What are the treatments for the condition?
NIH recommends weight loss treatment for people who have one or more of the following conditions:
a BMI between 25 and 29.9 and two or more risk factors
a BMI of 30 or higher
a high-risk waist circumference and two or more risk factors
The first weight loss goal should be a 10% weight loss over a 6-month period. The rate of weight loss should be 1 to 2 pounds a week. Faster weight loss does not improve the long-term results. After the first 6 months, additional weight management goals can be discussed with the healthcare provider. Sometimes more weight loss is needed. Others may be ready to maintain their weight loss.
No one treatment works for everyone. The healthcare provider should follow these guidelines in planning treatment:
know how the treatment fits into other healthcare and self-care needs of the person
make changes based on the person's preferences and responses
set weight loss goals with the individual
schedule regular office visits to track and support weight loss
A successful weight management plan will include the following components:
behavior therapy
dietary therapy
regular physical activity
The plan may also include medicines or surgery.
Dietary therapy
Dietary therapy is works best when it meets the needs of the individual. NIH recommends the following general dietary guidelines.
A diet with 1,000 to 1,200 calories a day is appropriate for most women.
A diet with 1,600 calories a day is appropriate for most men.
A diet with 1,600 calories a day may be appropriate for women who exercise regularly or weigh over 165 pounds.
A 1,200-calorie diet may be recommended for a person who is not losing weight on a 1,600-calorie diet.
If a person is hungry, the healthcare provider may recommend adding 100 to 200 calories a day.
Specific dietary recommendations should be given to be sure the person gets enough essential nutrients.
Physical activity
To begin treatment of obesity, NIH recommends moderate levels of physical activity 30 to 45 minutes a day, 3 to 5 days a week. The activity should be started slowly and gradually increased in intensity. Some moderate physical activities are as follows:
bicycling 5 miles in 30 minutes
gardening for 30 to 45 minutes
raking leaves for 30 minutes
walking 2 miles in 30 minutes
water aerobics for 30 minutes
Behavior therapy
Behavior therapy provides ways to overcome barriers to dietary therapy or physical activity. A good behavior therapy plan has the following characteristics:
incorporates the person's attitudes, beliefs, and history
includes a partnership with the healthcare provider
sets reasonable goals
includes self-monitoring, with appropriate rewards
focuses on what matters
includes frequent contact with the healthcare provider
Medicine and surgery
The Food and Drug Administration, or FDA, has approved only two medications for long-term use for weight loss. They are orlistat, or Xenical, and sibutramine, or Meridia. These medicines may be prescribed for people with a BMI of 27 to 29.9 with comorbidities. NIH also includes them as a consideration for people with a BMI of 30 or higher.
Surgery, which changes the way food is absorbed, is sometimes used to treat obesity. NIH includes surgery as an option for people with a BMI or 30 or higher and comorbidities.
Tools
NIH provides sample tools to aid in weight management. These include the following:
dietary information
guide to behavior change
guide to physical activity
weekly food and activity diary
weight and goal records
Contraindications
NIH states that these groups of people should be excluded from weight loss treatment:
women who are pregnant or breastfeeding
people with a serious uncontrolled psychiatric illness, such as major depression
individuals with serious illnesses that might be worsened by calorie restriction
NIH also recommends that certain individuals be referred to specialists for weight loss as needed. These include people with a history of eating disorders, such as anorexia nervosa or bulimia. People who are currently abusing drugs should also be referred to a specialist.
What are the side effects of the treatments?
Losing weight is not risk-free. Diets that are not carefully planned increase the risk of vitamin deficiencies. Rapid weight loss can cause nausea, tiredness, weakness, hair loss, and low blood pressure. Dieting can also lead to emotional changes and binge eating. Medicines may cause increased blood pressure and heart rate, decreased absorption of fat soluble vitamins, and loose stools. Surgery for weight loss has all the risk of any major surgery. Nutrient deficiencies can also occur if parts of the digestive system are bypassed.
What happens after treatment for the condition?
After the person has reached the weight loss goal, weight maintenance needs to be lifelong. The person should have regular treatment to continue with these measures:
behavior therapy
dietary therapy
regular physical activity
The ongoing therapy can be given in a number of ways. Some options recommended by NIH include:
e-mail reminders
group meetings
regular visits with the healthcare provider
telephone communications
Weight loss in an obese person can have the following effects:
lower blood pressure in those with high blood pressure
lower elevated blood glucose levels in people with diabetes
lower elevated cholesterol, LDL cholesterol, and triglyceride levels
increase low levels of HDL cholesterol
While these effects are beneficial, they may also signal a need for a change in medicines. For example, the person may need lower doses of a medicine to lower blood pressure. Other people may need different medicines or be able to stop medicine completely for elevated blood glucose levels.
How is the condition monitored?
After successful treatment for obesity, the person can check his or her weight regularly. The individual will also have regular visits with the healthcare provider. NIH recommends an appointment at 6 months and again one year after the start of the weight management plan. The healthcare provider will look at the person's weight, BMI, and waist circumference during these visits. Any new or worsening symptoms should be reported to the provider.
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