Treatments and drugs

By Mayo Clinic Staff

The goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals — including a dietitian, behavior therapist or an obesity specialist — to help you understand and make changes in your eating and activity habits.

You can start feeling better and seeing improvements in your health by just introducing better eating and activity habits. The initial goal is a modest weight loss — 3 to 5 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 6 to 10 pounds (2.7 to 4.5 kg) for your health to begin to improve. However, the more weight you lose, the greater the benefits.

All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. Other treatment tools include:

  • Dietary changes
  • Exercise and activity
  • Behavior change
  • Prescription weight-loss medications
  • Weight-loss surgery

Dietary changes

Reducing calories and eating healthier are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently.

Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term.

Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight loss success.

There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:

  • A reduced-calorie diet. The key to weight loss is reducing how many calories you take in. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
  • Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods — such as desserts, candies, fats and processed foods — are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods less packed with calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
  • Adopting a healthy-eating plan. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as nuts and olive, canola, and nut oils.
  • Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories.
  • Meal replacements. These plans suggest that you replace one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off.
  • Being wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight — and keep it off — you have to adopt healthy-eating habits that you can maintain over time.

Exercise and activity

Increased physical activity or exercise also is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking.

To boost your activity level:

  • Exercise. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more significant weight loss, you may need to exercise 300 or more minutes a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. To make your own exercise goal more doable, break it up into several sessions throughout the day, doing just 10 minutes at a time. Exercising with a partner can make this more fun and help you maintain your motivation.
  • Increase your daily activity. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day.

Behavior changes

A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns.

Behavior modification, sometimes called behavior therapy, can include:

  • Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Counseling may be available by telephone, email or Internet-based programs if travel is difficult. Therapy can take place on both an individual and group basis. More-intensive programs — those that include 12 to 26 sessions a year — may be more helpful in achieving your weight-loss goals.
  • Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers.

Prescription weight-loss medication

Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work.

Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked for you and you meet one of the following criteria:

  • Your body mass index (BMI) is 30 or greater.
  • Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea.

Prescription weight-loss medications your doctor may prescribe include:

  • Orlistat (Xenical). Orlistat is a weight-loss medication that has been approved by the Food and Drug Administration (FDA) for long-term use in adults and children 12 and older. This medication blocks the digestion and absorption of fat in your stomach and intestines. Unabsorbed fat is eliminated in the stool. Average weight loss with orlistat is about 4 to 9 pounds (2 to 4 kilograms) more than you can get from diet and exercise after one or two years of taking the medication.

    Side effects associated with orlistat include oily and frequent bowel movements, bowel urgency, and gas. These side effects can be minimized as you reduce fat in your diet. Because orlistat blocks absorption of some nutrients, take a multivitamin while taking orlistat to prevent nutritional deficiencies.

    The FDA has also approved a reduced-strength version of orlistat (Alli) that's sold over-the-counter, without a prescription. Alli is not approved for children. This medication works the same as prescription-strength orlistat and is meant only to supplement — not replace — a healthy diet and regular exercise.

  • Lorcaserin (Belviq). Lorcaserin is a long-term weight-loss drug approved by the FDA for adults. It works by affecting chemicals in your brain that help decrease your appetite and make you feel full, so you eat less. Your doctor will carefully monitor your weight loss while taking lorcaserin. If you don't lose about 5 percent of your total body weight within 12 weeks of taking lorcaserin, it's unlikely the drug will work for you and the medication should be stopped.

    Side effects of lorcaserin include headaches, dizziness and nausea. Rare but serious side effects include a chemical imbalance (serotonin syndrome), suicidal thoughts, psychiatric problems, and problems with memory or comprehension. Pregnant women shouldn't take lorcaserin.

  • Phentermine-topiramate (Qsymia). This weight-loss medication is a combination drug approved by the FDA for long-term use in adults. Qsymia combines phentermine, a weight-loss drug prescribed for short-term use, with topiramate, a medication that's used to control seizures. Your doctor will monitor your weight loss while taking the drug. If you don't lose at least 5 percent of your body weight within 12 weeks of starting treatment, your doctor may suggest either stopping use of Qsymia or increasing your dose, depending on your condition.

    Side effects include increased heart rate, tingling of hands and feet, dry mouth, and constipation. Serious but rare side effects include suicidal thoughts, problems with memory or comprehension, sleep disorders, and changes to your vision. Pregnant women shouldn't take Qsymia. Qsymia increases the risk of birth defects.

  • Phentermine (Adipex-P, Suprenza). Phentermine is a weight-loss medication approved for short-term use (three months) in adults. Using weight-loss medications short term doesn't usually lead to long-term weight loss.

You need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.

Weight-loss surgery

In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery offers the best chance of losing the most weight, but it can pose serious risks. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both.

Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and:

  • You have extreme obesity with a body mass index (BMI) of 40 or higher
  • Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure
  • You're committed to making the lifestyle changes that are necessary for surgery to work

Weight-loss surgery can often help you lose as much as 35 percent or more of your excess body weight. But weight-loss surgery isn't a miracle obesity cure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.

Common weight-loss surgeries include:

  • Gastric bypass surgery. This is the favored weight-loss surgery in the United States because it has shown greater long-term weight loss and improvement of complications, such as type 2 diabetes, than gastric banding. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach. Serious risks from the surgery include blood clots and the need for reoperation. People with higher BMIs and those who aren't able to walk 200 feet (61 meters) or who have a history of obstructive sleep apnea have a higher risk of complications.
  • Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. LAGB is popular because it is less invasive and generally causes slow, steady weight loss, and the band can be adjusted if needed. However, as with other procedures, this won't work without changes in your behavior. Results are usually not as good as with other procedures. Unlike other procedures, the Lap-Band gastric banding device has also been approved for use in people who have a BMI of 30 to 34 and have an additional health condition related to their obesity. Infection, blood clots and the need for another operation are possible complications associated with this surgery.
  • Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. There are ongoing studies evaluating this procedure.
  • Biliopancreatic diversion with duodenal switch. In this procedure, most of your stomach is surgically removed. This weight-loss surgery offers a better sustained weight loss, but it poses a slightly greater risk of surgical complications, such as hernia and blood clots. This procedure can also cause malnutrition and vitamin deficiencies. It's generally used for people who have a body mass index of 50 or more.

Preventing weight regain after obesity treatment

Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. But that doesn't mean your weight-loss efforts are futile.

One of the best ways to prevent regaining the weight you've lost is getting regular physical activity. Aim for 200 to 300 minutes a week. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost.

You may always have to remain vigilant about your weight. Combining a healthier diet and more activity in a practical and sustainable manner is the best way to lose weight and keep it off for the long term. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or eat foods laden with fat and calories.

Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term.

May. 13, 2014

You Are ... The Campaign for Mayo Clinic

Mayo Clinic is a not-for-profit organization. Make a difference today.