Treatment of obesity depends primarily on how overweight a person is and his or her overall health. However, to be successful, any treatment must affect lifelong behavioral changes rather than short-term weight loss. "Yo-yo" dieting, in which weight is repeatedly lost and regained, has been shown to increase a person's likelihood of developing fatal health problems than if the weight had been lost gradually or not lost at all. Behavior-focused treatment should concentrate on:
What and how much a person eats. This aspect may involve keeping a food diary and developing a better understanding of the nutritional value and fat content of foods. It may also involve changing grocery-shopping habits (e.g. buying only what is on a prepared list and only going on a certain day), timing of meals (to prevent feelings of hunger, a person may plan frequent, small meals), and actually slowing down the rate at which a person eats.
How a person responds to food. This may involve understanding what psychological issues underlie a person's eating habits. For example, one person may binge eat when under stress, while another may always use food as a reward. In recognizing these psychological triggers, an individual can develop alternate coping mechanisms that do not focus on food.
How they spend their time. Making activity and exercise an integrated part of everyday life is a key to achieving and maintaining weight loss. Starting slowly
and building endurance keeps individuals from becoming discouraged. Varying routines and trying new activities also keeps interest high.
For most individuals who are mildly obese, these behavior modifications entail life-style changes they can make independently while being supervised by a family physician. Other mildly obese persons may seek the help of a commercial weight-loss program (e.g. Weight Watchers). The effectiveness of these programs is difficult to assess, since programs vary widely, drop-out rates are high, and few employ members of the medical community. However, programs that emphasize realistic goals, gradual progress, sensible eating, and exercise can be very helpful and are recommended by many doctors. Programs that promise instant weight loss or feature severely restricted diets are not effective and, in some cases, can be dangerous.
For individuals who are moderately obese, medically supervised behavior modification and weight loss are required. While doctors will put most moderately obese patients on a balanced, low-calorie diet (1200–1500 calories a day), they may recommend that certain individuals follow a very-low-calorie liquid protein diet (400–700 calories) for as long as three months. This therapy, however, should not be confused with commercial liquid protein diets or commercial weight-loss shakes and drinks. Doctors tailor these diets to specific patients, monitor patients carefully, and use them for only a short period of time. In addition to reducing the amount and type of calories consumed by the patient, doctors will recommend professional therapists or psychiatrists who can help the individual effectively change his or her behavior in regard to eating.
For individuals who are severely obese, dietary changes and behavior modification may be accompanied by surgery to reduce or bypass portions of the stomach or small intestine. Such obesity surgery, however, can be risky, and it is only performed on patients for whom other strategies have failed and whose obesity seriously threatens their health. Other surgical procedures are not recommended, including liposuction, a purely cosmetic procedure in which a suction device is used to remove fat from beneath the skin, and jaw wiring, which can damage gums and teeth and cause painful muscle spasms.
Appetite-suppressant drugs are sometimes prescribed to aid in weight loss. These drugs work by increasing levels of serotonin or catecholamine, which are brain chemicals that control feelings of fullness. Appetite suppressants, though, are not considered truly effective, since most of the weight lost while taking them is usually regained after stopping them. Also, suppressants containing amphetamines can be potentially abused by patients. While most of the immediate side-effects of these drugs are harmless, the long-term effects of these drugs, in many cases, is unknown. Two drugs, dexfenfluramine hydrochloride (Redux) and fenfluramine (Pondimin) as well as a combination fenfluramine-phentermine (Fen/Phen) drug, were taken off the market when they were shown to cause potentially fatal heart defects. In November 1997, the United States Food and Drug Administration (FDA) approved a new weight-loss drug, sibutramine, (Meridia). Available only with a doctor's prescription, Meridia can significantly elevate blood pressure and cause dry mouth, headache, constipation, and insomnia. This medication should not be used by patients with a history of congestive heart failure, heart disease, stroke, or uncontrolled high blood pressure.
Other weight-loss medications available with a doctor's prescription include:
Phenylpropanolamine (Acutrim, Dextarim) is the only nonprescription weight-loss drug approved by the FDA These over-the-counter diet aids can boost weight loss by 5%. Combined with diet and exercise and used only with a doctor's approval, prescription anti-obesity medications enable some patients to lose 10% more weight than they otherwise would. Most patients regain lost weight after discontinuing use of either prescription medications or nonprescription weight-loss products.
Prescription medications or over-the-counter weight-loss products can cause:
constipation
dry mouth
headache
irritability
nausea
nervousness
sweating
None of them should be used by patients taking monoamine oxidate inhibitors (MAO inhibitors).
Doctors sometimes prescribe fluoxetine (Prozac), an antidepressant that can increase weight loss by about 10%. Weight loss may be temporary and side effects of this medication include diarrhea, fatigue, insomnia, nausea, and thirst. Weight-loss drugs currently being developed or tested include ones that can prevent fat absorption or digestion; reduce the desire for food and prompt the body to burn calories more quickly; and regulate
Height And Weight Goals
Men
Height
Small Frame
Medium Frame
Large Frame
5'2" 5'3" 5'4"
128–134 lbs. 130–136 132–138
131–141 lbs. 133–143 135–145
138–150 lbs. 140–153 142–153
5'5" 5'6" 5'7"
134–140 136–142 138–145
137–148 139–151 142–154
144–160 146–164 149–168
5'8" 5'9" 5'10"
140–148 142–151 144–154
145–157 148–160 151–163
152–172 155–176 158–180
5'11" 6'0" 6'1"
146–157 159–160 152–164
154–166 157–170 160–174
161–184 164–188 168–192
6'2" 6'3" 6'4"
155–168 158–172 162–176
164–178 167–182 171–187
172–197 176–202 181–207
Women
Height
Small Frame
Medium Frame
Large Frame
4'10" 4'11" 5'0"
102–111 lbs. 103–113 104–115
109–121 lbs. 111–123 113–126
118–131 lbs. 120–134 112–137
5'1" 5'2" 5'3"
106–118 108–121 111–124
115–129 118–132 121–135
125–140 128–143 131–147
5'4" 5'5" 5'6"
114–127 117–130 120–133
124–141 127–141 130–144
137–151 137–155 140–159
5'7" 5'8" 5'9"
123–136 126–139 129–142
133–147 136–150 139–153
143–163 146–167 149–170
5'10" 5'11" 6'0"
132–145 135–148 138–151
142–156 145–159 148–162
152–176 155–176 158–179
late the activity of substances that control eating habits and stimulate overeating.
Author Info:
Rosalyn Carson-DeWitt, The Gale Group Inc., Gale, Detroit,
2002
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