There's no way around it: To rid yourself of obesity you need to diet rigorously, though regular exercise is also helpful in shedding pounds and keeping them off. Although both over-the-counter and prescription medications help take off pounds temporarily, there is little evidence that they are effective in helping you maintain weight loss over the years.
The best diet includes nutritious foods served in smaller portions than you're in the habit of eating. Be sure to check with your doctor before undertaking low carbohydrate diets, liquid protein fasts, and other "fad diets." Some can be dangerous. Liquid diets of the past, for example, caused several deaths and hospitalizations; the dieters apparently starved to death because the liquids provided only a few hundred calories per day.
Losing weight can be a struggle, particularly if your problem is severe enough to classify you as obese. You may find help and support from local chapters of such organizations as Weight Watchers and Overeaters Anonymous. These groups can offer both advice on weight loss and a chance to ease your feelings of isolation by talking with people who understand what you're going through. (For more information, see "Directory of Support Groups.")
Medical treatment ranges from dieting under a doctor's supervision, sometimes with the aid of prescription medications, to outpatient or residential programs. These treatment programs are usually run by private doctors; some are associated with hospitals.
In an outpatient program, you will have regular consultations with the physician or other professionals. You will probably eat prepackaged diet foods for several months before gradually reverting to other foods. To prevent you from reverting to your old eating habits, the treatment may include behavior modification counseling.
Residential programs are more comprehensive; many include various forms of psychotherapy designed to treat obesity as an addiction. A residential program may charge thousands of dollars; outpatient therapy can cost you several hundred dollars or more per month.
While the mainstays of permanent weight control continue to be a low-fat diet, regular exercise, patience, and perseverance, for some people who are seriously obese, drug therapy also may provide at least a little help. Older stimulant-type diet drugs include diethylpropion (Tenuate), phendimetrazine (Bontril, Prelu-2, others), and benzphetamine (Didrex). A newer weight-loss drug sibutramine (Meridia) works by boosting certain chemical messengers in the brain.
The phentermine drugs (Adipex-P, Ionamin), nicknamed "phen," were often prescribed along with fenfluramine (Pondimin) or dexfenfluramine (Redux), nicknamed "fen," in combinations known as "fen-phen." But in September 1997, the Food and Drug Administration asked manufacturers to withdraw Pondimin and Redux because of studies strongly suggesting that the drugs damage the heart's mitral valve. Today, the "fen" drugs are no longer available, but the "phen" medications remain.
A review of numerous studies reveals that diet drugs are only modestly effective, typically working just 10 percent better than non-drug treatments, and losing their effect after about six months. However, a new type of diet drug called orlistat (Xenical) may produce greater and more lasting results. It works by blocking absorption of fat from the digestive tract, and can be taken both to shed pounds and to keep them off. The drug is for use by anyone whose weight is affecting her health. It does, however, cause unpleasant side effects in a significant number of the people who try it.
The last resort is surgery. It is generally reserved only for people who are massively obese or whose health is at risk. The two most common surgical techniques are liposuction and intestinal bypass. In liposuction, a tool is inserted under the skin to suck fat from the body. In bypass surgery, the digestive flow is routed past the large and small intestines to reduce the amount of food absorbed. Both surgical techniques can be dangerous and should only be used as a last resort.
