Treatment of Obesity

Obesity is a chronic disease that requires long-term treatment. Even a 5-10 per cent loss from
initial weight may produce marked improvement in diabetes, dyslipidemia and even sleep
apnea. The ease of weight gain difficulty in losing and maintaining weight all make obesity a
challenging illness to treat. The goals set for weight loss should be realistic.

Strategies for Weight Loss

 Diet Therapy
 Physical Exercise
 Stress Management
 Weight Loss Surgery

Diet Therapy

Very Low-Calorie Diet: Although much weight is initially lost on very low-calorie diets,
more weight is usually regained. Rapid weight reduction does not teach behaviour changes.
Patients on very low-calorie diets have increased risk for developing gallstones, very low-
calorie diets (400 to 800 kcal/day) can be used safely in extremely obese individuals (greater
than 50% overweight) where under the care of a physician and registered dietician.

Reducing Diet: The initial goal of weight loss therapy is to reduce body weight by
approximately 10 per cent from baseline. If this goal is achieved, further weight loss can be
attempted. A reasonable time line for a 10 per cent reduction in body weight is 6 months of
therapy.

The person should be put in negative energy balance ideally 500-1000 calories less than
RDA. An ideal reduction of 500g–1kg/week is approved. Once the target is fixed, progress
should be checked once a month. Usually 3 kgs are lost in the first month largely due to
utilisation of carbohydrate store and water. Reducing diets should provide adequate amounts
of protein, vitamins and minerals.

Calorie restriction for weight reduction is the safest and most effective method. One pound of
body fat is equivalent to 3500 kcal; therefore, intake must be reduced by 500 kcal daily to
produce a loss of one pound of body fat weekly (500 kcal × 7 days = 3500 kcal). A calorie
deficit of 1000 kcal/day is required to lose 2 pounds or approximately 1 kg of body fat
weekly. This is the maximum weekly weight loss recommended since a more restrictive diet
may not be nutritionally adequate.

The caloric recommendation can be determined from actual food intake and not from
formulas. A detailed 24-hour food recall and/or 3-day diet history are generally adequate to
determine intake.

Physical Exercise

Most obese patients lead sedentary lives. A low-calorie diet accompanied by moderate
exercise will be effective in causing weight loss. Aerobic exercise directly increases the daily
 energy expenditure and is particularly useful for long-term weight maintenance. Energy will
also preserve lean body mass and particularly prevent the decrease in basal energy
expenditure seen with semi-starvation. Exercise is extremely beneficial in weight
management because it helps to regulate appetite, increases the basal metabolic rate and
reduces the fat deposit ‘set-point’ level. Exercise also helps reduce stress related eating, since
it provides physical outlet for working off the hormonal physiologic events produced by
stress in the body.

Holland and some Scandinavian countries encourage exercise. They include bicycle and
pedestrian paths in urban design, school and business houses have provision for physical
activity, serve healthy meals and integrate health education into their routines. As a general
rule, exercise in the range of 45 minutes is recommended. Physical activity in overweight and
obese adults increases cardiorespiratory fitness independent of weight loss. The best exercise
for an obese person is walking. A major reason that many adults do not exercise as a weight
loss mechanism is that their level of physical fitness is so low they cannot sustain a moderate
level of exercise intensity for very long. However, this will change as one continues to
exercise.

Stress Management

It may sound surprising, but stress actually plays a large role in your waistline and how
easily you can lose weight. For example, multiple studies show how stress and lack of
sleep can lead to an increase in your cortisol levels (the stress hormone). Having higher
levels of cortisol in your body can cause you to:

 feel hungrier; and

 crave foods that have a lot of sugar, calories, and fat.
 Higher cortisol levels can also cause people to build up fat around their bellies.

Learning to reduce stress through exercise and meditation—while also being more
mindful about food—can have a large impact on your well-being and help you keep
weight off in the long-term.

Weight Loss Surgery

Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach
can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction
and malabsorption. Bariatric procedures also often cause hormonal changes. Most weight loss
surgeries today are performed using minimally invasive techniques (laparoscopic surgery).

The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy,
adjustable gastric band, and biliopancreatic diversion with duodenal switch. Each surgery has
its own advantages and disadvantages.