrate diets
  • Fasts
  • Protein sparing modified fasts

Obesity Fat Substitutes

Fat substitutes are used safely in commercial products. These products help foods retain some of the taste and cooking qualities of fats without the additional calories. One fat substitute is called olestra. Olestra is passed from the body without leaving behind any calories from fat.

Olestra has been shown to deplete the body of vitamins A, K, D, and E. It will also deplete important disease-fighting nutrients found in dark colored fruits and vegetables. Some nutrition experts are concerned about the possible effects this might have on the body.

Obesity Low Fat Diet

Strategies for a healthy diet include:

  • Limit your intake of fat to 30% of your total calories.
  • 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil.
  • Consume only unsaturated fats that are low in cholesterol.
  • Consume less than 300 milligrams of cholesterol a day.
  • Eat dietary fiber: whole grains are best.
  • Avoid fad diets.
  • Do not take iron supplements.
  • Check with your doctor about B vitamin supplements. Some people may benefit from B vitamins.

Key Dietary Recommendations for Chronic Disease Prevention
Energy (calories)to maintain BMI < 25
Total fats< or = to 30% of total daily calories
Saturated fats< 7% of total daily calories
Polyunsaturated fats< 10% of total daily calories
Monounsaturated fats< 13% of total daily calories
Cholesterol< or = to 300 mg per day
Dietary fiber25-30 grams per day
Fiber type3:1 insoluble to soluble fiber
Sodium< or = to 1,500 mg per day
Calcium 9-24 yrs1,200-1,500 mg per day
Calcium 25-50 yrs1,000 mg per day
Calcium 51-65 yrs1,200 mg per day
Calcium >65 yrs1,500 mg per day
Vitamin D 9-50 yrs200 IU per day
Vitamin D 51-70 yrs400 IU per day
Vitamin D >70 yrs600 IU per day
Folic acid400 micrograms (ug) per day
Fruits & vegetables5-7 servings per day
Alcohol (men)< or = to 2 drinks per day
Alcohol (women)< or = to 1 drink per day

Obesity Drugs

Facts about the drug treatment of obesity:

  • Diet drugs do not work well for long-term weight loss. In some cases, they are hazardous.
  • Drug treatment for obesity should only be used when lifestyle and diet modifications are unsuccessful.
  • Drug treatment should only be undertaken in combination with lifestyle and diet modification.
  • Weight loss drugs should only be used for those who are medically at risk because of their weight (high BMI), and should be administered only by a physician.
  • Medications used to treat obesity include:

Obesity Diethylpropion

Diethylpropion (Tenuate, Tenuate Dospan) is an appetite suppressant. It works by stimulating the hypothalamus gland, and affecting certain neurotransmitters to decrease appetite. It is used for the short-term treatment of exogenous obesity, along with other lifestyle modifications. It is similar to the amphetamines and has the potential for psychological dependency. It should be used with caution.

Obesity Orlistat

Orlistat (Xenical, Alli) works by slowing down the production of an enzyme (lipase) that breaks down fat in the stomach. This reduces the amount of dietary fat that can be digested by about 30 percent. Orlistat only works within the intestines, and not all over the body like the other diet drugs. Side effects of Orlistat are more common in those who do not follow a low-fat diet.

Diarrhea and cramps are common side effects in those who eat high fat foods when taking Orlistat. Other reported effects include oily spotting, flatulence with discharge, fecal urgency, fatty or oily stool, oily evacuation, increased defecation, and fecal incontinence. It may also interfere with absorption of vitamins A, D, and E.

Most experts recommend additional vitamin supplements for those taking this drug. Orlistat appears to be safe and effective for long-term weight loss.

At the end of the first year, many orlistat users can see an average 10% drop in body weight. Weight loss induced by orlistat can significantly reduce elevated blood pressure in overweight people. Weight loss with orlistat can also produce a significantly greater reduction in cholesterol levels.

Obesity Phendimetrazine

Phendimetrazine (Adipost, Anorex-SR, Bontril PDM, Bontril Slow-Release, Obezine, Phendiet, Plegine, Prelu-2 and Statobex) is a sympathomimetic amine. This class of drugs is similar to amphetamines. This drug works by causing a loss of appetite. Because it is a stimulant, it can also increase your heart rate and raise your blood pressure.

Phendimetrazine precautions:

Obesity Phentermine

Phentermine raises the level of a chemical in the brain, called serotonin. Increases in serotonin have been shown to decrease depression and reduce calorie consumption.

A rare, potentially life-threatening condition called pulmonary hypertension has occurred in people who take a drug, similar to phentermine. An important and serious drug interaction can occur when combining phentermine with Prozac (or similar antidepressant drugs).

Obesity Exercise

In order to lose weight, a healthy diet must be combined with regular physical exercise. Once a person reaches a lower weight, exercise also helps maintain that weight. Thirty minutes of physical exercise each day will not only burn more calories but will lower the blood pressure and pulse. These are direct measures of cardiovascular fitness. Another benefit of exercise is a lowering of blood cholesterol levels. Those with diabetes will find their blood sugar levels easier to control when exercising.

Physical activity may include walking, jogging, swimming, cycling, aerobics, or a step aerobics program. Almost any activity that involves mild to moderate exertion is good. Anyone over 40 or with any medical conditions should plan a program with their doctor. Those with physical disabilities or another health conditions may need to learn less conventional exercises.

Motivation is the key to successful weight loss. Many people find this by joining a health club or regularly exercising with friends.

For more information:

Obesity Goal Setting

Goals must be set that are both personalized and realistic. Each person may have a different reason for starting a weight management program. It may be to control high blood pressure, or it may be to look better and feel more energetic. Whatever the motivation, goals should be realistic and achievable. The maximum recommended amount of weight loss is 2 pounds per week. Therefore, it would not be wise to set the goal of losing 10 pounds per week.

Obesity Specialist

Physicians from the following specialties evaluate and treat obesity:

Obesity Surgery

Surgery is usually a last resort for patients who are dangerously obese and have failed other weight reduction strategies.

Liposuction for Obesity
This procedure removes fat cells in specific areas of the body. Most of these procedures are performed on parts of the body that have high concentrations of fat. This includes the buttocks, thighs, knees, and abdomen. Treatment may result in skin folds.

Gastric Banding for Obesity
This surgical procedure involves placing a band around part of the stomach, in order to reduce the size of the stomach. Dumping syndrome is a potential complication.

Gastric Bypass for Obesity
There are several different surgical approaches, but the most common one (Roux-en-Y) involves the creation of a small stomach pouch that bypasses a large portion of the stomach and a portion of the upper intestine. When food is swallowed, it travels from a small stomach pouch, and then directly into the lower intestine. This bypass has the effect of making a person feel full after eating a small amount of food, and restricts the amount of calories that can be absorbed by the small intestine. Dumping syndrome is a potential complication.

Continue to Obesity Home Care

Last Updated: Nov 3, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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