Weight Loss Treatment – Diet, Exercise and Surgery

Obesity is a major international public health problem and Americans are among the heaviest people in the world. The percentage of obese people in the United States rose steadily

Many people find that although they initially lose weight by dieting, they quickly regain the weight after the diet ends. Because it so hard to keep weight off over time, it is important to have as much information and support as possible before starting a diet. You are most likely to be successful in losing weight and keeping it off when you believe that your body weight can be controlled.

Weight Loss treatment can be grouped into
  • Lifestyle modification by diet and exercise
  • Pharmacotherapy
  • Surgery

1. Lifestyle modification by diet and exercise

Lifestyle modification by diet

Programs that help you to change your lifestyle are usually run by psychologists, nutritionists, or other professionals. The goals of lifestyle changes are to help you change your eating habits, become more active, and be more aware of how much you eat and exercise, helping you to make healthier choices.

It is the preferred method for weight loss for people who are overweight (BMI 23-27 kg.m2) or having class 1 obesity (BMI 27 -32 kg/m2). Its aims at modest weight reduction of 5-10% of body weight within 6 months. The target for weight loss should be 2 kgs every month.

The diet should be restricted to 1000-1200 kcal/day for women and 1200-1600 kcal/day for men. This would help in inducing a calorie deficit of around 500-1000 kcal/day and would help in the above mentioned weight loss goals without causing too much hunger.

The diet should be low in saturated fats, Trans fats, cholesterol, added sugar and salt. Foods to be avoided include deep fried foods, bakery products, refined flour, sweets, red meat, egg yolk and whole milk and its products.

Foods allowed include pan fried/roasted foods, lean meats, egg white, skimmed milk, green leafy vegetables, citrus fruits and whole grain cereals and bread.

Behavior changes include changing your surroundings to limit food intake and increase activity level, keeping a food diary, self -motivation and support as well as rewarding oneself with something other than food.
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Diet and Exercise

Combining exercise with a healthy diet is a more effective way to lose weight than depending on calorie restriction alone. Exercise can prevent or even reverse the effects of certain diseases. Exercise lowers blood pressure and cholesterol, which may prevent a heart attack.

In addition, if you exercise, you lower your risk of developing certain types of cancers such as colon and breast cancer. Exercise is also known to help contribute to a sense of confidence and well-being, thus possibly lowering rates of anxiety and depression.

Exercise is helpful for weight loss and maintaining weight loss.  Exercise can increase metabolism, or how many calories you burn in a day. It can also help you maintain and increase lean body mass, which also helps increase number of calories you burn each day.

To reap the health benefits of exercise, it is recommended that you to perform some form of aerobic exercise at least three times a week for a minimum of 20 minutes per session. However, more than 20 minutes is better if you want to actually lose weight. Incorporating just 15 minutes of moderate exercise — such as walking one mile — on a daily basis will burn up to 100 extra calories (assuming you don’t consume excess calories in your diet afterwards). Burning 700 calories a week can equals 10 lbs. of weight loss over the course of a year.
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Calculating Your Target Heart Rate

To receive all of the health benefits of exercise, you’ll need to mix in some higher intensity exercises. To get an idea of how hard you are working, you can check your heart rate. The basic formula for determining your target heart rate is to subtract your age from 220 and then calculate 60 to 80 percent of that number.

Talk to a trainer or your healthcare team to help you determine your best intensity for each workout. Those with special health concerns such as an injury, diabetes, or a heart condition should consult a physician before beginning any fitness program.

What Are Some Examples of the Different Types of Exercise?

The type of exercise you choose for weight loss doesn’t matter as much as whether or not you’re doing it. That’s why experts recommend you pick exercises you enjoy, so that you’ll stick to a regular routine.

No matter what exercise program you implement, it should include some form of aerobic or cardiovascular exercise. Aerobic exercises get your heart rate up and your blood pumping. Aerobic exercises may include walking, jogging, cycling, swimming, and dancing. You can also work out on a fitness machine such as a treadmill, elliptical, or stair stepper.

Weight Training

A big advantage of working out with weights is that, in addition to shedding fat, you’ll build muscle. Muscle, in turn, burns calories. Talk about a healthy feedback loop! Experts recommend working all the major muscle groups three times per week. This includes:
  •     abs
  •     back
  •     biceps
  •     calves
  •     chest
  •     forearms
  •     hamstrings
  •     quads
  •     shoulders
  •     traps
  •     triceps


Yoga is not as intense as other types of exercise, but it can help you lose weight in other ways, according to a recent study by researchers at the Fred Hutchinson Cancer Research Center. The study found that people who practice yoga are more mindful about what they eat and, therefore, less likely to be obese.

Activities and the Amount of Calories They Burn

The average adult male who doesn’t exercise requires approximately 2,200 calories a day to maintain his average weight. A female needs about 1,800 calories to maintain her weight.

The following list contains common activities and the approximate amount of calories burned per hour:

Activities Calories Burned
  • Playing baseball, golf, or cleaning the house,  calories burned 240 to 300
  • Brisk walking, biking, dancing, or gardening calories burned 370 to 460
  • Playing football, jogging (at a nine-minute-mile pace), or swimming calories burned 580 to 73
  • Skiing, racquetball, or running (at a seven-minute-mile pace) calories burned 740 to 920

Before You Start an Exercise Program

Talk to your doctor before you start a new exercise program, especially if you are planning on doing vigorous exercise.  This is especially important if you have:
  •     heart disease
  •     lung disease
  •     diabetes
  •     kidney disease
  •     arthritis

People who have been very inactive for the recent months, who are overweight, or have recently quit smoking should also talk to their doctors before staring a new exercise program.

When you are first starting a new exercise program, it’s important to pay attention to the signals your body is giving you. You should push yourself, so that your fitness level improves. However, pushing yourself too hard can cause you to injure yourself.  Stop exercising if you start to experience pain or shortness of breath.
See Also : Aerobic Exercise and Weight Loss

Drugs for weight loss

Taking a weight loss medicine may be helpful when used in combination with diet, exercise, and lifestyle changes . However, it is important to understand the risks and benefits of these medicines. It is also important to be realistic about your goal weight using a weight loss medicine; you may not reach your “dream” weight, but you may be able to reduce your risk of diabetes or heart disease. 

Medicines for weight loss may be indicated for people who are overweight or obese but are unable to achieve their goals through diet and exercise. It is important to remember that all drugs may have some side effects and should be taken on a short term basis on prescription by a registered medical practitioner only.

1. Orlistat 
Orlistat (brand name: Xenical) is a medicine that reduces the amount of fat your body absorbs from the foods you eat. A lower-dose version (brand name: Alli) is available without a prescription in many countries, including the United States. The recommended dose of the prescription version is 1 capsule three times per day, taken with a meal; you can skip a dose if you skip a meal or if the meal contains no fat.

After one year of treatment with orlistat combined with lifestyle changes, the average weight loss is approximately 11.7 pounds (5.3 kg) or 8 to 10 percent of initial body weight (4 percent more than in those who used a placebo pill with lifestyle changes). Cholesterol levels often improve and blood pressure sometimes falls. In people with diabetes, orlistat may help control blood sugar levels.

Side effects occur in 10 to 15 percent of people and may include stomach cramps, gas, diarrhea, leakage of stool, or oily stools. These problems are more likely when you take orlistat with a high-fat meal (if more than 30 percent of calories in the meal are from fat). Side effects usually improve as you learn to avoid high-fat foods. Severe liver injury has been reported rarely in patients taking orlistat, but it is not known if orlistat caused the liver problems.

2. Lorcaserin 
Lorcaserin (brand name: Belviq) is a medicine that reduces appetite and thereby reduces body weight in men and women. Lorcaserin appears to have similar efficacy as orlistat. After one year, the mean weight loss is approximately 12.8 pounds (5.8 kg, or approximately 5 to 6 percent of initial weight), compared with 6.4 pounds (2.9 kg, or approximately 2 to 3 percent of initial weight) in the placebo group. Adverse effects of lorcaserin included headache, upper respiratory infections, nasopharyngitis (inflammation in the nose and throat), dizziness, and nausea, occurring in 18, 14.8, 13.4, 8, and 7.5 percent of patients, respectively.

Lorcaserin is usually taken twice daily, with or without food. If you take lorcaserin, your doctor should monitor you closely to evaluate your weight loss. If you do not lose at least 5 percent of your initial body weight within 12 weeks, the medicine should be stopped.

Lorcaserin should not be used in individuals with reduced kidney function or during pregnancy. In addition, lorcaserin should not be used with certain drugs (including many medications used to treat depression).

3. Phentermine-topiramate 
Phentermine is a medicine that reduces food intake by causing early satiety (a feeling of fullness). Topiramate is used for the prevention of migraine headaches and epilepsy. Patients taking topiramate for these indications lose weight, but the way this works is uncertain. Phentermine and extended-release topiramate are available in combination as a single capsule (brand name: Qsymia). In one-year trials studying phentermine-topiramate, patients taking the medication lose approximately 8 to 10 percent of their initial body weight (mean weight loss 22.4 pounds [10.2 kg]) compared with 1.2 percent in the placebo group (mean weight loss 3.1 pounds [1.4 kg]).

The dose of phentermine-topiramate is usually increased gradually, while weight loss is monitored. If you do not lose 5 percent of your initial body weight after 12 weeks on the highest dose, phentermine-topiramate should be discontinued gradually, as abrupt withdrawal of topiramate can cause seizures.

The most common adverse events are dry mouth (13 to 21 percent), constipation (15 to 17 percent), and a “pins and needles” sensation of the skin. There is also a risk of psychiatric (eg, depression, anxiety) and cognitive (eg, disturbance in attention) adverse events; this risk increases with larger doses of the medication. Although phentermine-topiramate improves blood pressure slightly, it is also associated with an increase in heart rate.

Phentermine-topiramate should not be used during pregnancy because of the risk of birth defects; women of childbearing age should take a pregnancy test before starting this medication (and monthly thereafter) to ensure that they are not pregnant. It should also not be used in people with cardiovascular disease (high blood pressure or coronary heart disease).

4. Bupropion-naltrexone 
Bupropion is a medicine that is used to treat depression and to prevent weight gain in people who are trying to quit smoking. Naltrexone is a drug used to treat alcohol and drug dependence. In a one-year trial studying combination bupropion-naltrexone (in one pill), patients taking the medication lost approximately 5 to 6 percent of their initial body weight (11 to 13 pounds [5 to 6 kg]), compared with 1.3 percent (approximately 3 pounds [1.3 kg]) with placebo. Common adverse effects include nausea (30 percent), headache (17 percent), constipation (19 percent), insomnia, vomiting, dizziness, and dry mouth. Combination bupropion-naltrexone appears to have similar efficacy as but more adverse effects than lorcaserin.

The dose of bupropion-naltrexone is increased gradually over four weeks. If you do not lose at least 5 percent of your initial body weight after 12 weeks, the medication should be discontinued because benefit is unlikely.

Bupropion-naltrexone should not be used in people with uncontrolled high blood pressure, a seizure disorder, or an eating disorder. It should also not be used by people who take (or have recently taken) certain other medications, including those containing bupropion, chronic opioids (narcotics), or monamine oxidase inhibitors.

5. Liraglutide  
Liraglutide at 3.0 mg/day is approved by the US Food and Drug Administration (FDA) for weight loss. It can be used at a lower dose to treat diabetes. Patients without diabetes taking the highest doses of liraglutide for approximately six months lost 7.4 percent of their initial body weight (16 pounds [7.2 kg]), compared with 4.3 percent (9 pounds [4.1 kg]) in patients taking orlistat. Adverse effects of liraglutide include nausea (37 to 47 percent), vomiting (12 to 14 percent), diarrhea, low blood sugar, and loss of appetite. Serious but less common side effects include pancreatitis, gallbladder disease, renal impairment, and suicidal thoughts.

Liraglutide is injected under the skin in the abdomen, thigh, or upper arm once daily. The initial dose is 0.6 mg daily for one week. The dose can be increased at weekly intervals (1.2, 1.8, 2.4 mg) to the recommended dose of 3 mg. If after 16 weeks you have not lost at least 4 percent of your initial body weight, liraglutide should be discontinued, as it is unlikely to have significant effects after that point. Long-term data (greater than one to two years) on the effectiveness of liraglutide are not available.

Liraglutide should not be used in people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B.

Surgery For Weight Loss

Weight loss surgery, also called bariatric surgery, is used to treat people who are dangerously obese. This type of surgery is only available on the NHS to treat people with potentially life-threatening obesity when other treatments, such as lifestyle changes, haven't worked.

Resorting to surgery for weight loss is quite a drastic measure, but for some morbidly obese people, bariatric surgery can lower death rates especially for those with weight related complications. The easiest and most obvious route to weight loss is to make small steps, or gradual changes, in lifestyle, eating habits and exercise routines.  Despite best efforts this approach is not always effective for everybody and there may be reasons why you are not losing weight which should be explored before considering weight loss surgery.

This is only effective treatment for long term effective weight loss in morbidly obese individuals (BMI > 32 kg/m2 with associated comorbidities or BMI > 37 kg/m2 with or without comorbidities)

For people who meet the above criteria, weight loss surgery has proved to be effective in significantly and quickly reducing excess body fat. 

Because of these associated risks, most surgeons, whether they're working privately or for the NHS, would only consider someone for surgery if there was a clinical need, and not for cosmetic reasons.

However, it's always recommended that you try to lose weight through a healthy, calorie-controlled diet and increased amounts of exercise before you consider weight loss surgery, as surgery carries a risk of complications and requires a significant change in lifestyle afterwards.

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