Medical treatment overview

You may need to see your healthcare provider for help in losing weight if your own efforts have failed or if you have other medical conditions that make it crucial for you to lose weight. You may need to take prescription medicine if you have obesity-related health problems. Many people take over-the-counter or alternative medicine supplements in an attempt to lose weight. But to keep the weight off for the long term, you'll need to change your unhealthy habits and eating patterns. Behavior change focuses on unhealthy dietary habits. It also adds physical activity into your daily life. Obesity-related eating disorders need to be treated by a therapist, and may also need medicine.

Your healthcare provider will figure out the best treatment for you, based on:

• Your age, overall health, physical abilities, and medical history

• Past efforts to lose weight

• How overweight you are

• Your tolerance for specific medicines, procedures, or therapies

• Your expectations for the course of the condition

• Your opinion or preference

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Types of medical treatment for obesity

Prescription medicines

The most commonly prescribed medicines work by either blocking how fat is absorbed or by creating a feeling of fullness. One of the most commonly prescribed medicines is orlistat.

Orlistat blocks about 30% of the fat you eat as food travels through your digestive system. This medicine may cause frequent, oily bowel movements. But if you cut back on the amount of fat you eat, symptoms often get better. Once you stop taking this medicine, you may regain some or most of the weight you lost unless you make other changes to your diet and physical activity. Orlistat may not work for everyone, and it often has unpleasant side effects. 

Another medicine, sibutramine, was taken off the market by its makers in October 2010 after the FDA found that the medicine might raise the risk for heart attack.

Another medicine is locaserin. It boosts the amount of serotonin in the brain to reduce your appetite. A combination medicine, phentermine-topiramate, also works to reduce appetite.

Rarely, other prescription medicines are used on a short-term basis only. Amphetamines are not recommended because of the risk for addiction and substance abuse.

Always talk with your healthcare provider before taking any weight-loss drugs.

Supplements

Many over-the-counter supplements promise to help burn fat faster or reduce hunger. Some supplements have side effects that can be dangerous. A number of these products (perhaps most) have never been studied in clinical trials, so many of the side effects, benefits, and risks aren't well documented. If the claim of the maker sounds almost impossible, it probably is. (For example, "Burn fat at night while you sleep!") 

Ephedra (ma-huang) contains an ingredient used in asthma medicine. Dietary supplements containing ephedra have been banned by the FDA because of potentially dangerous side effects.

Products that work as a laxative can cause the potassium level in your blood to drop. This may cause heart and/or muscle problems. Pyruvate is a popular product that may result in a small amount of weight loss. But taking more pyruvate, which is found in red apples, cheese, and red wine, hasn't been thoroughly studied. Its weight loss potential hasn't been scientifically established.

No supplement that can take the place of eating a healthy diet, but a multivitamin taken every day can help close the nutritional gap even for those people who eat a balanced diet. But vitamin supplements won't help you lose weight.

Always talk with your healthcare provider before taking these supplements, because they can cause a number of side effects.

Behavior change

Over the long term, most obese adults who lose weight may regain it if they don't change their approach to healthy eating. You can change your behavior in several ways. One way is to keep a food journal. In it, you keep track of what you ate, where you ate it, and when you got hungry. You can also keep an activity journal, tracking when you exercised and for how long. These journals can help you figure out your eating and activity habits, so you can then determine what to change.

A counselor or psychologist may be helpful with behavior modification techniques. These techniques can help you change your thinking about body image. A reward system that doesn't include food can help you stay on track toward your weight-loss goals. Other behavioral ideas include serving food from the stove rather than family style, and never watching TV, reading, or doing another activity while eating. You can also keep portion sizes small, use smaller plates, drink water with each meal, and set specific weight-loss goals.

Psychotherapy for eating disorders

Eating a large amount of food at one time doesn't necessarily make a person a binge eater. Everyone overindulges from time to time. But some obese people binge and purge. Purge means vomiting brought about by oneself or taking laxatives to get rid of extra calories from binge eating. Others eat large amounts of food compulsively without purging. These behaviors are eating disorders that need to be treated by a healthcare provider. Most people who have these disorders are usually either overweight or obese. If you have an eating disorder, it's important to be treated for it before you try to lose weight.

Some eating disorders that may need to be treated with psychotherapy are:

• Bulimia. A disorder in which a person eats compulsively and then vomits or uses water pills (diuretics), laxatives, or strenuous exercise to prevent weight gain. Feelings of guilt, shame, and depression often follow the binge.

• Binge eating disorder. A disorder that is similar to bulimia. The person has episodes of uncontrolled eating or bingeing. It differs from bulimia in that its sufferers don't purge their bodies of the excess food by vomiting or using laxatives or diuretics.

• Nighttime eating. Waking from sleep and eating in the middle of the night is a potentially harmful behavior and a sign of abnormal eating. 

Healthcare providers, psychotherapists, and dietitians can help a person with an eating disorder. Therapy can also help change behavior and attitudes. Some people get help from medicine and support groups.