CONDITIONS

Obesity

What Is Obesity

According to the National Health and Nutrition Examination Survey, more than 2 out of every 3 adults—and 1 out of every 3 children—are overweight, and more than half of these overweight people are obese. Obesity is a multi-faceted and complex medical condition, characterized by a person being grossly fat or overweight. One can be overweight without being obese—some people weigh more than the average for their height because of muscles, bone, or water weight. But if you have too much fat, it can endanger your health and put you at serious risk of health conditions such as heart disease, diabetes, and high blood pressure.

The main tool used to measure body fat—and can hence tell whether one is overweight or obese—is the body mass index (BMI). You can calculate your body mass index by dividing your weight in kilograms (1 kg ≈ 2.2 lb) by your height in meters squared (1 m ≈ 3.28 ft; 1 m2 ≈ 10.76 ft2). You can find out your BMI online by entering your height and weight into the BMI calculator provided by the Centers for Disease Control and Prevention.

A typical healthy person has a BMI of 18.5 to 24.9.  A BMI of 25 or greater is considered overweight, and a BMI of 30 or greater is likely to be obese.

BMI Weight status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0-34.9 Obese (Class I)
35.0-39.9 Obese (Class II)
40.0 and higher Extreme obesity (Class III)

BMI is not a perfect measurement. Some people may have a BMI in the overweight or obese category, even if they don’t have a lot of body fat. Very muscular people are one example, and some people may have a high weight because of bone mass, excess water, or a stocky build. But for most people, BMI is a reasonable place to start when you want to know if you have a healthy weight.

Fortunately, if you are overweight or obese, even a little weight loss can help you improve your health and prevent some of the health problems that obesity may cause. Losing weight isn’t easy. It can take time and effort to get rid of excess pounds and keep them off. But losing weight can make a permanent and vital difference in your overall health.

What Causes Obesity

Ultimately, body weight is the result of genetics, metabolism, environment, behavior, and culture. But the most common causes of obesity and weight problems are overeating and physical inactivity. The essential equation remains: if you eat more calories than you use in a day, then you will gain weight, as your body stores those extra calories as fat.  If the number of calories you eat in a day is about the same as the number of calories you use, your weight should stay more or less the same. And if you use more calories than you take in, then you will likely lose weight.

Put a different way, obesity is caused by taking in more energy (calories) than your body uses. All living things need energy. Your body gets this energy from the foods you eat. Your body uses energy all the time, but it uses more energy when you’re moving than it does when you’re sitting still. Simply put, obesity is caused by an imbalance of energy consumption and energy expenditure. When the body consumes more calories than it burns, it stores the excess energy in fat cells – a gross accumulation of which can lead to obesity. Scientists are increasingly acknowledging the influence of factors like genetics, sleep level, and medications on the body’s ability to burn calories.

So if your weight has been constant for a long time and then starts increasing, it may mean that you’re eating more calories, or that you’re exercising less, or it could be caused by something else that changes the way your body uses energy, such as:

  • Being pregnant
  • Getting less sleep
  • Some medications or health conditions

Risk Factors For Obesity

Not everyone has the same risk of obesity. Some factors that can make you likely to be overweight or obese include:


Genetic Factors. Research suggests that genes, which give the body directions for responding to its environment, can influence several obesity-causing factors including the amount of body fat you store, where that fat is distributed, how efficiently your body converts food into energy, and how your body burns calories during exercise. Most recently, a team of international scientists has found that the AMY1 gene, which controls the production of an enzyme found in saliva, is strongly correlated with obesity risk. Individuals with less than four copies of the AMY1 gene are eight times as likely to be obese than individuals that who have more copies. According to the federal Centers for Disease Control (CDC), genes are also responsible for varying capacities for hunger and caloric intake. But genetic factors, the agency says, can’t be completely blamed for obesity. Genetic changes happen too slowly in the human population to be responsible for the fast-spreading “obesity epidemic” in the world, the CDC says. Instead, the agency cites increased inactivity and increased consumption of calorie- and fat-laden foods as the driving force behind the epidemic.


Family and Friends. A study by researchers from Harvard University and the University of California in San Diego found that if one sibling became obese, the odds of another sibling becoming obese increased by 40 percent. The same analysis found that if one spouse became obese, the odds that the other spouse would do the same increased by 37 percent. Scientists theorize that over time, a social or familial network changes what people see as usual and acceptable.


Physical Inactivity. When we take in more calories than we burn, we gain weight. The less active we are, the harder it is to burn those excess calories. The American Heart Association reports that sedentary jobs have increased by 83 percent since 1950, and physically active work now only accounts for 25 percent of jobs. Additional factors in the sedentary inactivity epidemic include improved transportation technology. From subways to automobiles to escalators, walking is becoming less and less a part of daily life. Overall, the AHA says, “the consequences of physical inactivity are staggering.”


Unhealthy Eating Habits. Although it’s a well-established fact that having a high-fat, high-calorie eating pattern promotes weight gain and is almost certain to lead to obesity, the reasons behind our unhealthy eating habits are complex. It’s not just lack of “willpower” that drives us to eat unhealthy foods: A recent study conducted in Belgium found that high-fructose corn syrup has the same addictive effects as cocaine on the brains of the mice the researchers studied. Over the past decades, Americans have been subjected to a never-ending bombardment of advertising promoting convenient but unhealthy foods. Marion Nestle, editor of the 1988 Surgeon General’s Report on Nutrition and Heal Weight Gain, cites Big Food’s targeted campaigns to minorities and children as examples of the industry’s lack of commitment to good health. Further, portion sizes have grown in restaurants. According to the National Heart, Lung and Blood Institute, part of the National Institutes of Health, portions today are equal to what would have been meals for two or three people twenty years ago.


Pregnancy. Ideally, a woman’s weight should increase 25 to 35 pounds during pregnancy, according to the federal National Library of Medicine (NLM). The agency says that much of the normal weight gain stems from the baby itself, as well as the placenta, amniotic fluid and increases in the amount of breast tissue, blood supply and fat stores. Women who are already obese when they become pregnant, or become obese during pregnancy, are at risk for a number of serious conditions. For women who are overweight prior to pregnancy, weight gain should be constrained to be more modest, because the risk of becoming obese is much higher. The federal Centers for Disease Control (CDC) lists some of the potential problems as stillbirth, cesarean deliveries and the baby being born with diabetes. Up to 10 percent of women may suffer an excess level of hormones that released by the thyroid gland after pregnancy. That usually causes mild hypertension, but the condition isn’t permanent. The National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH), says that other obesity-related hormones, including leptin and ghrelin, are genetic and can cause chronic obesity. But there is no evidence that levels of this hormone increase during pregnancy. The bottom line for post-childbirth weight gain: extra pounds is not inevitable; experts universally say that eating well and exercising can help you manage your weight.


Lack Of Sleep. The Landmark Nurses’ Study found a distinct link between lack of sleep and obesity. The investigation followed 60,000 nurses for 16 years. At the beginning of the study period, none were obese. But after 16 years, women who slept five hours or fewer per night had a 15 percent higher chance of becoming obese than those who got enough sleep. Experts cite several reasons for the link between weight and lack of sleep. People who don’t get enough sleep may be too tired to exercise. They also may eat more than people who are well rested because they are awake for more hours and because appetite-controlling hormones are disrupted by the lack of sleep. Other irregular eating patterns, such as skipping breakfast, may also lead to weight gain.


Several types of medications can lead to weight gain, including some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers. According to experts from the Johns Hopkins School of Medicine, the reasons for medication-related weight gain aren’t always clear. Some drugs may cause an increased craving for food, leading to overeating, and other medications, can lead to fatigue, which is likely to make a person less active. The Hopkins team also reports that weight gain is so common among Americans that it’s often impossible to single out a medication as a cause.


Generally, rates of obesity are highest during adulthood, specifically ages 50+. About 1 in 3 (approx. 30%) of American adults are obese, however this rate is higher for those who were obese as school-age children. One study found that about half (42 to 63%) of obese school-age children go on to be obese adults. The percentage of older people – age 65 and over – is more than one third, according to the Centers for Disease Control. The problem of obesity in older age may be aggravated by a reduction in what is already inadequate physical activity.


Illnesses and Health Conditions. Diseases that are linked to obesity include: Heart disease, high blood pressure, type 2 diabetes, cancer, osteoarthritis, depression and sleep apnea, according to the federal Centers for Disease Control (CDC). Other illnesses linked to obesity include Prader-Willi syndrome, hypothyroidism and Cushing’s syndrome. There may also be a link between obesity and smoking. According to the National Library of Medicine, one study found that obese smokers tended to have higher levels of fat accumulation than obese nonsmokers.


Improper Prenatal and Postnatal Care. According to the Harvard School of Public Health, factors influencing obesity begin in the “intra-uterine environment” and help shape the “trajectory of weight gain…throughout the life course.” Prenatal factors that influence an offspring’s obesity include the mother’s weight gain and blood sugar levels throughout pregnancy. Developing pregnancy-related (gestational) diabetes is especially harmful. Although it might seem like common sense to assume that the quality of a mother’s diet during pregnancy would affect her offspring’s weight, Harvard says no concrete relationship between the two has been established. A Harvard study published in 2007 found that children of mothers who gained an excessive amount of weight during pregnancy had four times the risk of being overweight at age three than children who were born to mothers who gained an “inadequate” amount of weight during pregnancy.

Diagnosing Obesity

When you visit your doctor about a weight problem, your doctor will check your height and weight, and calculate your BMI. Your doctor will also ask you questions about your eating and exercise habits, what you think might be causing or contributing to your excess weight, and how much weight you hope to lose. Other questions may focus on:

  • Your medical history
  • How your weight affects your day-to-day life
  • What methods you’ve tried, if any, to lose weight in the past, and whether they have been successful or not
  • How ready you are to make the necessary changes in your life
  • What obstacles may get in your way

Your doctor will also perform a physical exam to check vital signs such as your heart rate and blood pressure. Measuring the circumference around your waist can tell your doctor some information about how much your weight is likely to affect your overall health. Fat stored around your waist, sometimes referred to as abdominal fat or central obesity, may further increase your risk of diseases such as diabetes and heart disease. Women with a waist measurement (circumference) of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than those with smaller waist measurements.

In all likelihood, your doctor will also order blood tests to check for health problems associated with overweight and obesity. Some of the lab tests your doctor may request include:

  • Fasting glucose level
  • Cholesterol test
  • Liver function
  • Thyroid test

Your doctor may also want to check your heart function with an electrocardiogram or other tests.

Obesity is most commonly diagnosed using a patient’s body mass index (BMI). BMI is an estimation of body fat that is calculated using a patient’s height and weight in proportion to a healthy standard. You can calculate your own BMI by following the directions on the National Institute of Health’s online BMI calculator, but remember that it doesn’t take into account factors like muscle mass or bone density, so its conclusions might not be absolute. For the most accurate assessment of your weight and health, you should visit your doctor.

If you do decide to calculate your own BMI, here are guidelines to help you interpret the results:

For adults, a BMI of:

  • 18.5 to 24.9 is considered normal weight
  • 25.0 to 29.9 is considered overweight
  • 30.0 to 39.9 is considered obese
  • 40.0 and higher is considered extremely obese

Waist circumference can also be a helpful measure of obesity and obesity-associated health risks. A high waist-to-hip ratio (meaning that more fat is accumulated around the midsection than the hips) increases the risk for developing serious, even life-threatening conditions associated with obesity such as heart disease and diabetes. ­­­You can calculate your waist-to-hip ratio online here.


Guidelines for interpreting your waist-to-hip ratio are:

For Men:

.90 or below – Low health risk

.91-.9 – Moderate health risk

1.0+ – High health risk

 

For Women:
.80 or below – Low health risk

.81-.85 – Moderate health risk

.86+ – High health risk

Symptoms of Obesity

Obesity happens one pound at a time, and can quickly creep up on those who are already overweight. The following factors could be signs of existing or imminent obesity:

  • Excessive fat accumulation, especially around the midsection
  • Lack of physical activity
  • Binge eating or lack of control over food intake
  • A diet high in saturated fats and refined sugars

Prognosis

Eating and exercise habits can be hard to change. Many obese people are able to lose at least 20 pounds with diet and exercise plans, but only about 10 – 20% can maintain that weight loss for a long period of time. Because obesity develops over time, reversing obesity often requires making significant and permanent lifestyle changes.  However, if the necessary changes to diet and exercise regimens are made, obesity and nearly all of its associated health risks can be reversed.

Living With Obesity

If you are obese and have not been unable to lose weight, there are still things you can do to make living with this condition easier and safer. Here are 5 tips:

  • Don’t give up on being healthy. Even though you may not be seeing weight loss results, eating healthy and exercising regularly are still important for your health and will improve your general quality of life.
  • Eat less fried, salty foods. Even though fried, salty foods might be a treat for your taste buds, too much of either can lead to serious health complications. Fried foods are rich in saturated fats, which contribute to high cholesterol levels and raise your risk of heart attack and stroke. Foods high in salt contribute to high blood pressure, which also raises your risk of health complications such as heart attack, stroke, metabolic failure, and heart failure.
  • Keep active. If excess weight makes regular exercise too strenuous, find gentler ways to stay active. Stretching and modified yoga can help maintain muscle health, improve circulation, and boost energy levels.
  • Stay comfortable. Be mindful of the limitations your weight creates. Opt for a memory foam mattress to help make your nights more restful, and call ahead to ask about seating options at special events or restaurants. When flying, make sure to choose an airline that can provide larger seatbelts, wider seats, or an extra seat free of charge.
  • Drink a lot of water. Drinking 8 to 10 glasses of water each day helps to cleanse your body’s systems of toxins and impurities.

Screening

The U.S. Preventive Services Task Force recommends that doctors screen all adults and children aged 6 and over for obesity, and offer counseling and weight loss assistance for any patients with a BMI of 30 or higher. If you don’t know whether you have a weight problem, you can ask your doctor to check your BMI and screen you for weight-related health issues.

You can screen yourself for overweight and obesity using an online BMI calculator provided by the U.S. Centers for Disease Control and Prevention.

Prevention

If you are not currently overweight, healthy eating and exercise habits can help keep you at a healthy weight and prevent overweight, obesity, and related health problems. And the sooner you start, the better. If you have children, then setting a good example and encouraging your children to maintain a healthy lifestyle can help prevent weight issues in the future. Some things you can do to help maintain a healthy weight for yourself and your children include:

  • Choose healthy foods, such as fruits, vegetables, and whole grains.
  • Serve reasonable portion sizes, and watch out for large portions when eating out.
  • Find active, outdoor activities that you enjoy. If you have a family, focus on finding things that everyone can enjoy together.
  • Limit time on computers, TVs, video games, and other screen time. 2 hours of screen time or less per day is best. Focus on finding active things to do instead.
  • Keep track of your weight, your waist measurement, and your BMI, and track your kids’ growth as well.

Medication And Treatment

The first step in weight loss treatment is usually lifestyle changes. Changing the way you eat and getting up to move more often will help you lose weight and get yourself in shape. The general idea is to make sure that the number of calories you use in a day is just a little bit more than the number of calories you consume, so that your body will start to feed off your excess body fat to replace the calories it isn’t getting through food. You can learn more about diet and nutrition in our Healthy Eating Condition Center


There is no one right way to change your eating habits; different approaches work for different people. Some approaches that may help include:

  • Counting calories. This may be the most straightforward approach–measuring the calories you eat in a day and keeping as close as possible to a number just under the calories you use. Normally that’s about 1,200 to 1,500 calories for women or 1,500 to 1,800 calories for men.
  • Choosing filling foods with fewer calories. Serving larger portions of low-calorie foods can help you feel full without growing your waistline.
  • A healthy-eating plan such as the Mediterranean diet, based on fruits, vegetables, whole grains, and lean proteins such as beans and fish.
  • Limiting specific food types, such as fats, carbohydrates or sugars.

Watch out for fad diets that offer a quick fix. If you want to keep the weight off for the long term, then you need to find a long-term plan that works for you.

Developing an exercise regimen is also a very helpful step in losing weight. Aim to get at least 150 minutes of moderate exercise per week–or half an hour of exercise, five days a week. If you can’t find a half hour at one time, it’s OK to break it into smaller blocks throughout the day. It also helps to find ways to increase the amount you move throughout the day, such as taking the stairs instead of the elevator, or walking to places you would normally drive.

If it’s hard for you to stick with your weight loss program, you may benefit from behavior modification techniques to help you change. These may include:

  • Counseling with a therapist to help you work through issues and keep yourself on track
  • A support group where you can talk with other people going through the same challenges

If you are still struggling to lose weight without success despite diet, exercise, and other strategies, then there are medicines to help you lose weight. Your doctor may prescribe medical treatments for weight loss if your BMI is 30 or higher, or if you have weight-related complications and a BMI above 27.

Keep in mind, though, that medical weight loss treatments are intended for use alongside lifestyle changes, not to take their place. If you don’t stay active and keep watching what you eat, then weight loss medicines aren’t likely to help as much. And when you stop taking a weight loss medicine, you may regain much of the weight you lost. Prescription medicines for weight loss include:

  • Orlistat (Xenical), which stops your intestines from absorbing fat. Lower-dose orlistat is also sold over the counter as Alli.
  • Lorcaserin (Belviq), which alters chemicals in your brain to decrease your appetite and help you feel full. However, if you don’t lose about 5% of your body weight in the first 12 weeks of treatment, then lorcaserin probably won’t work for you. Pregnant women should not take lorcaserin.
  • Phentermine (Adipex-P, Suprenza) for short-term use–though you will need to find another way to keep the weight off in the long term.
  • Phentermine-topiramate (Qsymia), which combines phentermine with an antiseizure medication to make it safe for long-term use. If you don’t lose 5% of your body weight in the first 12 weeks, your doctor may need to stop this treatment or up your dose. This treatment is not appropriate for pregnant women.

If other treatments don’t help you, weight loss surgery may help you lose up to a third of your excess body weight, but you will still need to watch what you eat if you want to keep the weight off. Surgery may be an option, if:

  • Your BMI is 40 or higher
  • You have a serious weight-related problem and a BMI of 35 or higher
  • You’re committed to making the lifestyle changes you need to make surgery work.

There are several types of weight loss surgeries. Some of the most common surgical treatments for weight loss include:

  • Gastric bypass, in which the surgeon creates a small pouch at the top of your stomach and connects it directly to your small intestine, so that the food you eat skips your stomach and goes straight into the intestines. Gastric bypass is very effective for long-term weight loss and may help with type 2 diabetes and other complications, but it may cause blood clots, or you may require repeat surgery.
  • Laparoscopic adjustable gastric banding (LAGB, or Lap Band), in which the surgeon puts an inflatable band around your stomach and uses this band to cinch your stomach into 2 sections, connected by a narrow passage. Health risks include infections, blood clots, or the need to reoperate.
  • Gastric sleeve, a newer, experimental treatment in which a part of your stomach is removed, to give you a smaller stomach. The risks and benefits of this treatment are still being studied.
  • Biliopancreatic diversion, a somewhat riskier treatment in which most of the stomach is surgically removed. This highly effective surgery is usually reserved for people with a BMI of 50 or more, because of the risk of malnutrition and surgical complications.

The majority of medications for weight loss work by either making you feel fuller sooner or less hungry. They include the following prescribed drugs:

  • Orlistat (Xenical) is part of a class of medications known as lipase inhibitors, prevents some of the fat in foods from being absorbed by the intestines. That fat is then eliminated in bowel movements. It is used with low-calorie, low-fat diets and exercise programs to help overweight patients who may also have health risks like high blood pressure, diabetes, high cholesterol or heart disease. Additionally, it is used after weight loss to help people maintain their lower weight. According to Genentech, the pharmaceutical company that manufactures Xenical, the most common side effects are oily rectal discharge, passing gas with oily discharge, urgent need to have a bowel movement, oily or fatty stools, increased number of bowel movements, and uncontrollable bowel movements.
  • Phentermine, an appetite suppressant, is a drug of a class of drugs called anorectics. The exact weight-loss benefits of Phentermine are unknown, however it is thought to either reduce the amount of food that is consumed or increase the amount of energy produced by your body. According to the National Institutes of Health, phentermine should be used for three to six weeks in conjunction with a diet plan for patients who have been unable to lose weight with just diet and exercise.

Before you start taking this medication, you must tell your physician if you are taking any of the following drugs:

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Guanethidine
  • Insulin medications for weight loss and depression
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Also tell your doctor if you are taking monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar) and tranylcypromine (Parnate), or if you have stopped taking one of these medications in the past two weeks. Phentermine is classified as a controlled substance, meaning there is a potential for abuse.

This drug is no longer sold in Europe because of a possible link with heart and lung problems

  • Lorcaserin (Belviq) is a member of a class of medicines called serotonin receptor agonists, and works by making you feel full even when you eat less. Lorcaserin can be habit-forming, and it may interact with other drugs.

The NIH advises that you tell your doctor if you are taking any of the following:

  • bupropion (Aplenzin, Forfivo, Wellbutrin, Zyban)
  • cabergoline; codeine (in some pain medications and cough medications)
  • dextromethorphan (in cough and cold medications)
  • flecainide (Tambocor)
  • insulin and other medications for diabetes
  • linezolid (Zyvox); lithium (Lithobid)
  • medications for erectile dysfunction
  • medications for mental illness
  • medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
  • Other medications for weight loss;
  • Metoprolol (Toprol)
  • Mexiletine
  • Monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar)
  • Tranylcypromine (Parnate)
  • Odansetron (Zofran)
  • Propafenone (Rythmol)
  • Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft)
  • Selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor)
  • Tamoxifen (Soltamox)
  • Timolol (Blocadren)
  • Tricyclic antidepressants (TCAs) such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil)
  • Tramadol (Conzip, Ultram, Ryzolt).

According the NIH, you should be taken off the drug if you don’t lose weight within the first 12 weeks of treatment. Like with all medications, talk to your doctor before stopping a prescribed dosage you should be taken off the drug, according to the NIH. But, the NIH emphasizes, don’t stop taking it on your own. Talk to your doctor.

  • Qsymia, which combines the drugs phentermine and topiramate, was approved by the federal Food and Drug Administration (FDA) in 2012. It is approved for use in overweight or obese adults who have at least one weight-related condition such as hypertension or type 2 diabetes, and can be taken once a day to suppress appetite. If a patient doesn’t show a loss of at least 3 percent of body weight in twelve weeks of treatment, Osymia should be discontinued. It can’t be used by patients with hyperthyroidism or glaucoma, and its effect on patients at risk of heart attack or stroke is unknown.

**Use of any of these medications for children below the age of twelve is not recommended.

Nonprescription weight-loss products are not recommended. Some have dangerous side effects, and others have no proven benefit.

Weight loss surgery is also an option; talk with your physician to see whether he or she thinks you would do better with medicine or an operation.


Weight loss surgery is an increasingly popular treatment option. There are an estimated 200,000 weight-loss (or bariatric) surgeries each year, with women making up 80 percent of the patients. But not everyone is eligible for it: According to standards set by the Cleveland Clinic, one of the nation’s leading hospitals, a patient who is 100 pounds overweight is the ideal candidate for the surgery, as well as someone who has a body mass index (BM) of over 40, or a BMI of 35 or over with “severe negative health effects” such as obesity-related hypertension or type 2 diabetes.

It’s been estimated that the overall success rate for bariatric surgeries is 80 percent. The remaining 20 percent of patients regain their pre-operative weight. Even after surgery, eating a healthy diet and exercising are still crucial. The following four procedures are the most common weight loss surgeries. If you are considering weight loss surgery, talk to your doctor about what is the best option for you.

  • Gastric Bypass: (Roux-en-Y or RYGB) This is a commonly performed “malabsorptive procedure,” which makes the stomach smaller. After the operation, patients literally can’t fit as much food in their stomachs will and therefore absorb fewer calories. In the procedure, the surgeon forms a small stomach pouch by dividing the upper end of the stomach from the lower. A Y-shaped part of the small intestine is attached to the pouch so food can bypass the lower stomach and the first two segments of the small intestine. The procedure changes the digestive tract by bypassing portions of it that absorb calories and nutrients. Physicians may, in some cases, perform the bypass via minimally invasive surgical techniques. According to the Columbia University Center for Metabolic and Weight-Loss Surgery, the estimated weight loss in the first 1- 2 years after a Roux-en-Y Gastric Bypass is about 1/2 to 2/3rd of excess weight. Fifty percent excess weight loss has been documented 10 years and more after Gastric Bypass.
  • Adjustable Gastric Band. In this procedure, the surgeon puts a band around the upper part of the stomach, creating a small pouch to hold food. (This is in contrast to gastric bypass surgery, in which sections of the intestines are essentially rerouted via cutting.) It’s called an “adjustable” surgery because after the operation, the surgeon can adjust the band to make food pass through the stomach more quickly or more slowly. This method makes the stomach smaller, thereby restricting the amount of food that can be eaten. Gastric banding surgery is performed laparoscopically. This noninvasive surgical technique, in which a camera and instruments are placed in the patient via small incisions, usually means a faster recovery. The band may also be removed altogether. According to the Columbia University Center for Metabolic and Weight Loss Surgery, the procedure appears to be associated with 20% more excess weight loss than one would expect from gastric bypass alone. Expected weight loss is 60-90% of a patient’s excess weight.
  • Gastric Sleeve. Also known as vertical sleeve gastrectomy, this surgery involves the removal of a large portion of the stomach. The remaining parts of the stomach are stapled together, creating a banana-shaped stomach. As with other weight-loss surgeries, patients report feeling full after eating a small amount of food. According to the Columbia University Center for Metabolic and Weight Loss Surgery, most patients can expect to lose 30 to 50% of their excess body weight over a six- to 12-month period.
  • Duodenal Switch. According to the Columbia University Center for Metabolic and Weight Loss Surgery, duodenal switch is a procedure that involves removing about 60 percent of the stomach so that it is left in the shape of a tube. The lower intestine is divided much more in the duodenal switch procedure than it is in the gastric bypass procedure. Duodenal switch preserves the outlet muscle that controls emptying of the stomach and also offers the ability to eat larger portions than after gastric bypass or adjustable gastric banding. The procedure has reliable and long-lasting weight loss. According to Columbia medical experts, most patients can expect to lose 60 to 80 percent of their excess body weight over a two-year period. Clinical trials have demonstrated weight loss beyond 10 years.

Complementary and Alternative Treatment

Alternative and complementary treatments, by definition, aren’t as well studied as conventional medicine—and they generally aren’t as well regulated either, so you should be cautious about using alternative treatment, and always tell your doctor about any alternative treatments you use, as they may have dangerous side effects, or they might interact with your other treatments. According to the National Center for Complementary and Alternative Medicine (NCCAM) there is no scientific evidence that supplements claiming to help people lose weight are effective; some may even be dangerous. Even the much-touted green tea is questionable. A 2012 review of 18 studies in overweight or obese adults found that the loss in weight in adults who had taken a green tea preparation was very small, statistically not significant, and not likely to be clinically important.

The NCCAM reports that one alternative approach, Mindfulness Eating, shows promise. A 2013 systematic review of the effect of food intake memory and awareness of eating indicates that attentive eating is likely to influence food intake, and incorporating attentive, or mindful-eating principles, into other interventions may aid in weight loss and maintenance.

Remember that the best way to prevent and overcome obesity is to make long-term changes to your diet and exercise routines.

Herbal treatments that have been tried for weight loss include:

  • Acai berry
  • Bitter orange
  • Green tea

At present there isn’t enough evidence to say for sure whether acai and bitter orange are safe or effective. Green tea appears to be safe, but studies have shown only minor, nonsiginficant improvement in weight loss, if any at all.

Ephedra for weight loss has been banned in the United States, because it causes risk of heart disease or stroke, which can far outweigh the short-term weight loss benefits.

Research suggests that mind-body techniques such as yoga and meditation may be helpful as part of a larger program. Other techniques, including hypnosis and acupuncture, do not seem effective according to the most current studies, although large, well-controlled studies have not yet been performed.

Care Guide

If you are obese, your treatment plan should focus on long-lasting weight loss.

Here are some tips to help make long-term weight loss a reality:

  • Make slow and steady dietary changes. Begin by restricting certain foods, reducing portion size, and counting calories. Avoid any diets or programs that promise a quick fix.
  • Increase your activity level. Speak with your doctor about an exercise plan. You may have to start slowly by simply spending more time walking and less time sitting.
  • Talk with a counselor. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating.
  • Take medications and supplements only if prescribed by your doctor.
  • Consider surgical options and discuss them with your doctor.
  • Join a support group. You can find friendship and empathy in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or reliable weight-loss programs for support groups in your area.

When To Contact A Doctor

If you think you may have a weight problem, tell your doctor—especially if you’re concerned about weight-related health problems, such as diabetes, sleep apnea, or high cholesterol.

Questions For Your Doctor

If you are worried about your excess weight, start by talking with your primary care physician. He or she may refer you to a counselor, behavioral therapist, dietitian or bariatric surgeon.

It is important to find a doctor, therapist, or dietitian who is both realistic and motivating. Working with someone who is overly negative or who has unrealistic expectations of your health may cause more harm than good.

To find a bariatric physician or surgeon, visit the Obesity Action Coalition’s website 

To find a registered dietitian, visit the website of the Academy of Nutrition and Dietetics.

You might also want to look into what nearby hospitals and medical centers have to offer. Local doctors, dietitians, and support groups can be very helpful in guiding your obesity treatment.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • Do I have a weight problem?
  • How serious is it?
  • Am I at risk for health problems related to my weight?
  • Are there warning signs I should watch out for?
  • What steps do you recommend to keep my weight under control?
  • What do you think my weight loss goals should be?
  • Is it safe for me to start an exercise program?
  • Is there anything else I should know about my weight?

Resources

January is National Healthy Weight Awareness Month Awareness Month.

Here are some resources that can help you further your understanding of obesity:

Shape Up America! is a national coalition of industry and medical experts in nutrition and fitness. You can get information on how to lose weight and sty fit as well as order booklets on diet and fitness.

Weight-Control Information Network (WIN). You can get information on weight control, obesity and the medical disorders related to the condition. This site part of the National Institute of Diabetes and Digestive and Kidney Diseases, one of the National Institutes of Health (NIH)

Overeaters Anonymous (OA). This nonprofit international organization is not a weight loss program. It is a 12-step program aimed at helping you understand and control compulsive eating issues by focusing on the psychological and social reasons for overeating.

Obesity Action Organization (OAO). This organization will help you find a support group in your area.