Weight Loss Programs
All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. Other treatment tools include:
- Dietary changes
- Exercise and activity
- Behavior change
- Prescription weight-loss medications
- Weight-loss surgery
Reducing calories and eating healthier are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently.
Avoid drastic and unrealistic diet changes, such as crash diets, because they’re unlikely to help you keep excess weight off for the long term.
Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight loss success.
There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:
- A reduced-calorie diet.
- Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories.
- Adopting a healthy-eating plan. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as nuts and olive, canola, and nut oils.
- Restricting certain foods such as high-carbohydrate or full-fat foods.
- Meal replacements.
Exercise and activity
Increased physical activity or exercise also is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking.
To boost your activity level:
- People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight.
- Increase your daily activity. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits.
Prescription weight-loss medication
Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don’t make these other changes in your life, medication is unlikely to work.
Your doctor may recommend weight-loss medication if other methods of weight loss haven’t worked for you and you meet one of the following criteria:
- Your body mass index (BMI) is 30 or greater.
- Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea.
Prescription weight-loss medications your doctor may prescribe include:
- Orlistat (Xenical). Orlistat is a weight-loss medication that has been approved by the Food and Drug Administration (FDA) for long-term use in adults and children 12 and older. This medication blocks the digestion and absorption of fat in your stomach and intestines. Unabsorbed fat is eliminated in the stool. Average weight loss with orlistat is about 4 to 8 kilograms more than you can get from diet and exercise after one or two years of taking the medication. Side effects associated with orlistat include oily and frequent bowel movements, bowel urgency, and gas. These side effects can be minimized as you reduce fat in your diet. Because orlistat blocks absorption of some nutrients, take a multivitamin while taking orlistat to prevent nutritional deficiencies.
- Lorcaserin (Belviq). Lorcaserin is a long-term weight-loss drug approved by the FDA for adults. It works by affecting chemicals in your brain that help decrease your appetite and make you feel full, so you eat less. If you don’t lose about 5 percent of your total body weight within 12 weeks of taking lorcaserin, it’s unlikely the drug will work for you and the medication should be stopped. Side effects of lorcaserin include headaches, dizziness and nausea. Rare but serious side effects include a chemical imbalance (serotonin syndrome), suicidal thoughts, psychiatric problems, and problems with memory or comprehension. Pregnant women shouldn’t take lorcaserin.
- Phentermine-topiramate (Qsymia). This weight-loss medication is a combination drug approved by the FDA for long-term use in adults. Qsymia combines phentermine, a weight-loss drug prescribed for short-term use, with topiramate, a medication that’s used to control seizures. If you don’t lose at least 5 percent of your body weight within 12 weeks of starting treatment, your doctor may suggest either stopping use of Qsymia or increasing your dose, depending on your condition. Side effects include increased heart rate, tingling of hands and feet, dry mouth, and constipation. Serious but rare side effects include suicidal thoughts, problems with memory or comprehension, sleep disorders, and changes to your vision. Pregnant women shouldn’t take Qsymia. Qsymia increases the risk of birth defects.
- Phentermine (Adipex-P, Suprenza). Phentermine is a weight-loss medication approved for short-term use (three months) in adults. Using weight-loss medications short term doesn’t usually lead to long-term weight loss.
You need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.
Weight-loss surgery or bariatric surgery, offers the best chance of losing the most weight. Weight-loss surgery limits the amount of food you’re able to eat or decreases the absorption of food and calories or both.
Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven’t worked and:
- You have extreme obesity with a body mass index (BMI) of 40 or higher
- Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure
- You’re committed to making the lifestyle changes that are necessary for surgery to work.
Weight-loss surgery can often help you lose as much as 35 percent or more of your excess body weight. But weight-loss surgery isn’t a miracle obesity cure. It doesn’t guarantee that you’ll lose all of your excess weight or that you’ll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.
Common weight-loss surgeries include:
- Gastric Bypass Surgery. This is the favored weight-loss surgery in the United States because it has shown greater long-term weight loss and improvement of complications, such as type 2 diabetes, than gastric banding. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach.
- Laparoscopic Adjustable Gastric Banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. LAGB is popular because it is less invasive and generally causes slow, steady weight loss, and the band can be adjusted if needed. Results are usually not as good as with other procedures. Unlike other procedures, the Lap-Band gastric banding device has also been approved for use in people who have a BMI of 30 to 34 and have an additional health condition related to their obesity.
- Gastric Sleeve or Sleeve Gastrectomy. In this procedure, part of the stomach is removed, creating a smaller reservoir for food.
- Biliopancreatic Diversion with Duodenal Switch. In this procedure, most of your stomach is surgically removed. This weight-loss surgery offers a better sustained weight loss, but it poses a slightly greater risk of surgical complications, such as hernia and blood clots. This procedure can also cause malnutrition and vitamin deficiencies. It’s generally used for people who have a body mass index of 50 or more.
- Gastric Plication. In this procedure, part of the stomach is plicated, creating a smaller reservoir for food.