Obesity is a major public health problem. It is directly associated with several health conditions including diabetes, heart disease, stroke, hypertension, gallbladder disease and fatty liver disease as well as some cancers. Nearly 1 billion individuals worldwide are overweight or obese and the numbers are on the rise.
Aims of obesity management
Management of obesity and overweight revolves around some basic aims that include:-
- Reduction of body weight
- Maintenance of the lost body weight and prevention of recurrence or regaining the lost weight
- Maintenance of nutrition and preventing dietary deficiencies
Management of obesity
For most people, losing a small amount of weight to the tune of 5% can have benefits. This may be sufficient to reduce the risk of developing diabetes or lowering the blood pressure.
This is an achievable target that most patients can aim for and achieve by adopting a healthy life style of a healthy low calorie balanced diet and increasing physical activity. People should not be expected to lose more than 0.5–1 kg (1–2 lb) a week.
If management of obesity of a member of the family is the concern, the whole family may adopt healthy lifestyle measures. This is especially effective for obese children. Parents need to take responsibility for making changes to their child’s diet and improving their physical activity especially for children under 12 years of age.
Exercise to lose weight
For an average adult at least 30 minutes of moderate physical activity is recommended on 5 or more days a week to lose weight and maintain the weight loss.
Moderate activity usually means activities that make the person feel warm and raises their heart rate and breathing rate. These are termed cardio-exercises and prevent development of diabetes and heart disease.
Most obese individuals however need to target a 45 to 60 minutes of moderate activity a day to stop them gaining weight. After losing the weight 60 to 90 minutes a day of moderate activity is needed to prevent putting on the weight again. This activity can be in a single session or several lasting 10 minutes or more.
Children should do 60 minutes of moderate activity each day. Activities suggested include cycling, brisk walking, climbing stairs, gardening, swimming or exercises in gyms.
Apart from improving physical activity, obese and overweight individuals need to reduce the time spent sitting down and inactive. This includes idle time before the television or the computer.
Management of diet
The calorie intake is usually reduced for obese individuals along with increased physical activity. Adults should usually be advised to follow a low-fat diet.
The patient is advised about 600 kilocalories (kcal) less than what he or she needs to stay the same weight. A low calorie diet provides only 1000 to 1600 kcal a day. Along with decrease in calories, vitamins and vital nutrients are ensured in diet to prevent deficiencies.
For those with a body mass index (BMI) of over 30 and those who have stopped losing weight before reaching their target, a very low calorie diet may be recommended. However, this cannot be followed for more than 12 weeks continuously.
Alternatively this very low calorie diet can be followed for 2 to 4 days a week. Very low calorie diet provides less than 1000 kcal a day. Diet should never be designed to provide less than 600 kcal a day unless the patient is monitored closely.
Ideal diet should avoid sweets, sugary drinks, foods rich in saturated and trans fats and be low of sodium (salt). Reducing the temptation to overeat may include avoiding situations that lead to overeating, eating slowly, eating small and healthy meals, drinking adequate amounts of water, avoiding alcohol etc.
Medications for weight loss
There are two medicines – called orlistat and sibutramine - that are sometimes prescribed for weight loss. They are not suitable for everyone and are not commonly used due to their risk of serious side effects. The medicines are normally recommended only for people with a BMI over 30.
The WHO defines an adult who has a BMI between 25 and 29.9 as overweight - an adult who has a BMI of 30 or higher is considered obese - a BMI below 18.5 is considered underweight, and between 18.5 to 24.9 a healthy weight .
Surgery for weight loss
Sometimes surgery may be suggested to lose weight. There are several different types of surgery that may help lose weight. They involve reducing the size of the stomach to induce early satiety and result in smaller meals and lower calorie intake.
An operation is only recommended for people with morbid or severe obesity, and those who have failed with other methods of weight reduction.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)