Obesity treatment may involve diet, regular excise, and medications to suppress appetite and reduce compulsive eating. In some cases, bariatric surgery may be recommended to decrease absorption of nutrients in the digestive tract, leading to weight loss.

The main goal of obesity treatment is to reach and maintain a healthy weight in order to prevent obesity-related complications such as diabetes, high blood pressure, high cholesterol, gastroesophageal reflux disease (GERD), osteoarthritis, impotence, and infertility.

Obesity treatment should involve a multidisciplinary team that includes an endocrinologist, a registered dietitian, a bariatric surgeon, and an exercise physiologist. In addition, it is important to see a psychologist in order to identify behaviors that can lead to compulsive eating and for help staying on track with treatment.

Obesity specialists

Healthcare providers with special training in obesity treatment are known as bariatricians or bariatric healthcare providers. Endocrinologists are also trained in the evaluation and treatment of obesity and play an important role in managing this condition. Obesity treatment often requires a team of specialists, however, that may include a registered dietitian, an exercise physiologist, and, in some cases, a bariatric surgeon.

Treatment approaches

The main treatments for obesity include:

1. Diet changes

The first step in both the treatment and prevention of obesity is making changes to your diet. This includes adopting a diet rich in fruits, vegetables, fiber, and water, as directed by your doctor or a registered dietitian.

These diet changes help control the number of calories ingested in a day, which should be less than the number of calories burned through normal metabolism. Your recommended daily caloric intake can be calculated based on your eating habits and how much weight you need to lose, as well as your age, sex, height, and current weight.

Gradual, consistent weight loss over time is more likely to be maintained than rapid weight loss from extreme diets. While drastic dietary changes can show more immediate results, it is common to quickly regain the weight lost.

2. Regular exercise

Physical exercise, such as walking or swimming, is an essential part of obesity treatment. Exercise helps facilitate weight loss by increasing metabolism so the body burns more calories.

The recommendation for weight loss is 150 to 300 minutes of physical exercise per week. Make sure to see your doctor or other primary care provider to check for any health conditions before starting any new exercise program. It is also a good idea to meet with an exercise physiologist to learn proper techniques to avoid injury.

There are other small changes you can make to add more physical activity to your day, including using the car less and taking the stairs instead of the elevator. These lifestyle changes can help to optimize weight loss.

3. Medications

The use of medication for obesity treatment is indicated in people with a BMI greater than 30kg/m²and in those with a BMI greater than 27kg/m²who have other obesity-related conditions such as diabetes, high cholesterol, or high blood pressure. Weight loss medication may also be indicated for people with any class of obesity in which diet and exercise are not enough.

The most common types of medication for obesity treatment include:

Appetite suppressants, such as sibutramine, amfepramone, and fenproporex, act directly on the area of the brain that controls satiety (feeling of fullness), helping to decrease appetite. This can result in fewer calories ingested, leading to weight loss;
Lipase inhibitors, such as orlistat, that reduce fat absorption by inhibiting enzymes in the gut that break down fat. This allows fat to be excreted by the body instead of stored as calories;
Receptor CB1 antagonists, such as rimonabant, act directly on the brain to suppress appetite, increase satiety, and help prevent compulsive eating;
Thermogenics, such as ephedrine, which speed up metabolism and cause the body to burn stored fat as its primary source of energy.
GLP-1 agonists, such as semaglutide, are used in the treatment of type 2 diabetes and may also help with weight loss by regulating appetite and increasing satiety.

Medications used to treat other conditions may also have weight loss benefits. These include antidepressants such as fluoxetine, sertraline, and bupropion.

Medications for obesity treatment should only be taken under a doctor's supervision and require regular follow up appointments to evaluate for any side effects, which may include increased heart rate, increased blood pressure, headaches, diarrhea, changes in mood, irritability, anxiety, and insomnia.

4. Bariatric surgery

Bariatric surgery is indicated for the treatment of morbid obesity (BMI greater than 40kg/m²) as well as moderate obesity (BMI between 35 and 40kg/m²) in the presence of other obesity-related conditions such as diabetes, sleep apnea, high blood pressure, high cholesterol, cardiovascular disease, stroke, arrhythmias, or osteoarthritis.

The main types of bariatric surgery are:

Gastric band: involves the placement of an adjustable band around the stomach, decreasing the size of the stomach and limiting food intake;
Gastric bypass: performed by surgically reducing the size of the stomach and making alterations to the small intestine, thereby reducing food intake and nutrient absorption and leading to weight loss;
Biliopancreatic diversion: done by removing a large portion of the stomach and attaching the small stomach pouch directly to the final part of the small intestine;
Gastric sleeve: a procedure in which the left part of the stomach is removed, decreasing storage capacity.

The decision on what type of bariatric surgery to pursue is made in consultation with a bariatric surgeon, who will make recommendations based on the individual needs of the patient.

Helpful tips

Obesity treatment can be challenging because it is not always easy to break habits and make changes to diet and lifestyle patterns you have followed your whole lie. Some tips for sticking with it and avoiding setbacks include:

Establishing weekly, attainable goals;
Asking a dietitian to adjust your diet if it feels too difficult to maintain;
Choosing a type of exercise you enjoy most and will practice regularly;
Keeping track of your results by writing down your measurements or through weekly photographs.

Talk to your doctor or primary care provider about any obesity treatment programs available through your hospital or clinic. Some obesity treatments may be covered by insurance.