It is important to realize that obesity is a chronic condition much like diabetes and high blood pressure. Therefore, there are no quick fix treatment strategies. Many strategies that aim for rapid weight loss usually result in rapid weight regain. More than 95% of the people lose weight regain the weight within five years. Rather, a multidisciplinary, life long approach to weight loss is what is advocated at our institution. Treatment strategies are not aimed at achieving ideal body weight, but instead at reducing obesity and the hazards that attend it. We know that even modest weight reduction can have great health benefits including: lowered blood pressure, reduced blood cholesterol levels, reduced risk of diabetes or improvement in diabetes control, decreased chance of stroke, heart disease and overall mortality. In summary, the goal in treatment of obesity is to achieve and maintain a “healthier weight.
Treatment strategies for treating obesity include:
- dietary modification performed by a trained nutritionist,
- institution of an exercise regimen under the direction of a exercise physiologist,
- treatment of psychological conditions predisposing to weight gain, and institution of preventive measures to lower cardiovascular risk in subjects with obesity.
Recent studies have shown that a sedentary lifestyle was a large contributor to obesity, despite dietary modifications. Physical activity and exercise helps burn calories, build muscle, burn fat, preserve weight loss, and include other health benefits such as: improved blood sugar control, increased insulin sensitivity, reduced cholesterol levels, lowered blood pressure, reduced abdominal fat and reduced risk for heart disease. Many of these health benefits can occur independently (with or without) achieving weight loss. Before starting an exercise program, you should talk to your doctor about the type and intensity of the exercise program. However, general exercise recommendations include 30 minutes of moderate exercise 5-7 days of the week, preferably daily. Exercise should start slowly and progress gradually to avoid injury, excessive soreness or fatigue. For additional information on weight loss and obesity, please visit the Preventive Cardiology Exercise Rehabilitation Program.
The first goal of dieting is to stop further weight gain. The next goal is to establish realistic weight loss goals. While the ideal weight is a BMI of 20-25, this is difficult to achieve for many people with obesity and morbid obesity. Rather a goal is set to lose 10% to 15% of baseline weight. Even modest weight reduction translates into substantial health benefits. General diet guidelines for achieving and maintaining a health weight include: eating more nutritious foods that have low energy density, eating less energy dense foods, and educating yourself in reading food labels, estimating calories and serving sizes. A number of popular diets such as Atkins, Weight Watchers, Ornish, Zone, Susanne Summers, Pritikin, Sugar Busters are available to the public. A recent study that compared four popular diets showed modest and equal weight loss at one year. The biggest hurdle for subjects in this study as with many diet research studies is adherence to the diet over time. Carbohydrate restricted diets have been shown to result in rapid weight loss within 2 weeks largely due to reduced intake of calories rather than effects on appetite, satiety, or fluid shifts. To initiate a dietary program to facilitate weight loss please call 216.444.6568.
Medication treatment of obesity should be used only in patients who have health risks related to obesity. Medications should be used in patients with a BMI greater than 30 or in those with a BMI of greater than 27 who have other medical conditions (such as high blood pressure, diabetes, high blood cholesterol) that put them at risk for developing heart disease. Medications should not be used for cosmetic reasons. One class of medication (sibutramine, phentermine) used for weight control effects the sympathetic nervous system. These medications also decrease appetite and create a sensation of fullness by affecting neurotransmitters in the brain. Another class of drugs changes the metabolism of fat. Orlistat is the only drug that is FDA approved that blocks absorption of fat by the intestines. Orlistat prevents the intestinal absorption of fat by 30%. The drug has few side effects but include gas, cramps, and diarrhea. Clearly there are pro and cons to each medication that is approved for the treatment of obesity. However, one should contact a Cleveland Clinic physician to discuss the appropriateness of drugs for the treatment of obesity.
What is the role of surgery in the treatment of obesity? The National Institute of Health consensus has suggested the following guidelines for patients considering obesity surgery:
- Patients with a BMI of greater than 40.
- Patients with a BMI of greater than 35 who have serious medical problems such as sleep apnea, that would improve with weight loss.
A recent study done in Sweden, evaluated 2 and 10 year data from subjects undergoing bariatric surgery and found approximately 26% weight loss at 2 years and 16% weight loss at 10 years after bariatric surgery. These subjects also a significant rate of recovery from high blood pressure, adult onset diabetes and high triglycerides. The incidence of diabetes and cardiovascular risk was also significant decreased in the bariatric group of subjects.
For information regarding surgical intervention for obesity, please visit our Bariatric and Metabolic Institute.