Treatments for obesity

Treatments for obesity, as in other chronic conditions, involve prescription medications, alternative treatments, surgery, long term therapy, and lifestyle changes to promote and sustain weight loss.

Studies conducted by NHS Centre for Reviews and Dissemination, University of York show that behavioral, diet, exercise, drug and surgical treatments for obesity are effective to some extent, especially when two or more approaches are used in combination. [1]

Treatments for obesity involve a range of interventions, as following:

1. Behavioral Intervention: Behavioral treatments for obesity usually involve management of obesity using several techniques such as conditioning and managed reinforcement. [1]

2. Pharmacological Interventions
Most commonly prescribed pharmacological treatments for obesity include:

• Dexfenfluramine (Redux) and Fenfluramine (Pondimin) prevent the body from absorbing dopamine and norepinephrine, resulting in the sensation of being energized, while reducing the craving for sugar. Side effects include heart problems (damage to the valves of the heart) and lung problems (i.e., pulmonary hypertension).

• Sibutramine (Meridia) works by keeping brain chemicals (neurotransmitters), such as serotonin and norepinephrine in balance and increasing metabolism, resulting in significant weight loss. Sibutramine also causes an increase in energy levels and a feeling of fullness. Side effects of this class of diet pills for obesity include dry mouth, Insomnia, hypertension, and arrhythmias.

• Orlistat (Xenical, 120 mg capsule three times a day ) is related to Olestra, a fat substitute. This diet pill for obesity acts by slowing down the production of lipase, an enzyme in the stomach that breaks down fat, thus preventing the absorption of fat. Side effects include gastrointestinal problems (gas, oily loose stools, and cramping) and may interfere with absorption of vitamins A, D, and E, so vitamin supplements are recommended.

Treatments for obesity

3. Dietary Intervention with an exercise component: The use of Pharmacological treatments for obesity should be combined with physical activity and improved diet to successfully reduce and maintain weight, over the long term. [2]

4. Surgical Intervention

Surgical treatments for obesity do not mean cosmetic procedures, like removal of adipose tissue (fat) by suction or excision.  Generally, surgical treatments for obesity are chosen by severely obese patients who have significant obesity related medical complications, like hypertension, diabetes, and sleep apnea. There is no fixed criterion, but generally patients who go for surgical treatments for obesity are overweight by at least 45 Kg, over their ideal body weight.

There are a number of surgical treatments for obesity available, each with their pros and cons. Surgical treatments for obesity are mainly divided into gastric (stomach) restrictive procedures and gastrointestinal (intestinal) bypass procedures. These procedures involve reducing the size of the gastric reservoir, with or without a degree of associated malabsorption. Various studies have shown that eating behavior improves dramatically after these surgical treatments for obesity. [3]

NHS Centre for Reviews and Dissemination, University of York note that the weight loss achieved by surgical treatments for obesity is greater and more sustained than by any other means. However these surgical procedures are associated with complications, like vitamin and mineral deficiencies, associated mortality, feeling of fullness, dizziness and nausea. [1] Post surgical follow-ups and use of maintenance interventions are necessary to sustain weight loss, as most people begin to regain weight after a few months of surgical treatments of obesity.

References:

[1] NHS Centre for Reviews and Dissemination (1997). Effective Health Care. The prevention and treatment of obesity.

[2] National Institute for Health (1996). Journal of the American Medical Association. Prescription Medicine for the Treatment of Obesity

[3] American Society for Bariatric Surgery (2001). Treatments for obesity. Rationale for the surgical treatment of morbid obesity.