If a person's body mass index (BMI) is in the obese range, a health care provider will usually review their health history in detail, perform a physical examination and recommend testing. While taking a person's health history, a doctor might review their weight history, exercise habits, weight-loss efforts, eating patterns, other conditions the person experiences, stress levels, medications and additional issues related to their health. The person's doctor might also review the person's family health history to find out if they may be predisposed to some conditions. A doctor may also pursue the following.
The word obesity is defined as a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health, leading to reduced life expectancy and/or increased health problems. Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. Diet and exercise are the main treatments for obesity.
A General Physical Examination: The examination includes measuring the person's height as well as checking vital signs such as blood pressure, heart rate and temperature, listening to the person's lungs and heart and examination of the person's abdomen.
Check for Additional Health Issues: If a person has known health issues, a doctor will evaluate them. The doctor will also check for other potential health issues such as diabetes or high blood pressure.
Calculating the Person's BMI: A doctor will check the person's body mass index (BMI) with the goal of determining their level of obesity, something that should be done at least one time each year. A person's BMI also helps to determine the their overall health risk and what treatment might be appropriate.
Blood Tests: The kind of blood tests a doctor may order depend on the person's health, risk factors, as well as any current symptoms they may be experiencing. The tests may include liver function tests, a cholesterol test, a thyroid test, a fasting glucose test and others. The person's doctor might also recommend certain heart tests such as an electrocardiogram.
Measuring the Person's Waist Circumference: Fat stored around a person's waist, at times called, 'abdominal fat,' or, 'visceral fat,' might further increase their risk of diseases such as heart disease and diabetes. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than people who have smaller waist measurements. As with the BMI measurement, a person's waist circumference should be checked at least once every year.
Gathering of this information helps both the person and their doctor to determine how much weight the person needs to lose and what health conditions or risks they already have, something that will guide the doctor's treatment decisions. The goal of obesity treatment is to obtain and remain at a healthy weight. The person might need to work with a team of health care professionals, to include a behavior counselor, a dietitian or an obesity specialist. The health care professionals can help the person to understand and make changes to their eating and activity habits.
The initial treatment goal is often times a modest weight loss, 3 to 5% of the person's total weight. What this means is that if the person weights 200 pounds and is obese by BMI standards, they would need to lose only around 6-10 pounds for them to notice an improvement in their health. The more weight the person loses; however, the more benefits they receive.
All weight-loss programs require changes in a person's eating habits and an increase in physical activity. The treatment methods that are right for the person depend on their level of obesity, their willingness to participate in their weight-loss plan, as well as their overall health. Additional treatment tools include the following:
Changes in Diet
Cutting calories and practicing healthier eating habits are crucial to overcoming obesity. While a person may lose weight rapidly at first, slow and steady weight loss over the long term is considered to be the safest way to lose weight and the best way to keep the weight off permanently. Avoid drastic and unrealistic diet changes such as crash diets because they are not likely to help a person to keep excess weight off over time.
A person who is obese should plan to participate in a comprehensive weight-loss program for at leas a 6 month period of time. They can expect to be in a maintenance phase of a program for at least 1 year to increase their odds of success with losing weight. There is no, 'best,' weight-loss diet. A person should choose one that includes healthy foods they feel will work for them. Dietary changes to treat obesity include the following:
Cutting Calories: The key to weight loss is reducing how many calories a person takes in. The person and their health care providers may review the person's usual eating and drinking habits to find out how many calories the person usually consumes and where they can cut back. The person and their doctor can decide how many calories the person needs to take in every day to lose weight, yet a typical amount is 1,200-1,500 calories for women and 1,500-1,800 calories for men.
Restricting Some Foods: Some diets limit the amount of a certain food group such as high-carbohydrate or full-fat foods. The person should ask their doctor which diet plans have been found to be effective and which ones may help them. Drinking sugar-sweetened beverages is a sure way to consume more calories than the person intended and limiting these drinks, or eliminating them entirely, is a great place to begin cutting calories.
Meal Replacements: Meal replacement plans suggest that a person replace 1 or 2 meals with their particular products, such as meal bars or low-calorie shakes. The plans suggest that a person eat healthy snacks and a healthy and balanced third meal that is low in calories and fats. Over the short term, this type of diet may help someone lose weight. Bear in mind that these diets most likely will not teach a person how to change their overall lifestyle, the person may have to continue the diet if they want to keep weight off.
Making Healthier Choices: To make someone's overall diet healthier, they need to eat more plant-based foods such as vegetables, fruits, and whole-grain carbohydrates. It is important to emphasize lean sources of protein such as lentils, beans, soy and lean meats. If the person likes fish they should try to include fish two times per week. It is important to limit added sugar and salt. They should stick with low-fat dairy products, eat small amounts of fats, and make sure they come from heart-healthy sources such as canola, olive and nut oils.
Feeling Full On Less: The concept of energy density can help a person to satisfy their hunger with fewer calories. All foods have a certain number of calories within a given amount or volume. Some foods, to include candies, fats, desserts and processed foods, are high in energy density. What this means is that a small volume of that food has a large number of calories. On the other hand, other foods such as vegetables and fruits have lower energy density. The foods provide a larger portion size with a lower number of calories. By eating bigger portions of foods that have less calories, a person can reduce hunger pangs, take in fewer calories and feel better about the meal, something that contributes to how satisfied they feel overall.
It is important for people to be very cautious where, 'quick fixes,' are concerned. A person might be tempted by fad diets that promise quick and easy weight loss. In reality, there are no, 'magic foods,' or quick fixes. Fad diets might help in the short term, yet the long-term results do not seem to be any better than other diets. A person may lose weight on a crash diet, although they are likely to regain the weight when they stop the diet. To lose weight and keep it off a person has to adopt healthy eating habits they have the ability to maintain over time.
Exercise and activity
Increased physical activity or exercise is an important part of obesity treatment. The majority of people who have the ability to maintain their weight loss for more than a year get regular exercise, even if it is simply walking. In order to boost your activity level:
Keep Moving: Although regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps with burning calories. Making simple changes in a person's day can add up to big benefits. Park farther from the entrances to stores, increase your household chores, get up and move around periodically, do some gardening and wear a pedometer to track how many steps you have taken over the course of your day.
Exercise: People who are overweight or obese need to get at least 150 minutes each week of moderate-intensity physical activity to prevent additional weight gain, or to maintain the loss of a modest amount of weight. To achieve more significant weight loss, a person might need to exercise 300 minutes each week or more. A person will most likely need to gradually increase the amount of exercise they receive as their fitness and endurance improve.
Changes in Behavior
A behavior modification program can help a person to make lifestyle changes and lose weight while keeping the weight off. Steps to take include examining your current habits to find out what stresses, factors or situations might have contributed to your obesity. Everyone is different and has different obstacles to managing weight such as late night eating or a lack of time to exercise. Tailor your behavior changes to address your individual concerns. Behavior modification, at times referred to as, 'behavior therapy, may include the following:
Support Groups: You can find friends and understanding in support groups where others share similar challenges with obesity. Check with your doctor, commercial weight loss programs for support groups in your area, as well as local hospitals.
Counseling: Therapy or interventions with trained mental health or other professionals may help you to address behavioral and emotional issues related to eating. Therapy can help a person to understand why they overeat and learn healthy ways to cope with anxiety. You can learn how to monitor your activity and diet, understand eating triggers and cope with cravings for food. Therapy can take place on both a group and individual basis. More intensive programs, ones that include 12-26 sessions each year, might be more helpful in achieving your weight loss goals.
Prescription Weight Loss Medication
Losing weight requires a healthy diet in combination with regular exercise. Yet in certain situations, prescription weight loss medication may help. Keep in mind that weight loss medication is meant to be used in conjunction with diet, exercise and behavior changes, not instead of them. If a person does not make these and other changes in their life, medication most likely will not work. A doctor may recommend weight loss medication if other methods of losing weight have not worked for a person and they meet one of the following criteria:
Prior to selecting a medication for someone, a doctor will consider their health history and potential side-effects. Some weight loss medications cannot be used by pregnant women or people who take certain medications, or experience chronic health conditions. Commonly prescribed weight loss medications include:
A person on these medications needs close medical monitoring. Bear in mind that a weight loss medication might not work for everyone and the effects may wane over time. When a person stops taking a weight loss medication, they may regain much or all of the weight they have lost.
Surgery and Weight Loss
In some instances, weight loss surgery, also referred to as, 'bariatric surgery,' is an option. Weight loss surgery limits the amount of food you are able to comfortably eat or decreases the absorption of calories, food, or both. While weight loss surgery offers the best chance of losing the most weight, it may also present serious risks. Weight loss surgery for obesity might be considered if someone has tried other methods of losing weight and have not succeeded. Surgery might be considered if someone:
Surgery does not guarantee that someone will lose all of their excess weight, or that they will keep the weight off over the long-term. Weight loss success following surgery depends on the person's commitment to making lifelong changes in their eating and exercise habits. Common weight loss surgeries include the following:
Gastric Sleeve: With this procedure, part of a person's stomach is removed, creating a smaller reservoir for food. It is a less-complicated surgery than biliopancreatic or bypass diversion with duodenal switch.
Laparoscopic Adjustable Gastric Banding (LAGB): In LAGB, a person's stomach is separated into two pouches with an inflatable band. Pulling the band tight, a surgeon creates a small channel between the two pouches. The band keeps the opening from expanding and is usually designed to remain in place on a permanent basis.
Gastric Bypass Surgery: In gastric bypass, the surgeon creates a small pouch at the top of the person's stomach. The person's small intestine is then cut a short distance below the main stomach and connected to the new pouch. Fluids and food flow directly from the pouch into this portion of the intestine, bypassing the majority of the person's stomach.
Biliopancreatic Diversion with Duodenal Switch: The procedure starts with a surgeon removing a large part of the person's stomach. The surgeon leaves the valve that releases food to the person's small intestine and the first part of the small intestine or, 'duodenum.' The separated section of the intestine is re-attached to the end of the person's intestine, allowing bile and digestive juices to flow into this part of the intestine.
Vagal nerve blockade is another type of treatment for obesity. It involves implanting a device under the skin of the person's abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which then tells the person's brain when their stomach feels empty of full. The new technology gained FDA approval in 2014 for use by adults who have not been able to lose weight with a weight loss program and have a BMI of 35-45 with at least one obesity-related condition such as diabetes type 2.