Obesity - Treatment

Treatment of obesity depends on two factors: how overweight is a person and how good is his or her general health. The most important point is that to be successful, any treatment must effect lifelong, not short-term, changes. Many people try "yo-yo" dieting. Yo-yo dieting is a pattern in which a person tries some kind of diet for a few weeks or a few months and then quits the diet. Later on, the person tries the same diet again or a new one.

As a result, the person is constantly losing weight and then regaining it. This pattern can be very dangerous. A person who practices yo-yo dieting is more likely to develop fatal health problems than someone who lost the weight all at once and kept it off or someone who never lost the weight at all.

Effective treatment for obesity depends on a few general issues, such as:

• What and how much a person eats. Patients are often asked to keep a food diary listing the foods they eat each day. Then they can analyze their diet to determine its nutritional value and the fat content of foods. The patient may be encouraged to change his or her grocery-shopping habits. For example, buying only the items on a shopping list prevents a person from buying other foods on impulse. Patients can also be taught to eat smaller, more frequent meals and to slow down the rate at which they eat during meals.
• How a person responds to food. Patients can be taught that eating can reflect psychological issues. For example, a person under stress may binge—that is, eat large amounts of food at once. With this understanding, a person may be able to find other ways of dealing with emotional issues besides eating.
• How they spend their time. Many obese people engage in little or no exercise. By making exercise a regular part of their lives, they may be able to lose weight and to keep it off. A variety of exercises can be tried so that the patient does not become bored with only one kind of activity.

For most individuals who are mildly obese, changes of this kind can be made with or without consulting a physician. Other mildly obese people may seek the help of a commercial weight-loss program, such as Weight Watchers. The success of such programs is difficult to measure, however. The programs themselves vary from the highly reputable to the less promising. Also, people tend to drop out of such programs quickly, so it is difficult to judge how effective any one program might be in helping a person lose weight.

Generally speaking, people should be cautious of programs that offer quick and easy results. Losing weight usually requires significant lifestyle changes, including diet and amount of exercise.

People who are moderately obese may require a higher level of professional help. A common approach is to recommend a balanced diet of no more than 1,500 calories per day. Less commonly, a doctor may recommend a verylow-calorie liquid protein diet. A diet of this kind provides no more than 700 calories a day and may be continued for up to three months. This kind of diet should not be confused with commercial liquid protein diets or commercial weight-loss shakes and drinks. Doctors design these diets for the specific needs of each individual patient.

Doctors may also recommend counseling for obese patients. Counseling sometimes helps people deal with psychological issues that lead to their weight-gain problems.

Dietary and lifestyle changes are useful with severely obese patients. But such patients may need even more aggressive treatment. For example, surgery may be performed to decrease the size of a person's stomach or small intestine. The purpose of this kind of surgery is to reduce the volume of food a person can eat.

Other forms of obesity surgery are sometimes performed. Liposuction, for example, is a procedure in which fat is removed from beneath the skin. Liposuction is of little or no value in solving a person's obesity problems. It may change his or her physical appearance, but it does not solve any of the underlying problems that lead to obesity in the first place.

Zack Stenkert at age seventeen months weighing 70 pounds. Obesity is generally measured as 20 percent or more over an individual's ideal body weight. (Reproduced by permission of

AP/Wide World Photos

)

Appetite-suppressant drugs are sometimes prescribed to aid in weight loss. These drugs work by increasing the level of certain chemicals that occur naturally in the brain, making a person feel full. Appetite suppressants can work on a short-term basis. That is, people are likely to lose weight while they are taking the drugs. But the drugs do not solve the basic problems that lead to obesity. When a person stops taking the drugs, his or her appetite returns. The person once again begins eating too much, and the weight returns.

Appetite suppressants are also of some concern because they may have harmful side effects and long-term effects that are not well understood. In November 1997, for example, the U.S. Food and Drug Administration removed a group of appetite-suppressant drugs from the market because they could cause potentially fatal heart defects.

The only weight-loss drug available without a prescription is phenyl-propanolamine (pronounced FEN-uhl-PRO-puh-NOL-uh-meen, trade names Acutrim, Dexatrim). This drug has been found to increase weight loss by a factor of about 5 percent. The problem is that the weight tends to return as soon as the drug is discontinued.

Some of the side effects that may accompany the use of weight-loss drugs include:

• Constipation
• Dry mouth
• Headache
• Irritability
• Nausea
• Nervousness
• Sweating

Alternative Treatment

Some alternative forms of treatment for obesity have problems similar to those of drugs. For example, the Chinese herb ephedra has been recommended in a weight-loss program that also includes a low-fat diet and exercise. The herb does help a person lose weight on a short-term basis. But the weight tends to return when use of the herb is discontinued. In addition, large amounts of ephedra can produce a number of side effects, such as anxiety, irregular heartbeat, heart attack, high blood pressure, insomnia, irritability, nervousness, seizures, stroke, and even death.

Diuretic herbs have also been suggested for the treatment of obesity. A diuretic is a substance that increases the rate of urine output. As a person produces more urine, his or her weight decreases. However, once the herb is discontinued, urine production returns to normal, as does obesity.

Other natural remedies that have been suggested for weight loss include:

• Red peppers and mustard, because they increase a person's metabolic rate (the rate at which food is digested). They also make a person thirsty, so he or she is more likely to drink water (which contains no calories) than to eat food.
• Walnuts, because they increase the level of brain chemicals that tell a person he or she is no longer hungry.
• Dandelion, because it increases the metabolic rate and decreases desire for sugary foods.

Acupressure and acupuncture are also said to decrease the desire for food. Acupuncture is a Chinese therapy that uses fine needles to pierce the body; acupressure involves applying pressure to certain points in the body. Mental techniques such as visualization and meditation may create a better self-image and decrease the need to overeat. Mental concentration, yoga, and similar techniques may provide similar benefits. In many cases, support groups can help a person deal with the problems that led to his or her obesity.