Weight Loss treatment can be grouped into: lifestyle modification by diet and exercise; pharmacotherapy and surgery.
Lifestyle modification by diet and exercise
It is the preferred method for weight loss for people who are overweight (BMI 23-27 kg.m2) or having class 1 obesity (BMI 27 -32 kg/m2). Its aims at modest weight reduction of 5-10% of body weight within 6 months. The target for weight loss should be 2 kgs every month.
The diet should be restricted to 1000-1200 kcal/day for women and 1200-1600 kcal/day for men. This would help in inducing a calorie deficit of around 500-1000 kcal/day and would help in the above mentioned weight loss goals without causing too much hunger.
The diet should be low in saturated fats, Trans fats, cholesterol, added sugar and salt.
Foods to be avoided include deep fried foods, bakery products, refined flour, sweets, red meat, egg yolk and whole milk and its products.
Foods allowed include pan fried/roasted foods, lean meats, egg white, skimmed milk, green leafy vegetables, citrus fruits and whole grain cereals and bread.
Exercise should be aerobic with modest weight training. Around 300 minutes of exercise per week is recommended for people who want to achieve >5% reduction of their body weight. This exercise plan should be started gradually and initially done in intervals of 10-15 minutes to avoid fatigue. The daily activity level should be increased and exercise such as brisk walking, jogging, cycling, dancing or swimming should be incorporated in the routine.
Behavior changes include changing your surroundings to limit food intake and increase activity level, keeping a food diary, self -motivation and support as well as rewarding oneself with something other than food.
Drugs for weight loss
Medicines for weight loss may be indicated for people who are overweight or obese but are unable to achieve their goals through diet and exercise. It is important to remember that all drugs may have some side effects and should be taken on a short term basis on prescription by a registered medical practitioner only.
Sibutramine - this medicine has resulted in weight loss of 5-10 pounds but also causes serious side effects and hence has been withdrawn from the market.
Orlistat - It reduces the amount of fat which is absorbed through food and can be taken three times a day with meals. It causes upto 8-10% of weight loss after one year of regular treatment but may cause side effects like stomach cramps, gas and oily stools in some people. It has also been linked to liver disease in few cases.
Lorcraserin - It reduces appetite and results are almost similar to orlistat but has other side effects like nasophyngitis, headache, respiratory infections, etc. It is not to be given in patients with reduced kidney function and in pregnant women.
Phentermine
Other products such as Ephedra, Chromium, diuretics, herbal laxatives and hoodia have been linked to weight loss but there is no firm scientific evidence that these products actually help in long term and effective reduction of body weight.
Surgery
This is only effective treatment for long term effective weight loss in morbidly obese individuals (BMI > 32 kg/m2 with associated comorbidities or BMI > 37 kg/m2 with or without comorbidities)
This article written by Dr Anirudh Vij. He is founder of Dioms (Delhi Institute of Obesity and Metabolic Surgery). He is the Chief Bariatric Surgeon in DIOMS and one of the best Bariatric Surgeon in Delhi.
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