Approaches to Weight Management
What and how much we put into our mouths, and how much of it is absorbed is at the heart of obesity treatment. Dietary intake is central regardless of whether the approach to obesity treatment is lifestyle changes, medication, or surgery alone or combined.
Getting to the roots means focusing on changes in diet. Any dietary changes that are made should be to promote long-term healthy changes in eating habits. There is no one-size-fits-all type of diet and what works for one person may not work for another. It is important that you choose a diet that you can live with to help achieve long-term success. Approaches to dietary changes include decreasing the portion of food eaten at every meal, and replacing “calorie-dense” foods (such as foods high in fat) with “nutrient-dense” foods (such as foods that are plant-based, or high in fibre) to help you feel fuller for longer. Decreasing or eliminating the consumption of “liquid calories/energy” such as sugar-sweetened beverages or juice is a particularly good place to start cutting down on the amount of energy consumed.
Changes in Physical Activity and Exercise
What about exercise you say? Incorporating exercise into weight management is beneficial during weight loss in a number of ways. Depending on what exercise is done, muscle mass can be maintained, blood pressure can improve, and a better cholesterol profile can be obtained, among other benefits. However, exercise alone without dietary changes does not often amount in significant weight loss. It is especially beneficial to incorporate an exercise program into weight loss if possible because exercise greatly helps in maintaining weight loss. Currently, 150 minutes of moderate-intense exercise per week is recommended to maintain a health weight.
Addressing Psychology and Emotion
Losing weight can be mentally demanding. Sometimes, individual professional counselling and support groups can help to address some of the behavioural obstacles to achieving your treatment goals.
Medications for Weight Loss
There are several medications on the market that can be prescribed to help with weight loss. Weight loss pills target different aspects of weight loss. These include preventing the absorption of fat (e.g. orlistat), or decreasing appetite (e.g. lirglutide). It is important to note that these medications are not “magic beans”. In other words, taking them does not result in fat miraculously melting away. To increase the chances of maintaining weight loss, these medications need to continue to be taken forever AND they are only successful if changes in diet, exercise, and behaviour are made. Moreover, all of the medications used in aiding weight loss have side effects that should be considered in choosing which to take.
Surgery is only recommended when someone with a BMI over 40 kg/m2 or 35 kg/m2 with medical complications has not been able to lose weight through lifestyle changes. There are different types of weight-loss surgery, some which decrease the volume of the stomach to restrict the amount of food eaten (e.g. gastric sleeve) and some that also decrease the length of the small intestine to limit the amount of food that is absorbed (e.g. gastric bypass). Weight loss surgery has a good rate of success and may reduce comorbidities of obesity by 40-70%. However, surgery can be accompanied by short and long term complications. Moreover, surgery does not always work and, at times, a second surgery is needed. Though the rate of long-term success and weight maintenance is not clear, a study by Sheppard et al (2013) indicated that weight regain or insufficient weight loss may occur in 20% of patients.
Weight Loss Is Not Always Good
Unintentional weight loss is when weight is lost without changes in diet or exercise habits. Unintentional weight loss occurs with shifts in metabolism and energy use within the body and could be an early sign of a health issue that needs to be addressed. Should this be the case, a medical professional should be consulted.