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Medical Treatment for Obesity

Medical treatment overview

Treatment by a doctor may be necessary when an individual's own efforts to lose weight have failed and/or when coexisting medical conditions make it crucial for a person to lose weight. Prescription medication may be necessary for those with obesity-related health problems. Many people take over-the-counter or alternative medicine supplements in an attempt to lose weight. However, to ensure long-term success, behavioral measures aimed at changing bad habits and eating patterns are an important part of any weight loss program. Behavioral strategies target unhealthy dietary habits and incorporate physical activity into daily life. Obesity-associated eating disorders require treatment by a therapist, and may also require medication.

Specific treatment for obesity will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Types of medical treatment for obesity

Medical treatment for obesity includes, but is not limited to, the following:

• Prescription medications. The most commonly prescribed medications work either by blocking the absorption of some fat or by creating a feeling of fullness. One of the most commonly prescribed medications is called orlistat or Xenical.

  Orlistat reduces the absorption of about 30 percent of fat as food travels through the digestive system. It may cause frequent, oily bowel movements, but if fat in the diet is reduced, symptoms often improve. Once the medication is stopped, some or most of the weight may be regained. Orlistat may not work for everyone and often has unpleasant side effects. 

  Another medication, sibutramine (sold as Meridia), was voluntarily removed from the market by its makers in October 2010 after the FDA found that the drug was associated with an increased risk for heart attack.

  Amphetamines are not recommended because of the risk of substance abuse and addiction.

  Always consult with your doctor before taking any weight loss drugs.

• Supplements. Many over-the-counter supplements promise to help burn fat faster or reduce hunger. Some supplements have side effects that can be dangerous. A number of these products (perhaps most) have never been studied in clinical trials, so many of the side effects, benefits, and risks aren't well-documented. If the claim of the maker sounds almost impossible, it probably is. (For example, "Burn fat at night while you sleep!") 

  Ephedra (ma-huang) contains an ingredient used in asthma medication. Dietary supplements containing ephedra have been banned by the FDA because of potentially dangerous side effects.

  Products that work as a laxative can cause the blood's potassium level to drop, which may cause heart and/or muscle problems. Pyruvate is a popular product that may result in a small amount of weight loss. However, additional ingestion of pyruvate, which is found in red apples, cheese, and red wine, hasn't been thoroughly studied. Its weight loss potential hasn't been scientifically established.

  While there's no supplement that can take the place of eating a healthy diet, a multivitamin taken daily can help close the nutritional gap even for those people who eat a balanced diet. However, vitamin supplements don't produce weight loss.

  Always consult with your health care provider before taking these supplements since they can cause a number of unexpected side effects.

• Behavioral strategies. Over the long term, most obese adults who lose weight will return to their baseline weight if ongoing behavioral strategies aren't used to change their approach to healthy eating. There are techniques for initiating and maintaining changes in lifestyle that may result in sustained weight loss. Some behavioral strategies include keeping a food journal of what was eaten, where food was eaten, when food was eaten, when hunger occurred, and the feelings that were present when eating. A similar activity journal may also be kept. These techniques are useful to analyze eating and activity behaviors, so that behaviors that need to be modified can be identified and strategies for changing those behaviors can be developed.

  A counselor (psychologist) may be helpful with cognitive techniques that may be used to help change a person's thinking about body image. A reward system, unrelated to food, may be developed to help keep a person on track toward weight loss goals. Additional behavioral techniques may include serving food from the stove rather than family style, and never watching television, reading, or doing another activity while eating.

• Psychotherapy for eating disorders. Eating a large amount of food at one time doesn't necessarily make a person a binge eater. Everyone overindulges from time to time. However, there are some obese people who binge and purge (self-induced vomiting or laxative abuse to get rid of unwanted calories from binge eating) or eat large amounts of food compulsively without the purging component and nighttime eating. These behaviors are eating disorders that require treatment by a doctor or other health care provider. Most people who have these disorders are usually either overweight or obese. It's important that the eating disorder be treated before an obese person attempts to lose weight.

  Some eating disorders for which psychotherapy may be prescribed include:

  • Bulimia. A disorder in which a person eats compulsively and then vomits or uses water pills (diuretics), laxatives, or strenuous exercise to prevent weight gain. Feelings of guilt, shame, and depression often follow the binge.

  • Binge eating disorder. A disorder that resembles bulimia and is characterized by episodes of uncontrolled eating or bingeing. It differs from bulimia in that its sufferers don't purge their bodies of the excess food by vomiting, laxative abuse, or diuretic abuse.

  • Nighttime eating. Waking from sleep and eating in the middle of the night is a potentially harmful behavior and a sign of abnormal eating. 

Doctors, psychotherapists, and dietitians can help a person with an eating disorder. Therapy can also help modify behavior and attitudes. Some people benefit from medication and support groups.