A BMI of 30 or higher suggests obesity, notes the Centers for Disease Control and Prevention (CDC). All the same, the conversation around weight is changing. Weight bias exists, and discussing body size comes at an emotional toll for many people. Therefore, certain healthcare professionals may target lowering your risk of associated diseases, rather than focusing on BMI alone. If your doctor believes that treating obesity may help lower your risk of or help manage chronic conditions, and you choose to work with them, there are multiple options to consider. Here, we explore the different treatment approaches to obesity, including dietary changes, medications, and complementary and integrative approaches.
Various Factors Can Contribute to Obesity
To lose weight and maintain it, the age-old advice is to avoid taking in more calories than you burn in a given day. But when considering obesity, the causes are more complex than simply calories in and out. According to the CDC, obesity may be caused by a combination of the following factors:
Eating patternsA lack of physical activityPoor sleep hygieneGene changes that may influence appetiteCertain medications, such as antidepressants and steroidsIllnesses that may cause weight gain, such as Cushing’s syndrome
Your social, home, work, and community environments may also increase the risk for obesity. According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development, not having access to outdoor parks or stores with healthy foods can also contribute. Long-term stress is another risk factor to consider. According to the NHLBI, the following strategies may help with obesity:
Reduce your daily calorie intake gradually.Consider adopting a heart-healthy eating plan, such as the Dietary Approaches to Stop Hypertension (DASH) diet.Gradually add physical activity that you enjoy to your daily life, and ask your doctor how to safely begin an exercise program.Get about seven to eight hours of sleep every night.
You may also consider working with a therapist or psychologist to help you with behavioral modifications that can improve your chances of sticking with healthy diet and lifestyle changes while also learning stress management. According to the Obesity Action Coalition, people with mental health conditions may be up to 2 to 3 times more likely to develop obesity and related health diseases. It’s not clear whether this may be due to lifestyle or emotional eating, or perhaps due to mental health medications that can cause side effects such as weight gain. The Obesity Action Coalition identifies the following mental health conditions that may be associated with obesity:
DepressionBipolar disorderSchizophrenia
On the flip side, having obesity may also increase the risk of developing mental health conditions, such as depression. The CDC found that 43 percent of adults with depression also had obesity, and women who were obese were particularly at risk for developing depression. Having a mental health condition doesn’t necessarily mean you will develop obesity, nor does having obesity definitively mean you will develop a mental health condition. That said, it’s important to be aware of such comorbidities so you may seek help from a doctor or therapist. For example, if you’re facing emotional eating, the Mayo Clinic recommends first trying self-help techniques, such as reducing stress and keeping a food diary. If such methods don’t work, they recommend working with a therapist to help you uncover the reasons you may engage in emotional eating so then you may help overcome it, and possibly lose weight along the way.
Oral Medications
Diethylpropion (Amfepramone), naltrexone/bupropion (Contrave), and phendimetrazine, which are all types of stimulants that may help reduce appetite and lead to subsequent weight lossOrlistat (Alli, Xenical), an oral medication that complements a low-fat diet and helps to block the absorption of dietary fats by your intestines
Injectables
Semaglutide (Ozempic), a type of injection that works by releasing insulin from the pancreas when your blood glucose is high, as well as reducing the rate that food moves through your stomach to help decrease your appetiteTirzepatide (Mounjaro), an injection approved by the FDA in May 2022 to help reduce blood sugar that has also been found to help adults lose weight along with exercise and dietary changes, making it a potential obesity medication in the future
While medications are available to help treat overweight and obesity, the majority are for adults only. Furthermore, lack of access is another issue. According to a report published in 2020 in the Cleveland Clinic Journal of Medicine, fewer than 2 percent of people in the United States with overweight and obesity are ever prescribed weight loss medications. Researchers believe this is due to a combination of factors:
Obesity biasLack of communication between doctors and patients about obesityRefusal of insurance companies to pay for obesity medicationsPossible side effects, such as gastrointestinal discomfort, dizziness, and heart palpitations
In addition to the resources offered here by the Obesity Action Coalition, it’s important to discuss obesity medication options with a doctor — even if they don’t initiate this discussion. Below are a few questions you may ask to help you get started:
Do I qualify for possible obesity medications? Why or why not?What lifestyle changes do I need to make before starting medications for obesity? How long do I need to wait to see if any changes have an effect before taking medications?What are the potential risks versus benefits of the currently available oral and injectable medications for obesity?How can I work with my insurance provider? What are the out-of-pocket costs of treatment? Are there any manufacturer coupons or discounts available?
According to the American Academy of Family Physicians (AAFP), surgery may also be an option if you have obesity-related health conditions, including heart disease, high blood pressure, diabetes, or sleep apnea. There are multiple types of bariatric surgeries. According to the NHLBI, one of the following methods may be recommended:
Gastric bypass surgery, which involves connecting part of your stomach to your middle intestinal tract to decrease the amount of food you can eatGastrectomy, the most common weight loss procedure, for which a large piece of the stomach is removed to help decrease overall food consumptionGastric banding (lap band), which involves a surgically implanted band around the stomach to help reduce food consumption and increase the amount of time your food digestsTemporary implanted devices, such as gastric balloons and emptying systems, which are removed after you lose weight
Weight loss surgery isn’t for everyone, and it’s important to discuss the possible risks with your doctor. Your insurance company may have specific requirements, such as proof of trying other methods first. According to the AAFP, the amount of weight you may lose could be significant at first, then taper off after two years. Continued weight loss — and eventually maintenance — may be achieved when surgery is combined with diet and lifestyle changes.
MeditationMindful eatingYoga
Another area of potential interest is the practice of acupuncture. In a study, acupuncture was thought to decrease overall BMI in participants by helping regulate the neuroendocrine system, which affects metabolism and eating behaviors. Still, as with other complementary weight loss methods, acupuncture works best with other treatments, and more research needs to be done to prove its efficacy in obesity management. While individual treatment plans may vary, obesity management will likely include multiple approaches, including diet, lifestyle changes, behavioral modifications, and possible medications or surgeries. Talk with your healthcare team about all these options, including the benefits and drawbacks in your individual case.
