Current Non-Surgical Treatment Options for Obesity

Obesity is the second-most preventable death group with 400,000 preventable deaths annually, behind only tobacco-related deaths. But does the fact that it is preventable make it avoidable? Less than 5% of the morbidly obese can lose weight on their own (it is harder to lose weight than to gain weight). Interestingly, it requires a 25% reduction in caloric intake for a 10% reduction in weight. The goal for the individual is to be in a state of negative energy balance so that the body will utilize its stored energy reserves in the fat cells. Thus all treatment options are directed toward decreasing calorie consumption, increasing energy usage, or both.

Diet programs: America’s $30 million fight against the fat

Dieting is the most common therapy used to shed pound, and it is a huge market (just ask Richard Simmons, Jenny Craig, and Dr. Atkins). However, from a clinical standpoint, they are not effective. Despite the fact that Americans spend in excess of $30 billion on diet products, the problem with most diets is that they fail to have patients make permanent lifestyle changes. As a result, even if short-term results are successful, dieters will usually gain back the weight over time. An NH study showed that approximately 98% will gain any lost weight back and 90% will gain more than they originally lost.

The most common diets are:

• Low-carbohydrate diets have been very popular recently due to programs such as South Beach, Zone, and Atkins diets. These replace a person’s consumption of carbohydrates with protein and fat. Instead of eating breads, pastas, rice, and other starchy food, dieters will eat meats and soy products. These regimens typically show good results but have attracted a lot of controversy from the American Heart Association due to the increase in cholesterol.

• Low-calorie (LCD) and very low-calorie (VLCD) diets generally target caloric intake. A LCD has a range of 1,000-1,500 calories per day, while the VLCD is 400-1,000. Since a VLCD produces the same effects as starvation (diminished appetite after five days), it requires protein and vitamins supplements. This is most common diet prescribed to the morbidly obese and can yield a three- to five-pound loss per week.

• Low-fat diets are good at lowering cholesterol as well as weight. B avoiding foods that are high in fat, patients can also see a reduction in calorie consumption

Exercise

It is no secret that regular exercise provides numerous benefits to one’s health, especially when it comes to weight loss. The best results can be seen by utilizing the large muscles in the legs that require a lot of energy to do work. For the obese running and riding a bike are not even an option, so low-impact exercise such as walking, swimming, and general physical activity are prescribed.

Aside from the direct calorie burn during exercise, physical activity can lead to increased energy expenditure even during times of rest. Additional lean muscle mass will increase metabolism because muscle tissue has a higher metabolic weight than adipose tissue. Even intense aerobic exercises such as swimming or running can speed up metabolism for four to eight hours after the workout.

The power of daily exercise was highlighted in a recent study that compared a group of physically active Amish with a predisposition to obesity (FTO gene) with those having the same FTO gene but living a sedentary lifestyle. The study showed that daily physical activity negates the effects of this gene and even though they have a predisposition to be obese, the labor-intensive lifestyle of the Amish group allowed the participants to remain at a normal weight. This highlights how the modern sedentary lifestyle can bring out the big person inside all of us.