Obesity: Treatment Overview

Reviewed by the Office of Clinical Evaluation and Policy (OCEP), Evernorth

Obesity is a significant health issue that affects millions of people worldwide. It is defined as having a body mass index (BMI) of 30 or higher, and it can increase the risk of serious medical conditions such as heart disease, diabetes, obstructive sleep apnea and certain cancers.

Treating obesity involves a combination of lifestyle changes, such as following a healthy diet and exercising regularly, and in some cases, medication or weight loss surgery. The specific treatment plan will depend on the individual's needs and circumstances.

Continue reading to learn more about obesity treatment.

Obesity Treatment Options

Lifestyle changes, such as following a healthy diet and exercising regularly, are the foundation of obesity treatment. If medication is prescribed, it should be taken along with an appropriate diet and exercise plan. As a last resort, surgery may be a potential option.

Lifestyle Changes

Diet and exercise are key components of obesity treatment. A healthy diet should consist of a variety of nutrient-dense foods, including fruits, vegetables, whole grains, and lean proteins. Guidelines suggest aerobic exercise and resistance training along with a reduced-calorie diet. Regular physical activity, such as walking, running, or participating in sports, can help to burn calories and improve overall health. Behavioral interventions such as goal setting, group meetings or sessions with clinicians (dietitians, psychologists) are also recommended.

Medication

Medications, such as appetite suppressants and fat absorption inhibitors, may be prescribed to help people lose weight. Patients considered appropriate for medication treatment have a BMI of at least 30kg/m2 or 27kg/m2 with at least one additional obesity-related risk factor (such as hypertension or diabetes). These medications should be used in conjunction with diet and exercise, and they may not be suitable for everyone. It is also important to discuss the potential risks and benefits of these medications with a healthcare provider before starting treatment.

Lipase inhibitors, or fat absorption inhibitors, work by blocking the action of lipase, an enzyme that breaks down fats in the intestine. By blocking the action of lipase, these medications can reduce the absorption of dietary fat, which can lead to weight loss. Orlistat is a common lipase inhibitor used to treat obesity, and it is available as a prescription (Xenical®) and over-the-counter medicine (Alli®).

Appetite suppressants are indicated for short-term use only and work by altering chemicals released by the hypothalamus, a part of the brain that controls hunger and feeling full. Examples include benzphetamine, diethylpropion, phendimetrazine and phentermine (Adipex-P®).

Glucagon-like peptide-1 (GLP-1) agonists are a class of medications that are used to treat obesity and other conditions, such as type 2 diabetes. They may help to reduce appetite and increase feelings of fullness, which can lead to weight loss. Examples of GLP-1 agonists used to treat obesity include semaglutide (Wegovy®) and liraglutide (Saxenda®). These medications are administered as an injection under the skin (subcutaneous).

Combination drugs are medications that contain two or more active ingredients that work differently to provide a multi-layered obesity treatment approach. Some common combination drugs used to treat obesity include phentermine and topiramate (Qsymia®) and bupropion and naltrexone (Contrave®).

Surgery

Surgery is an option for people with obesity who have not been able to achieve significant weight loss through other methods, such as lifestyle changes and medication. There are several types of weight loss surgery, also known as bariatric surgery, which can help people lose weight by altering the digestive system. Examples of bariatric surgery include gastric bypass surgery, sleeve gastrectomy, and adjustable gastric banding.

It is important to discuss the potential risks and benefits of bariatric surgery with a healthcare provider and a qualified surgeon before making a decision. Surgery is a major procedure and carries risks, such as infection, bleeding, and complications from anesthesia. It is also important to note that lifestyle changes, such as following a healthy diet and exercising regularly, are important for long-term weight management after surgery.

Getting the Right Treatment

Obesity is a complex condition that requires a comprehensive approach to treatment. Lifestyle changes, such as following a healthy diet and exercising regularly, are the foundation of obesity treatment. Medications and surgery may be appropriate for some individuals, but it is important to discuss the potential risks and benefits of these treatments with a healthcare provider before making a decision.

Obesity treatment is a lifelong process, and ongoing support and management are crucial for long-term success. If you are struggling with obesity, don't hesitate to reach out to a healthcare professional for help and guidance.

Source: https://www.ajmc.com/view/review-of-current-guidelines-for-the-treatment-of-obesity