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# 1.4 Obesity treatment

Obesity treatment is only successful if weight is reduced and maintained to within a desired range. There are three approaches to obesity treatment: changing behaviour and diet is the most common approach although drugs and surgery can be used in some severe cases of obesity.

Behaviour and diet: it is important to be realistic about an obese patient's target weight as many patients have over-ambitious targets that they are unlikely to achieve. A severely obese patient probably cannot reach an ideal BMI quickly (losing too much weight too quickly puts metabolic stress on the body), but even a weight loss of 10% body weight can significantly reduce the risk of obesity-related disorders. The best combination for weight loss is increasing exercise and decreasing food intake and for lasting effects of obesity treatment a change in eating and exercise habits is necessary and most effective.

Exercise must be based around activities the patient enjoys and can fit into their lifestyle and any increase in exercise is better than no exercise at all. Exercise is beneficial in a weight-loss plan because it uses calories and also increases resting metabolic rate afterwards. Most people also experience a feeling of well-being following exercise and this can be a motivating factor to the patient.

Weight loss is not a simple procedure for most people and requires a dogged determination on behalf of the dieter to stick to the desired regime. People losing weight need support and encouragement to adapt to their recommended dietary and behavioural changes. The motivation for women to lose weight is often their own physical appearance, whereas men are more motivated by health concerns. Partners and friends of the person losing weight can help by providing positive support and motivation and emphasizing the benefits of weight loss such as increased stamina, mobility and self-confidence as well as decreased risk of coronary heart disease, strokes, diabetes, etc.

A practice nurse may suggest that a personalized diet plan is made considering the weight, age and activity level and could include the following:

- include fruit and vegetables with meals;

- avoid high-density-energy between-mealtime snacks and replace crisps and chocolate with fruit;

- spread low fat margarine thinly on wholemeal bread;

- eat low-fat products instead of full-fat products;

- do not fry food; instead bake it in the oven or boil it;

- use skimmed milk instead of full-fat milk;

- remove fat from meat and skin from chicken;

- reduce salt intake (this affects water retention;

- do not add sugar to drinks and avoid soft sugary drinks;

- do not eat pastry, cakes or biscuits as part of a daily routine;

- reduce alcohol intake to national guideline levels (alcohol is high in kcal);

- start walking for an hour or 10 000 steps every day.

Drugs: the only drugs licensed for obesity treatment in the UK are sibutramine (Meridia™) which is an appetite suppressant and orlistat which causes fat malabsorption. Drugs are only licensed for those with a BMI greater than 30 and then only after at least 3 months supervised exercise and behaviour modification has failed to achieve weight loss.

Surgery: surgery can be used to treat Class III obesity, although this is not commonly undertaken in the UK. Either the absorptive capacity of the small intestine is reduced by surgically by-passing part of the small intestine or the size of the stomach is reduced (gastric reduction) so limiting the amount of food that can be taken in. There are considerable risks associated with surgery as it puts a strain on the heart and this risk is increased in obese patients. Some patients have their jaws wired which limits the rate and consistency (i.e. texture) of food intake.

In summary:

1. There is a need for a certain level of daily energy intake to allow the body to maintain its BMR, and to carry out work.
2. Adenosine triphosphate (ATP) is the chemical currency of energy used by the body and is produced from the metabolism of food.
3. The body mass index or BMI indicates whether an adult is a healthy weight for their height.
4. Inadequate nutrition is a huge problem globally. Anorexia nervosa is one example of inadequate nutrition seen in the UK.
5. Obesity is an increasing problem in the western world and is associated with a number of other medical disorders, such as cardiovascular disease.

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OpenLearn - Obesity: balanced diets and treatment
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