What is the best treatment for obesity?

The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly. To do this you should: eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian) join a local weight loss group.

nhsinform.scot - Obesity causes & treatments - Illnesses & conditions - NHS inform

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If you're obese, speak to your GP for advice about losing weight safely. Your GP can advise you about losing weight safely by eating a healthy, balanced diet and regular physical activity.

They can also let you know about other useful services, such as:

local weight loss groups – these could be provided by your local authority, the NHS, or commercial services you may have to pay for exercise on prescription – where you're referred to a local active health team for a number of sessions under the supervision of a qualified trainer If you have underlying problems associated with obesity, such as polycystic ovary syndrome (PCOS), high blood pressure, diabetes or obstructive sleep apnoea, your GP may recommend further tests or specific treatment. In some cases, they may refer you to a specialist.

Diet

There's no single rule that applies to everyone, but to lose weight at a safe and sustainable rate of 0.5 to 1kg (1lb to 2lbs) a week, most people are advised to reduce their energy intake by 600 calories a day. For most men, this will mean consuming no more than 1,900 calories a day, and for most women, no more than 1,400 calories a day. The best way to achieve this is to swap unhealthy and high-energy food choices – such as fast food, processed food and sugary drinks (including alcohol) – for healthier choices.

A healthy diet should consist of:

plenty of fruit and vegetables

plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties)

some milk and dairy foods

some meat, fish, aggs, beans and other non-dairy sources of protein

just small amounts of food and drinks that are high in fat and suagr Try to avoid foods containing high levels of salt because they can raise your blood pressure, which can be dangerous for people who are already obese. You'll also need to check calorie information for each type of food and drink you consume to make sure you don't go over your daily limit. Some restaurants, cafés and fast food outlets provide calorie information per portion, although providing this information isn't compulsory. Be careful when eating out because some foods can quickly take you over the limit, such as burgers, fried chicken, and some curries or Chinese dishes.

Diet programmes and fad diets

Avoid fad diets that recommend unsafe practices, such as fasting (going without food for long periods of time) or cutting out entire food groups. These types of diets don't work, can make you feel ill, and aren't sustainable because they don’t teach you long-term healthy eating habits. This isn't to say that all commercial diet programmes are unsafe. Many are based on sound medical and scientific principles and can work well for some people.

A responsible diet programme should:

educate you about issues such as portion size, making behavioural changes and healthy eating not be overly restrictive in terms of the type of foods you can eat be based on achieving gradual, sustainable weight loss rather than short-term rapid weight loss, which is unlikely to last

Very low calorie diets

A very low calorie diet (VLCD) is where you consume less than 800 calories a day. These diets can lead to rapid weight loss, but they aren't a suitable or safe method for everyone, and they aren't routinely recommended for managing obesity. VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss. VLCDs shouldn't usually be followed for longer than 12 weeks at a time, and they should only be used under the supervision of a suitably qualified healthcare professional.

Speak to your GP first if you're considering this type of diet.

Exercise

Reducing the amount of calories in your diet will help you lose weight, but maintaining a healthy weight requires physical activity to burn energy. As well as helping you maintain a healthy weight, physical activity also has wider health benefits. For example, it can help prevent and manage more than 20 conditions, such as reducing the risk of type 2 diabetes by 40%. The Chief Medical Officers recommend that adults should do at least 150 minutes (two-and-a-half hours) of at least moderate-intensity activity a week – for example, five 30-minute bouts a week. Something is better than nothing, and doing just 10 minutes of exercise at a time is beneficial. Moderate-intensity activity is any activity that increases your heart and breathing rate, such as:

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brisk walking

cycling

recreational swimming

dancing

Alternatively, you could do 75 minutes (one hour, fifteen minutes) of vigorous-intensity activity a week, or a combination of moderate and vigorous activity. During vigorous activity, breathing is very hard, your heart beats rapidly and you may be unable to hold a conversation. Examples include:

running

most competitive sports

circuit training

You should also do strength and balance training two days a week. This could be in the form of a gym workout, carrying shopping bags, or doing an activity such as tai chi. It's also critical that you break up sitting (sedentary) time by getting up and moving around. Your GP, weight loss adviser or staff at your local sports centre can help you create a plan suited to your own personal needs and circumstances, with achievable and motivating goals. Start small and build up gradually. It's also important to find activities you enjoy and want to keep doing. Activities with a social element or exercising with friends or family can help keep you motivated. Make a start today – it’s never too late.

Other useful strategies

Evidence has shown that weight loss can be more successful if it involves other strategies, alongside diet and lifestyle changes. This could include things like: setting realistic weight loss goals – if you're obese, losing just 3% of your original body weight can significantly reduce your risk of developing obesity-related complications eating more slowly and being mindful of what and when you're eating – for example, not being distracted by watching TV

avoiding situations where you know you may be tempted to overeat

involving your family and friends with your weight loss efforts –they can help to motivate you monitoring your progress – for example, weigh yourself regularly and make a note of your weight in a diary Getting psychological support from a trained healthcare professional may also help you change the way you think about food and eating. Techniques such as cognitive behavioural therapy (CBT) can be useful.

Avoiding weight regain

It's important to remember that as you lose weight your body needs less food (calories), so after a few months, weight loss slows and levels off, even if you continue to follow a diet. If you go back to your previous calorie intake once you've lost weight, it's very likely you'll put the weight back on. Increasing physical activity to up to 60 minutes a day and continuing to watch what you eat may help you keep the weight off.

Medication

Many different types of anti-obesity medicines have been tested in clinical trials, but only one has proved to be safe and effective: orlistat. You can only use orlistat if a doctor or pharmacist thinks it's the right medicine for you. In most cases, orlistat is only available on prescription. Only one product (Alli) is available over the counter directly from pharmacies, under the supervision of a pharmacist. Orlistat works by preventing around a third of the fat from the food you eat being absorbed. The undigested fat isn't absorbed into your body and is passed out with your faeces (stools). This will help you avoid gaining weight, but won't necessarily cause you to lose weight. A balanced diet and exercise programme should be started before beginning treatment with orlistat, and you should continue this programme during treatment and after you stop taking orlistat.

When orlistat should be used

Orlistat will usually only be recommended if you've made a significant effort to lose weight through diet, exercise or changing your lifestyle.

Even then, orlistat is only prescribed if you have a:

body mass index (BMI) of 28 or more, and other weight-related conditions, such as high blood pressure or type 2 diabetes

BMI of 30 or more

Before prescribing orlistat, your doctor will discuss the benefits and potential limitations with you, including any potential side effects (see below). Treatment with orlistat must be combined with a balanced low-fat diet and other weight loss strategies, such as doing more exercise. It's important that the diet is nutritionally balanced over three main meals. If you're prescribed orlistat, you'll also be offered advice and support about diet, exercise and making lifestyle changes.

Orlistat isn't usually recommended for pregnant or breastfeeding women.

Dosage and duration of treatment

One orlistat capsule is taken with water immediately before, during or up to one hour after, each main meal (up to a maximum of three capsules a day). If you miss a meal, or the meal doesn't contain any fat, you shouldn't need to take the orlistat capsule. Your doctor should explain this to you, or you can check the patient information leaflet that comes with your medicine.

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Treatment with orlistat should only continue beyond three months if you've lost 5% of your body weight. It usually starts to affect how you digest fat within one to two days. If you haven't lost weight after taking orlistat for three months, it's unlikely to be an effective treatment for you. Consult your doctor or pharmacist, as it may be necessary to stop your treatment.

Taking orlistat with other health conditions

See your GP before starting treatment with orlistat if you have another serious health condition, such as type 2 diabetes, high blood pressure, or kidney disease, which you're taking medication for. It may be necessary to change the dose of your medicine. If you have type 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after three months may therefore be slightly lower. If orlistat has helped you lose weight after three months, your prescription may be continued for up to a year. After that, your GP will carry out a review and decide whether you should continue taking it.

Side effects

Common side effects of orlistat include:

fatty or oily stools

needing the toilet urgently

passing stools more frequently

an oily discharge from your rectum (you may have oily spots on your underwear)

flatulence (wind)

stomach pain

headaches

upper respiratory tract infections, such as a cold

These side effects are much less likely to occur if you stick to a low-fat diet. Women taking the oral contraceptive pill should use an additional method of contraception, such as a condom, if they experience severe diarrhoea while taking orlistat. This is because the contraceptive pill may not be absorbed by your body if you have diarrhoea, so it may not be effective.

Surgery

Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are severely obese. Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria: they have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetes or high blood pressure all appropriate non-surgical measures have been tried, but the person hasn't achieved or maintained adequate, clinically beneficial weight loss

the person is fit enough to have anaesthesia and surgery

the person has been receiving, or will receive, intensive management as part of their treatment

the person commits to the need for long-term follow-up

Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes. In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a person's BMI is 50 or above.

Treating obesity in children

Treating obesity in children usually involves improvements to diet and increasing physical activity using behaviour change strategies. The amount of calories your child should eat each day will depend on their age and height. Your GP should be able to advise you about a recommended daily limit, and they may also be able to refer you to your local family healthy lifestyle programme. Children over the age of five should ideally get at least one hour (60 minutes) of vigorous-intensity exercise a day, such as running or playing football or netball. Sedentary activities, such as watching television and playing computer games, should be restricted. Referral to a specialist in treating childhood obesity may be recommended if your child develops an obesity-related complication, or there's thought to be an underlying medical condition causing obesity. The use of orlistat in children is only recommended in exceptional circumstances, such as if a child is severely obese and has an obesity-related complication. Bariatric surgery isn't generally recommended for children, but may be considered for young people in exceptional circumstances, and if they've achieved, or nearly achieved, physiological maturity.

nhsinform.scot - Obesity causes & treatments - Illnesses & conditions - NHS inform

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