Treatments for Obesity

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.

 

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.

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.

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.

Transcript to follow

Transcripts are auto generated, if you find an error, please let us know.

 

My name is Hermann Toplack, I am professor of internal medicine in the Medical University of Graz in Austria and I am currently the president of the European Association for the Study of Obesity. The European Association for the Study of Obesity is dealing with all aspects of obesity from prevention to treatment and we are also dealing with patient organizations supporting patients’ ideas and wishes. When we are going to the current anti-obesity treatments, diet and exercise are fully the basis for the treatment of overweight and obesity wherever possible.

Additionally to that, care providers should be able to provide a wide spectrum of clinically proven treatment options in different combinations. Such options would be individual or group lifestyle modification, lifestyle modification including dietary supplements, addition of anti-obesity drugs and addition of bariatric surgery. Why do we need pharmacotherapy for obesity? There is a significant need for non-invasive treatment options to bridge the gap between lifestyle modification and surgical interventions.

With lifestyle modifications we reach only 3 to 4 percent loss in body weight. With surgical procedures beyond 15 or 20 percent up to 40, 50 percent of body weight and so there is a gap of about 10 percent which could be suitable for obesity drugs. Pharmacotherapy should be considered as an adjunct to diet and exercise and recommended for patients with a BMI above 30 or a BMI above 27 with an obesity related comorbidity like hypertension, diabetes or hyperlipidemia.

Responders to pharmacotherapy will then achieve at least 5 percent of weight loss or at least 3 percent in those with diabetes and then the treatment should be continued. Treatment on the other hand should be discontinued in non-responders. Unfortunately, since 1999 there was only one drug available in Europe which was a lipase inhibitor reducing triglyceride absorption and thus leading to less triglyceride absorption and less calorie uptake.

In the last years some drugs tried to come to the market which are now available in the US but not in Europe because they were rejected by the European Medicines Agency. This year in March two new drugs got approval by the European Medicines Agency, Liraglutide 3mg which is an injectable drug and a naltrexone-bupredione combination, a tablet with different dosages. In the past the cardiovascular safety issues with many of the drugs approved and later have been withdrawn have caused concern in the European Medicines Agency and the regulators look now very carefully and critically to the new drugs.

But associated with that requirements have been done or at least desired that we should have long-term cardiovascular safety trials before approval with all new drugs and that would restrict the availability of these agents for years and stifle the further advances in the field. In Europe such mandatory requirement for pre-approval cardiovascular outcome studies would be problematic as there is currently fewer treatments available. To allow fast access to new therapies an approval decision should take into consideration whether a drug has clear and beneficial effects on surrogates of cardiovascular risk in the registration trials.

So what would we like for the future? We would hope that the European Commission, the European Parliament will work together with scientific society and potentially patient groups to ensure that new obesity treatment options are more readily available. Within the experts we have to adapt the risk benefit model to the approval and regulatory process. If we then are successful in the management of obesity we will block a key progression route for many chronic diseases like diabetes, hyperlipidemia, hypertension and following that cardiovascular disease.

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 centr