Obesity
Treatment Overview
Treatment for obesity will be most successful if you create a long-term plan with your doctor. A reasonable goal might be to begin making lifestyle changes by increasing physical activity and limiting calories.
Your initial goal should be to improve your health, not to achieve an ideal weight. Although the “formula” for weight loss—to burn more calories than you take in—is not complicated, it is often hard to achieve and maintain. Along with lifestyle changes, medicines and surgery may be options for some people. The treatment you need depends on your level of obesity, your overall health, and your motivation to lose weight.
Health guidelines suggest that people should make lifestyle changes for at least 6 months before trying medicines or surgery. Your doctor may suggest medicines and surgery earlier if you also have conditions such as coronary artery disease or type 2 diabetes.2
Medicines for obesity work in different ways. Depending on the medicine, they make you feel full sooner, limit your body's ability to absorb fat, or control binge eating. Surgery is used to reduce the size of the stomach and limit how many calories are absorbed by the intestines.
Your doctor may also suggest counseling. If you use food to cope with depression, loneliness, anxiety, or boredom, you need to learn new skills to deal with those feelings.
Initial treatment
Before beginning treatment, it is important to decide if you are ready to make the lifestyle changes needed to lose weight. Losing weight and maintaining weight loss can be hard, and it may be difficult to find the motivation if you have lost and regained weight several times. Think about successes that you had before and how you were able to achieve them.
If you are not ready to make the changes to lose weight, your doctor may suggest that you set a goal to not gain any more weight or set a date in the future to reconsider your decision.
If you are ready, your doctor may suggest losing 10% of your weight at a rate of 1 lb (0.45 kg) to 2 lb (0.9 kg) per week as your first target. Research shows that a 10% weight loss can improve your health.2 It is better that you maintain a small amount of loss rather than lose a lot of weight fast and gain it back.
Changing eating habits: Eating fewer calories while increasing activity is the best way to lose weight. For most adults, a low-calorie diet of 1,200 to 1,500 calories per day for women and 1,500 to 1,800 calories per day for men is recommended for weight loss.
Research shows that limiting calories—not the types of foods you eat— causes more weight loss. For example, cutting only carbohydrate or fat will not cause any more weight loss than a healthful and balanced low-calorie diet.4, 3
Rather than focusing on a particular type of diet, try to eat healthier foods. Don't try to restrict the foods you love; eat less of them. Eat smaller portions.
In some cases, a very low-calorie diet may be considered, but generally it is not recommended. It should only be conducted under close medical supervision. Over the long term, a low-calorie diet and a very low-calorie diet have similar results.3, 5
Research on low-carbohydrate diets, such as the Atkins plan, show that weight loss is more likely to result from eating fewer calories and staying with the diet for a long time rather than cutting out the carbohydrate.6
Learn more about popular diets for obesity, such as the Zone, Atkins, and Sugar Busters diets.
A dietitian can show you how to make healthy changes in your diet by helping you:
- Plan your meals, which helps you eat regular meals and a balanced, nutritious diet. It can also save you money when shopping. See a meal planning form
(What is a PDF document?).
- Maintain your new diet by eating small serving sizes and not skipping meals.
- Cut fat from your diet, especially by substituting healthy monounsaturated fat for saturated fat. To do this, you will need to understand the difference in types of fat.
- Use lean meats and meat alternatives to limit saturated fat.
Increasing activity: Physical activity helps you burn more calories. One of the best ways to increase your activity is by walking. It is an activity that most people can do safely and routinely alone or with family members, friends, coworkers, or pets, and it is easy to work into a daily schedule.
Keep track of your steps with a step counter or pedometer. If you have a desk job, you may be surprised to see how little you move in a typical day. Wearing the step counter will motivate you to accumulate more steps during the day. Start with a goal of increasing your steps by 2,000 steps per day and work up to 10,000 to 12,000. For more information see:
Overall, experts advise doing either of these things to get and stay healthy:7
- Do moderate activity for at least 30 minutes a day, 5 days a week or more. Moderate activity is equal to a brisk walk, cycling about 10 to 12 miles per hour (mph), sailing, or shooting baskets. You notice your heart beating faster with this kind of activity. Although 30 minutes of activity is not likely to cause weight loss, it does lower your risk for disease and is a good starting point.
- Do vigorous activity for at least 20 minutes a day, 3 days a week or more. Vigorous activity is equal to jogging, cycling at least 12 mph, cross-country skiing, or playing a basketball game. You breathe rapidly and your heart beats much faster with this kind of activity.
Being active in several chunks of 10 minutes or more throughout the day can count towards the above recommendations. You can choose to do one or both types of activity. But research shows that to lose weight and keep it off, you will need 60 to 90 minutes per day of moderate activity.8 Even though you may not be able to do this now, you can make it a long-term goal.
To find out how many calories are burned during various activities, use the Interactive Tool: Calories Burned
calculator.
Talk with your doctor before starting a fitness program. If you have arthritis, you will need to find an activity that does not stress your joints.
For more information on exercise and fitness, see the topic Fitness.
Sticking with it: Stress, family, your environment, and other influences can affect your progress. If you stray from your plan one day, get back on track the next day.
Research shows that people who keep track of what they eat and drink each day are more successful at losing weight. Start a food journal
Track your daily activity. Use the Interactive Tool: Calories Burned
- Understand the connection between stress and eating: Decide whether you eat to calm yourself.
- Have you noticed a change in your eating or weight since a change occurred in your stress level/lifestyle?
- Do you eat when you are not hungry or when you are full?
- Do you eat (or cook) to avoid dealing with a stressful situation?
- Do you find food very soothing?
- Do you use food as a reward?
- If you eat to relieve stress, stop and think about what is really bothering you and how you could deal with it.
- Change what you are doing. Take a short walk down the hall or around the block.
- Call a friend.
- If you are truly hungry, reach for a healthy meal or snack. Focus on the experience of eating and enjoy your food.
- Remove temptations, and think before eating: If you have easy access to a lot of high-fat, high-sugar, tasty foods, it is tempting to eat them. Take a look at your environment and see what causes you to eat more than you need.
- Do you sometimes eat without thinking? If so, give your food the attention it deserves. Try eating only at the kitchen table. Avoid eating in front of the television or the computer, at your desk, or while driving your car. Be aware of what you do while you are preparing food. Do you snack on ingredients as you make dinner? Chew gum while you cook so that you will not be tempted to snack on the ingredients.
- Do you eat whatever is most available because you don't plan ahead? Make it a habit to pack a healthy lunch and snacks the night before.
- Snack from a plate, not from the package. Plan your snacks just like your meals.
- Is eating a positive, pleasurable experience for you? Take some time to relax before a meal so that you can eat slowly and enjoy it. Eat your meals with others and make your mealtime enjoyable.
- Do you try to ignore feelings of hunger and skip meals? This can lead to overeating or eating a high-fat snack later on. Plan for meals and snacks to eat at times when you know you will be hungry. The goal is to eat when you are hungry and not eat when you are not hungry.
- Avoid straying from your plan: Isolated slips are normal, but try these tips to stay with your plan.
- Anticipate situations that may be difficult and visualize how you will deal with them. For example, if you're going to a friend's house to watch a movie, snack food may be present. Bring healthy foods to eat, such as raw vegetables or low-fat crackers.
- Plan for special occasions and situations. Sometimes social situations, such as holidays, parties, and travel, will entice you to eat more. Eat a healthy snack, such as yogurt or fruit before these meals. It will help you have the willpower to make healthier choices.
For more information, see the topics Healthy Eating and Healthy Weight.
Ongoing treatment
See your doctor after 6 months to check your progress. Some people stop losing weight around this time, because their bodies adjust to fewer calories, and their motivation starts to slip.
At this point your doctor may want you to increase your activity and revisit the dietitian to make further changes in your diet. Your goals may switch from losing more weight to keeping the weight off. Staying active is very important for maintaining weight loss.3
If you have lost weight but gained it back, don't be discouraged; it is not uncommon to try several times before weight comes off and stays off. Talk to your doctor about starting again. It may be helpful to work with others who are trying to lose weight in a structured program.
If you cannot keep weight off or have not managed to lose 1 lb (0.5 kg) per week, your doctor may want you to add medicines. Weight-loss drugs generally are used along with eating changes and exercise. Use of medicine without lifestyle changes is not likely to have long-term success. Medicines for weight loss include sibutramine, orlistat, and phentermine.
Treatment if the condition gets worse
If you do not lose weight, continue to gain weight, or have lost weight several times only to regain it, or if your doctor is concerned about a related health problem, you might need to try medicines or surgery.
Weight-loss medicines are not prescribed alone. Diet changes and physical activity are needed for keeping weight off long-term. If not, once medicine is stopped, weight will return.
Medicines for weight loss include sibutramine, orlistat, and phentermine. These drugs work by making you feel full sooner, lowering your appetite, or limiting the amount of fat your body can absorb.
Your doctor may suggest surgery if you have not been able to lose weight with other treatments and you are at high risk for developing other health problems because of your weight.
If your body mass index is over 40 or if it is 35 or higher and you have a serious medical problem that is made worse by your weight, one of the following surgeries may be an option:
- Stomach stapling (vertical banded gastroplasty) or gastric banding. Both make your stomach smaller.
- Roux-en-Y bypass or biliopancreatic diversion not only make your stomach smaller but also limit how much food is absorbed in the small intestine.
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| Author: | Caroline Rea, RN, BS, MS | Last Updated: April 20, 2007 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Matthew I. Kim, MD - Endocrinology & Metabolism | |
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