Treatment.

"How can I lose weight?" It seems to be the central question of the last few decades in the much of the Western world. Weight loss theories are everywhere in the media - online, on TV, in the news, on talk shows, in magazines, on library bookshelves, in doctors' offices, at Subway. There's always a new diet or workout or magic pill to try. There are entire TV series dedicated to watching people lose extreme amounts of weight.

 

There are currently three central strategies for combating obesity - weight loss through diet and exercise (lifestyle changes) first and foremost, then medication, then surgery.

 Lifestyle Changes
The National Heart, Lung, and Blood Institute has several recommendations for weight loss through diet and exercise. The recommended healthy rate of weight loss is 1-2 pounds per week.

• Calorie restriction - the number of calories consumed usually needs to be reduced by 500-1000 calories per day. For women, this usually means 1000-1200 calories per day, and for men this usually means 1200-1600 calories per day. An important part of this is portion control - this means eating one piece of toast rather than three.
• Food choices - avoid saturated and trans fats, cholesterol, and excess sodium (these are found in red meats, egg yolks, and processed foods). Choose low fat dairy products (yogurt, milk, and cheese), proteins (lean meats, fish, beans), whole grains (oatmeal, whole grain bread and pasta), and plentiful fresh or frozen fruits and vegetables.
• Physical Activity - to lose weight, it is recommended to exercise at moderate intensity for 300 minutes each week. This exercise can be broken up into 10 minute chunks.
• Change Leisure habits - Reduce the amount of leisure time spent watching TV or on the computer.
• Reward success - set small goals (losing the first ten pounds, eliminating soda, making it to the gym every day for a week) and reward them as you meet them. The reward should not be food, but rather something like a massage, a day trip, or watching a good movie.

One good tool for considering which foods to eat is the USDA "My Plate". It provides some visual perspective on portion size and food groups.

 

ChooseMyPlate.com also has a feature called the SuperTracker, which allows you to enter in all the food you eat in a day and then visually shows your what your diet is in relation to recommended daily food intake. It is based on the standard guideline of 2000 calories per day, but still provides good feedback on whether you're actually eating enough vegetables or not, or if that granola bar is really as healthy as it claims to be. I used the SuperTracker tool to track my food intake for several weeks as a part of a nutrition class, and was surprised to discover that I generally eat too much sodium and not enough whole grains or vegetables.

 

Regardless of the recommendations, it is an immense challenge to lose weight. In order for weight loss to be permanent, there must be a lifestyle change. This is why fad diets fail - they cause intense amounts of weight loss because they are so extreme, but they aren't sustainable in the long run, and so people return to their previous habits and gain the weight back. It is incredibly difficult to change one's lifestyle permanently, especially if your family or culture functions differently than your goal. As I mentioned earlier, food has great cultural and personal significance for many people. I can't eat my mom's molasses cookies without thinking of Christmas and all the happy times associated with it. They are more than just fat and sugar and empty calories - they are a memory that I can participate in every time I eat them. When all the treasured family recipes are heavy in fat and sodium and light on fresh produce, it can feel like treachery to tweak the recipe or try something new. This is why social support is so significant in weight loss, and why obesity is so much larger than just a medical problem - it is a social problem, affected by many interwoven systemic causes.

 

Medications

There are several approved medications available for weight loss. They are usually not prescribed unless the patient has tried lifestyle changes for at least six months without significant weight loss. It's also important to note that these medications are to be used in addition to lifestyle changes. There is no magic pill that will cause maintainable weight loss without changes in nutrition and exercise. One category of weight loss drugs works by blocking the enzyme that allows for fat to be digested, effectively reducing the calories that the body absorbs. Another class of drugs works on receptors in the brain to reduce appetite. All medications have side effects, and must be prescribed and monitored by a doctor.

 

Surgery

The final medical intervention for obesity is surgery. This is reserved for people with extreme obesity (with a BMI of 40 or higher) or moderate obesity with significant health consequences like sleep apnea or diabetes. Reasonable attempts and lifestyle changes like diet and exercise are required before surgery will be considered.

 

 





 The basic function of weight loss surgery is to reduce the size of the stomach or the amount of food the stomach can hold, forcing people to eat less, more frequently, and more slowly. Surgery is usually effective, but can have serious side effects.