Losing weight is difficult for many people. Keeping it off can be even harder. There are many approaches when trying to lose weight, and no one approach is effective for everyone who tries it.
Types of treatments for obesity
Lifestyle changes – eating healthier and getting more exercise – are considered first-line therapy for obesity. Some people find commercial diet programs helpful. Several classes of medications can help promote weight loss. Bariatric (weight loss) surgery is effective at helping many people lose weight, while others try weight loss balloons.
Improving diet and increasing exercise are fundamental to weight loss.
Diet and nutrition
Eating a lower-calorie, more nutritious diet can help you lose weight, feel better, control blood glucose, and keep cholesterol at healthy levels. Even small changes in what, when, and how much you eat can significantly affect your health. Replacing soft drinks with fruit-flavored water or high-calorie snack foods with fresh fruit or veggie snacks could provide significant results.
There are many different diets designed to help people lose weight. No one diet is effective or healthy for everyone trying to lose weight.
A nutritious diet for someone trying to lose weight is not very different from a healthy diet for other people. In general, focus your diet on fresh vegetables and fruit, whole grains, legumes, fish, low-fat dairy products, and sources of healthy unsaturated fats such as nuts and olive oil.
For people trying to lose weight, increasing physical activity is one of the most important things you can do. In addition to burning calories, exercise can improve your mood, help you keep cholesterol and blood pressure in check, and prevent serious complications such as diabetes and heart disease from developing or growing worse. Even if you only lose a small amount of weight, exercise is still highly beneficial for your health.
Regular exercise does not necessarily mean going to the gym or playing sports. Nearly any physical activity that gets you up and moving can provide significant benefits to those with obesity.
Commercial weight loss programs
Commercial weight loss programs are a popular way to try to lose weight. Well-known brands include Weight Watchers, Jenny Craig, and Nutrisystem, but there are many other programs available. Some programs involve eating branded, prepackaged meals that must be purchased from the company, while others allow you to eat any food you like but ask you to track points or calories.
Many commercial programs include an aspect of community support, counseling, or behavior change as part of their system. Depending on what works best for you, you can find a program that provides regularly scheduled group meetings, individual counseling, or online community forums.
Depending on your health conditions, some weight loss programs might provide too much or too little of the nutrients you need. Always check with your doctor before making significant changes to your diet.
Several prescribed medications are approved to help people lose weight along with diet and exercise. Most medications are indicated for people with a body mass index (BMI) of 30 or higher, or for people with a BMI of 27 who have weight-related conditions such as type 2 diabetes, hypertension (high blood pressure), or sleep apnea.
Adipex-P is a stimulant and an appetite suppressant. It is believed that Adipex-P works by reducing the perception of hunger. Desoxyn (Methamphetamine) is another stimulant used to promote weight loss. Belviq (Lorcaserin) and Didrex (Benzphetamine) are other appetite suppressants. Some drugs in these classes can be addictive.
Alli (Orlistat) is sold over the counter. Alli is a lipase inhibitor that works by preventing your body from absorbing calories from fat in foods. Alli can cause fecal incontinence along with other side effects. Orlistat is also sold at prescription strength under the brand name Xenical.
Saxenda (Liraglutide) is prescribed to treat both diabetes and obesity. Saxenda is an incretin mimetic that signals the pancreas to make more insulin and prevents the liver from releasing glucose. Saxenda can cause dizziness and upset stomach.
Contrave (Bupropion/Naltrexone) is a combination of two drugs, Naltrexone and Bupropion. Naltrexone is an opiate antagonist that decreases cravings, and Bupropion is an antidepressant that causes weight loss as a side effect. Common side effects of Contrave include headache, dizziness, and digestive upset.
Qsymia (Phentermine/Topiramate) is another combination drug composed of a stimulant/appetite suppressant and an anti-seizure drug that causes weight loss as a side effect.
Other treatments for obesity
If diet, exercise, and medications have not resulted in weight loss, and your BMI is very high or you have serious obesity-related health conditions, your doctor may suggest trying a more invasive treatment. Bariatric (weight loss) surgery, a balloon system, or a vagal nerve blockade have been proven to help many obese people lose weight when other treatments were ineffective.
Some people with obesity undergo bariatric surgery such as gastric bypass (Roux-en-Y), adjustable gastric band (also known as the lap-band or LABG), or sleeve gastrectomy to lose weight. To be eligible for bariatric surgery, it is usually necessary to have a body mass index (BMI) over 35, or a lower BMI with medical complications such as poorly controlled diabetes. Bariatric surgery has been proven effective for weight loss and can reverse diabetes in many people, enabling them to control blood glucose without insulin or diabetes medication.
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery. Weight loss surgery can cause reflux, incisional hernias, leaks, and bowel obstructions. After bariatric surgery, you must drastically change when and how much you eat and increase your exercise levels to avoid side effects. Some people experience poor food absorption in the intestines after bariatric surgery that results in nutritional deficiencies and symptoms such as gas, constipation, and diarrhea.
Obalon, Orbera, and ReShape are temporary balloon systems approved by the U.S. Food and Drug Administration (FDA) to aid weight loss in people with obesity above a certain BMI or with obesity-related complications. Balloon systems work by taking up space in the stomach, making the person feel full and causing them to eat less.
Each balloon system is a little different, but most are placed in the stomach by swallowing a capsule, then inflated. Most balloon systems are retrieved after a few months via endoscopy, which involves a flexible tube with a camera and tools on it being inserted down the throat.
Rare but serious side effects of balloon systems can happen if the balloon deflates, enters the intestines, and causes a blockage that requires surgery to correct.
Vagal nerve blockade
The vagal nerve carries messages of hunger from your digestive system to your brain. A vagal nerve blockade involves surgically implanting a small electrode onto the vagal nerve in the abdomen. The electrode is controlled externally and can be programmed by a doctor. A vagal nerve blockade is designed to be used for eight years. In addition to the risks of any surgery, vagal nerve blockade can cause pain, heartburn, and nausea among other symptoms.
After major weight loss
If you lose a lot of weight quickly, you may develop significant amounts of loose skin. Some people feel embarrassed about the way the loose skin looks, and some choose to have plastic surgery to remove it.
Do natural treatments help with weight loss?
Some people incorporate natural or holistic treatments and report weight loss when they try complementary or alternative treatments such as vitamin B-12 injections or herbal or nutritional supplements. Complementary treatments such as Garcinia cambogia, raspberry ketone, potato skin extract, and Cissus quadrangularis are a few herbal preparations that have shown potential in some studies for promoting weight loss.
Complementary therapies cannot replace diet changes and increased exercise, which have been proven to foster weight loss. Unlike prescription medications and bariatric surgeries, most natural weight loss products have not been proven safe or effective in clinical trials. Unlike medications, supplements are not tested by the FDA for quality and purity. Many products labeled as “natural” have ingredients that can cause side effects or interact with other medications. For instance, ephedra (also called ma huang), an herbal supplement formerly marketed for weight loss, was banned in 2004 when it was found to increase the risk of death from heart attack or stroke.
Some people find meditation or mindfulness practices helpful for reducing stress that can contribute to overeating.
Where can I get help paying for obesity treatment?
Treatments for obesity, especially bariatric surgery, can be very expensive. Some private health insurance plans as well as Medicare, Medicaid, and Tricare cover bariatric surgeries or other weight loss treatments under certain circumstances. Whether you are eligible for coverage may depend on which state you live in, your BMI, and whether you have any other health conditions. This page offers resources to help you check whether your health insurance covers bariatric surgery.