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Weight Loss: What Are Your Options?

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Energy Balance: The Simple Principle of Weight Loss | Using Strategies to Get Started | Looking at Weight Loss Aids | Setting Realistic Goals

Related Media: Changing Our Eating Habits

image for weight loss option article The prevalence of obesity has increased steadily in Western cultures over the past century, particularly during the last several decades. In fact, most health professionals agree that we are in the midst of an obesity epidemic in the United States.

Being overweight is closely linked to many very serious health conditions, most particularly risk factors for heart disease and stroke, including high blood pressure, high cholesterol, high triglycerides, low levels of HDL (high-density lipoprotein—the "good" cholesterol), and type 2 diabetes. Fortunately, even modest reductions in weight can help improve these conditions. Plus, practicing the behavioral changes of a healthier diet and regular exercise can actually reduce these risk factors whether weight loss occurs or not.

Energy Balance: The Simple Principle of Weight Loss

Scientists often explain weight loss quite simply in terms of the energy balance equation: energy in versus energy out. To lose weight, you must consume fewer calories than you burn or, in reverse, you must burn more calories than you consume.

This is, of course, easier said than done. But no matter what weight loss methods you may employ—diet, exercise, medicine, supplements, surgery, therapy, group support—the principle of energy balance is unavoidable. In fact, experts from both traditional and nontraditional disciplines agree that to achieve and maintain weight loss you must make changes in your diet and activity level to favorably affect the balance of the energy equation.

Using Strategies to Get Started

Getting started is often the most difficult part of losing weight. Any changes you make in your eating and exercising behaviors must become habitual, which takes time. In addition, carrying extra weight, no matter how much, can affect how you feel about yourself psychologically, sometimes making it more difficult to take the necessary steps to begin to change.

The following five strategies are crucial to successful weight loss and can help to overcome some of these barriers:

  • Set realistic goals and monitor your progress toward achieving these goals.
  • Modify your eating and exercise behaviors, as well as habits influencing both.
  • Examine and restructure unrealistic, negative thoughts, or expectations.
  • Reduce stress.
  • Develop a network of social support.

Looking at Weight Loss Aids

There is a great deal of interest in whether prescription medicines or supplements can facilitate weight loss. Some medicines suppress appetite by interfering with brain chemicals that affect mood and appetite. Others reduce fat absorption from the gut. Here are examples of medicines that may be recommended for weight loss:

  • Diethylpropion (eg, Tenuate, Tenuate Dospan)
  • Orlistat (eg, Alli [nonprescription], Xenical [prescription])
  • Phendimetrazine (eg, Bontril)
  • Phentermine (eg, Adipex-P)

Some studies have supported the use of these medicines when combined with lifestyle changes. For example, as part of a review of weight loss drugs, researchers analyzed 15 trials involving almost 10,000 people who were either taking orlistat or placebo. Compared to the placebo group, those taking orlistat had a higher chance of achieving a 5% or 10% weight loss. These types of medicines, though, are usually prescribed only for people who are severely obese when other methods of weight loss have not worked. Accordingly, these medicines are not without side effects or potential adverse events and should only be used with careful monitoring by your doctor.

The same goes for dietary supplements. Supplements do not undergo the same rigorous approval process as drugs. That being said, certain supplements may provide weight loss benefits since they may contain similar mechanisms of action as drugs. Along the same line, some of the same risks and side effects may be present, as well, which is why you should talk to your doctor before taking any over-the-counter weight loss products.

Also, be sure you know what is in diet medicines and supplements. Some medicines and supplements that were used in the past have been pulled from the market as it was found that the dangers of taking them were higher than the benefits. Whenever you are considering taking a diet supplement, know exactly what is in the product and share this information with your doctor.

The question is: when should you consider taking these weight loss aids? While it depends on your overall health and medical history, the best approach may be a conservative one. For example, adopt lifestyle changes for 6-12 months before trying a drug or supplement. Your doctor can give you guidance as to which weight loss options you should try first.

Setting Realistic Goals

It is clear that losing weight is not simple. Changing your diet and being more physically active are the building blocks for successful weight loss. Depending on your health status, medicines and supplements may be an option for you. As you think about a health weight loss plan for you, consider these suggestions:

  • Remember that even modest changes can make a big difference.
  • Work with a therapist. A therapist can help you to explore the deeper individual and cultural issues you may have about food, eating, and body image. Use this information to gain a greater degree of self-understanding, acceptance, and compassion.
  • If you are interested in trying medicines or supplement, have realistic ideas about what these can do for you. There is no substitute for making long-term lifestyle changes.
RESOURCES:

National Heart, Lung, and Blood Institute

http://www.nhlbi.nih.gov/

National Institute of Diabetes and Digestive and Kidney Diseases

http://www2.niddk.nih.gov/

CANADIAN RESOURCES:

Canada's Food Guide

http://www.hc-sc.gc.ca/

References

Prescription medication for the treatment of obesity. National Institute of Diabetes and Digestive and Kidney Disorders. Available at: http://www.niddk.nih.gov/health/nutrit/pubs/presmeds.htm. Accessed May 10, 2009.

Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007;335(7631):1194-1199.

Statistics related to overweight and obesity. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.niddk.nih.gov/health/nutrit/pubs/statobes.htm#preval. Accessed October 2, 2003.

Weight loss medications for obesity in adults. DynaMed Editorial Team. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 9, 2012. Accessed May 31, 2012.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Seo DC, Sa J. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults. Prev Med. 2008;47:573-582.

10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: US Food and Drug Administration. Meridia (sibutramine): market withdrawal due to risk of serious cardiovascular events. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm. Published October 8, 2010. Accessed October 15, 2010.

Last reviewed May 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.