The main ways that obesity is treated is by encouraging people to eat more healthily and to take more exercise. There are also pharmacological and surgical interventions for those whose weight problems are considerable.
Diet
The NHS recommends that, by using the "food diary" technique, 500 calories can be cut from a person's daily intake. Keeping a diary may bring to light particular times of the day when a person overeats or certain types of food that a person is more inclined to binge on.
People are encouraged to cut down on snacks and to avoid buying high calorie snacks, junk food and ready meals as these are often packed with fat, high levels of sugar and salt and do not satiate the appetite. Dired fruit, yoghurt, oatcakes and fruit are healthier and keep people feeling full for longer. People should avoid special diets and concentrate on eating a healthy, balanced diet instead of cutting out particular food groups.
People are discouraged from losing too much weight too quickly, losing 1-2lbs per week is considered to be adequate- people should be able to lose 12- 24lbs if the diet is maintained for three months.
Exercise
Exercise is an important component of losing weight as it burns off calories. It is recommended that people should undertake a minimum of moderate intensity (gardening, swimming, walking) exercise for thirty minutes each day for at least five days per week. Before starting an exercise programme people should seek advice from their gp because some people may not be able to manage 5 half-hourly sessions whereas others may be able to do more.
During exercise people should aim to raise the heart rate, break into a light sweat and be out of breath by the end of the activity.
Medication
The NICE guidance on obesity states that- "Pharmacological treatment should be considered only after dietary, exercise and behavioural approaches have been started and evaluated."
Drug treatment is only offered to those adults who have either failed to reach their target weight or have reached a plateau whilst relying on behavioural, dieatary and activity changes alone.
Pharmacological treatments may be used to maintain weight loss as well as to lose weight.
The NICE guidance recommends that drug treatment is regularly reviewed in order to monitor its effectiveness and to reinforce lifestyle advice and adherence.
Orlistat works by blocking the action of enzymes which digest fat. It is taken with each main meal. Orlistat is only prescribed if the patient has a body mass index (BMI) of 28 or more and has an associated disease which is a risk factor risk factors or a BMI of 30 or more without any risk factors. The use of orlistat should only be continued after 3 months if the patient has lost at least 5% of body weight since starting the drug tratment.
Sibutramine affects chemicals in the brain called noradrenaline and serotonin and makes the patient feel fuller or satiated with less food. Sibutramine is only given to people with a BMI of 27 with risk factors or 30 without. Sibutramine will not be continued if the patient hasn't lost at least 2kg within the first four weeks and 5% of body weight in the first three months.
Surgery.
The NICE guidance sets out the following criteria for people who may require surgical treatment:
There are three types of surgical intervention:
The following factors should be taken into account when choosing which surgical intervention should be made:
