Weight Loss: What Are Your Options? by Jacki Hart, MD
The prevalence of obesity has increased steadily in Western cultures over the past century, particularly during the last several decades. In fact, most health professionals agree that we are in the midst of an obesity epidemic in the United States. Recent research shows that nearly two-thirds of Americans are overweight and nearly one-third are obese.
Being overweight is closely linked to many very serious health conditions, most particularly risk factors for heart disease and stroke, including high blood pressure, high cholesterol, high triglycerides, low levels of HDL (high-density lipoprotein -- the "good" cholesterol), and type 2 diabetes. Fortunately, even modest reductions in weight can help improve these conditions. Plus, practicing the behavioral changes of a more healthful diet and regular exercise can actually reduce these risk factors whether weight loss occurs or not.
Energy Balance: The Simple Principle of Weight Loss Scientists often explain weight loss quite simply in terms of the "energy balance equation": energy in versus energy out. To lose weight, you must consume fewer calories than you burn or, in reverse, you must burn more calories than you consume.
This is, of course, easier said than done. But no matter what weight loss methods you may employ—diet, exercise, medication, supplements, surgery, therapy, group support—the principle of energy balance is unavoidable. In fact, experts from both traditional and nontraditional disciplines agree that to achieve and maintain weight loss you must make changes in your diet and activity level to favorably affect the balance of the energy equation.
Getting Started Getting started is often the most difficult part of losing weight. Any changes you make in your eating and exercising behaviors must become habitual, which takes time. In addition, carrying extra weight, no matter how much, can affect how you feel about yourself psychologically, sometimes making it more difficult to take the necessary steps to begin to change.
The following five strategies are crucial to successful weight loss and can help to overcome some of these barriers:
Set realistic goals and monitor your progress toward achieving these goals.
Modify your eating and exercise behaviors as well as habits influencing both.
Examine and restructure unrealistic, negative thoughts or expectations.
Develop a network of social support.
These strategies bridge the gap between traditional and alternative medicine and have been used successfully by people engaged in many different approaches to weight loss.
Medications and Supplements There is a great deal of interest in whether prescription medications or supplements can facilitate weight loss. Most prescription medications suppress appetite by interfering with brain chemicals that affect mood and appetite. The following is a list of some of the available prescription weight-loss medications:
Tenuate, Tenuate dospan
Bontril, Plegine, Prelu-2, X-Trozine
Adipex-P, Fastin, Ionamin, Oby-trim
Studies have shown that some medications, such as sibutramine and orlistat, facilitate weight loss and maintenance of that loss for up to two years when they are used as adjuncts to diet and exercise. These types of medications are usually prescribed only for severely obese individuals for whom other methods of weight loss have not worked. Accordingly, these medications are not without side effects or potential adverse events and should only be used with careful monitoring by a medical doctor and a registered dietitian. The same goes for dietary supplements, which should be treated as medications and taken only under the supervision of a qualified health professional. It is also important to point out that medications and supplements should not be used indefinitely since the long-term risks are not known.
Although supplements do not undergo the same rigorous approval process as drugs, it is possible, even likely, that some of the same benefits, and therefore principles of use, are applicable to weight loss supplements, since many have the same mechanisms of action as drugs. Similarly, some of the same risks and side effects may be present as well.
The question is: At what point should you consider taking medications or supplements? Some health experts say that after three or more months of behavioral changes that fail to produce a 5% to10% reduction in total body weight. However, most advocate a more conservative approach that focuses on behavioral change for at least six to 12 months before introducing a drug or supplement—unless there are other factors, such as high blood sugars or high blood pressure, that are not responding to diet and exercise alone.
An additional note of caution for both diet medications and diet supplements: There are certain substances that are potentially dangerous and carry risks that clearly outweigh the possible benefits. The prescription drugs dexfenfluramine (trade name Redux) and fenfluramine (trade name Pondimin) were taken off the market because of their connection to valvular heart abnormalities and a lung disorder known as pulmonary hypertension. Similarly, in April 2004 the FDA banned the sale of dietary supplements containing the herbal substance ephedra (also known as ma huang) due to concerns over their cardiovascular effects, including increased blood pressure and irregular heart rhythm. Make sure that whenever you are considering taking a diet supplement, you know exactly what is in the product and you share this information with your doctor.
Conclusion It's clear that while the "energy balance" principle behind weight loss may be simple, actually losing weight is not. Lifestyle changes in diet and exercise are imperative to successful weight loss, but trying a prescription medication or dietary supplement might also be an option to consider, depending on your weight and your health status.
Both medications and supplements can be useful adjuncts to diet and exercise when used under the supervision of a doctor or qualified practitioner. Consider the following suggestions:
Medications and supplements are not substitutes for behavioral changes, which are crucial to maintaining weight loss over the long term.
Medications and supplements should be used only by people who are significantly overweight and when more standard methods have been unsuccessful.
Medications and supplements should be used for a limited period of time to be decided upon in conjunction with the healthcare professional, but no longer than one year.
Try to have realistic ideas about what the medications or supplements will help you accomplish.
Explore the deeper individual and cultural issues you may have about food, eating, and body image, with guidance from a professional. In doing so, use this information not for self-judgement but for greater self-understanding, acceptance and compassion.
Remember that even modest changes can make a big difference.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.