Treatments for Obesity

With the realisation that you are living with obesity, you may arrive at a point at which you feel you need to do something about it.

Some people feel they prefer to try to manage their condition alone, others seek help.
Often your family doctor (Primary Care Physician) can be your first port of of call.

We have opted give you advice which will cover treatments, and products for weight management, from across the spectrum.

The options available to you, may be determined by your weight, and coexisting health issues. This is why we have, and will continue to relay the importance of seeking the advice of a health care professional.

You may be offered advice, or even sign up to a program which may help you to control, and maintain your weight. There are other options for obesity treatment, and management, you will find these further along on this page.

Many health care professionals will initially advise the approach of trying to control your dietary input, whilst at the same time, increasing your calorie expenditure (via exercise/physical activity). Depending on your exact condition, overall health, and need for treatment, this may be a sensible approach. Often we find that for many people, the chronic, relapsing and progressive nature of the disease that is obesity, may render this advice that is difficult to follow, and depending on the biology of a person, may have little effect.

You may also consider some options either alone, or with guidance from a health care professional, which we advise.

Commercial Slimming Programs

Across Europe there are various programmes that exist for doing this. Your local health provider may in fact run groups or online activities you can join. You may also be referred (or make contact yourself) to a commercial slimming provider.

Many people find belonging to a group, either face to face very supportive, and are often very successful.

They can offer:

  • Structure
  • Education
  • Support
  • Skills and strategies
  • The befit of increased activity are outlined in all programs

All cost money to attend, though your state or national government may offer subsidies.

The two largest programs available across Europe are WW (formerly Weightwatchers), and Slimming world. Both of these programs have an evidence basis, that demonstrates their effect in weight loss and maintenance.

Meal replacement Plans

These can be an effective alternative to weight control for some people. They are designed to replace one or more meals a day, providing nutrients within a known calorie limit.

  • This approach usually provides around 1200-1600 calories per day.
  • Range includes shakes, bars and soups.
  • Users are advised to replace 1-2 meals (often breakfast and lunch) with a meal replacement and include a healthy meal in the evening (or at lunchtime).
  • Additional fresh fruit and a modest number of healthy snacks are allowed, as well as drinking at least 6-8 glasses of water or low-calorie drinks.
  • Meal replacement products are usually fortified with extra vitamins and minerals to help ensure they provide the recommended amount of nutrients for good health.
  • Many of these plans provide additional online or written support.

Be aware of the cost of these programs, possible boredom due to lack of everyday food such as vegetables, fruits, grains, meats and cooking meals. In addition, when returning to a more “normal diet”, care needs to be taken to avoid eventual weight regain, and emotional upset this may cause.

Very Low Calorie Diets (VLCD’s)

These are the most restrictive form of dieting, where the total calorie intake is severely reduced (below 800 calories), and for which medical supervision is highly recommended. VLCDs are scientifically proven to achieve effective weight loss, and therapeutically effective in treating sleep apnoea and osteoarthritis.

However, VLCDs should only be a last option, and should only be undertaken with the help of a health professional, and not recommended for long term weight management.

Nutritional supplements are also highly recommended with a VLCD.

Typical Features

  • These are nutritionally balanced formula foods designed to replace all meals.
  • As a ‘sole source’ of nutrition, they provide a total daily calorie intake of between 400-799 calories
  • Organisations such as Cambridge Weight Plan offer a range of weight loss and maintenance programmes from 415 calories increasing to 1500 calories per day
  • At least 2¼ litres of water (4 pints) must be taken in addition to the formula foods to help maintain hydration
  • The product range consists of drinks, soups, porridge and bars
  • The programmes are provided with written information which gives detailed instructions about which foods to include on different plan options and recipe ideas
  • Side effects such as headache, nausea, constipation, diarrhoea and dizziness can occur, usually as a result of inadequate water intake
  • May be helpful in very overweight individuals where other approaches have not worked, and when immediate weight loss is needed for medical reasons i.e. before an operation
  • To follow the VLCD approach, individuals need to be highly motivated
  • After the initial weight loss, support and advice are important in order to  avoid rapid weight regain
  • To ensure nutritional adequacy, people using this approach should only use branded products, rather than their own ‘home made’ drinks

Be aware that these diets should only be used in conjunction with the supervision of a health care professional.

Pharmacotheraphy

Seeking Further Help in Managing your Obesity.

Your family doctor (primary care physician) may offer you some treatment with medication or this may take place in a specialist clinic (often called a weight management or centre).

There are a range of drugs available depending on the country in which you live and its health care system.

All of these drugs need to be prescribed and monitored by a health care professional during your treatment. The mode of action and its side effects vary depending on the drug which you are taking.

Some drugs inhibit the absorption of fats from your digestion. Others may mimic hormones to help convince your brain your stomach is full. We would once again stress that education and monitoring of patients is of vital importance during treatment.

The evidence base suggests that the best results for these drugs are obtained when patients monitor their dietary intake and increase activity levels, as well taking the prescription drugs.

Many patients have experienced difficulties with medications in the past, or have been disappointed when medicines have been withdrawn from the market.

It is believed that new treatments are being developed and hopefully these will become readily available in the future.

Professor Hermann Toplak speaks about the need for anti-obesity medication.

Bariatric Surgery

This is a surgical procedure which can help with dramatic weight loss and improvement in health conditions such as Type II diabetes, hypertension (high blood pressure) and Obstructive sleep apnoea (Problems breathing at night).

Bariatric surgery is a relatively safe procedure that is clinically and cost effective with long term data to back this up. Though funding and access varies across countries it is generally considered as a treatment for people with a BMI> >40 or >35 with co-morbidities.

Bariatric surgery is not a quick fix but rather a lifelong tool that requires input from the patient and regular follow up to get the best outcomes.

Surgery generally works by restricting the amount of food you can eat. Other surgeries work by causing malabsorption of the calories and nutrients you can absorb. A third group offer a combination of both restrictive and malabsorptive elements. It should also be considered that some of the surgeries may have an effect on the hunger hormone producing parts of the gastro-intestinal tract.

 If you are considering surgery you should discuss with your family doctor and any other health care professional involved in your care as well as your surgeon. Your immediate family may be a great source of support in your decision so please involve them as early as possible.

 Try to find out as much as possible about bariatric surgery before your procedure as possible. You might consider going along to a support group to meet people who have had surgery.

Research on the internet can be useful try to look for validated reliable sources of information. You may be well advised to look beyond unmoderated internet groups to help you make your decision.

In writing this article we have realised the huge variety of access to surgery, types of operations and aftercare plans across Europe. We will be expanding this section in the near future.

Two of the many validated reliable sources that we have found are  

  • https://www.ifso.com   International Federation for the Surgery of OBESITY AND METABOLIC DISORDERS (IFSO)  look under the Obesity and Bariatric Surgery tabs
  • https://asmbs.org/patients American Society for Bariatric and Metabolic Surgery – the patients learning centre