Treatment

Ifyou're obese, speak to your GP for advice about losing weight safely.

Your GP can advise you about losing weight safely by eating a healthy, balanced diet and regular physical activity .

They can also let you know aboutother useful services, such as:

  • local weight loss groups these could be provided by your local authority, the NHS, or commercial services you may have to pay for
  • exercise on prescription where you're referred to a local active health team for a number of sessions under the supervision of a qualified trainer

If you have underlying problems associated with obesity, such as polycystic ovary syndrome (PCOS) , high blood pressure , diabetes or obstructive sleep apnoea , your GP may recommend further tests or specific treatment. In some cases, they may refer you to a specialist.

Readsome tips for a lower-salt diet .

You'll also need to checkcalorie information for each type of food and drink you consume to make sure you don't go over your daily limit.

Some restaurants,cafs and fast food outlets provide calorie information per portion, although providing this information isn't compulsory. Be carefulwhen eating out because some foods can quickly take you over the limit, such as burgers, fried chicken, and some curries or Chinese dishes.

These types of dietsdon't work, can make you feel ill, and aren't sustainable because they dont teach you long-term healthy eating habits.

This isn't to say that all commercial diet programmes are unsafe. Many are based on sound medical and scientific principles and can work well for some people.

A responsible diet programme should:

  • educate you about issues such as portion size, making behavioural changesand healthy eating
  • not be overly restrictive in terms of the type of foods you can eat
  • be based on achieving gradual, sustainable weight loss rather than short-term rapid weight loss, which is unlikely to last

Read about the pros and cons of different diets .

Very low calorie diets

A very low calorie diet (VLCD) is where you consume less than 800 calories a day.

These diets can lead to rapid weight loss, butthey aren't a suitable or safe method for everyone, and they aren't routinely recommended for managing obesity.

VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss.

VLCDsshouldn't usually be followed for longer than 12 weeks at a time, and they should only be used under the supervision of a suitably qualified healthcare professional.

Speak to your GP first ifyou're considering this type of diet.

Further information

For more information about diet and weight loss, read:

  • how to start losing weight
  • healthy food swaps
  • eight tips for healthy eating
  • food labels

Exercise

Reducing the amount of calories in your diet will help you lose weight, but maintaining a healthy weight requires physical activity to burn energy.

As well as helping you maintain a healthy weight, physical activity also has wider health benefits. For example, it can help prevent and manage more than20 conditions, such as reducing the risk of type 2 diabetes by 40%.

The Chief Medical Officers recommend that adults should do at least 150 minutes (two-and-a-half hours) of at least moderate-intensity activity a week for example, five 30-minute bouts a week. Something is better than nothing, and doing just 10 minutes of exercise at a time is beneficial.

Moderate-intensity activity is any activity that increases your heart and breathing rate, such as:

  • brisk walking
  • cycling
  • recreational swimming
  • dancing

Alternatively, you could do 75 minutes (one hour, fifteen minutes) of vigorous-intensity activitya week, or a combination of moderate and vigorous activity.

During vigorous activity, breathing is very hard, your heart beats rapidly and you may be unable to hold a conversation. Examples include:

  • running
  • most competitive sports
  • circuit training

You should also do strength and balance training two days a week. This could be in the form of agym workout, carrying shopping bags, or doing an activity such as tai chi .It's also critical that you break up sitting (sedentary) time by getting up and moving around.

Start small and build up gradually.

It's alsoimportant to find activities you enjoy and want to keep doing. Activities with a social element or exercising with friends or family can help keep you motivated. Make a start today its never too late.

This could include things like:

  • setting realistic weight loss goals if you're obese, losing just 3% of your original body weight can significantly reduce your risk of developing obesity-related complications
  • eating more slowly and being mindful of what and when you're eating for example, not being distracted by watching TV
  • avoiding situations where you know you may be tempted to overeat
  • involving your family and friends with your weight loss efforts they can help to motivate you
  • monitoring your progress for example, weigh yourself regularly and make a note of your weight in a diary

Getting psychological support from a trained healthcare professional may alsohelp you change the way you think about food and eating. Techniques such as cognitive behavioural therapy (CBT) can be useful.

Avoiding weight regain

It's important to remember that as you lose weight your body needs less food (calories), so after a few months, weight loss slows and levels off, even if you continue to follow a diet.

If you go back to your previous calorie intake once you've lost weight, it's very likely you'll put the weight back on. Increasing physical activity to up to 60 minutes a day and continuing to watch what you eat may help you keep the weight off.

Medication

Manydifferent types of anti-obesity medicines have been tested in clinical trials , but only one has proved to be safe and effective: orlistat.

You can only use orlistat if a doctor or pharmacist thinks it's the right medicine for you. In most cases, orlistat is only available on prescription. Only one product (Alli) is available over the counter directly from pharmacies, under the supervision of a pharmacist.

Orlistat works by preventingaround a third of the fat from the food you eat being absorbed. The undigested fat isn't absorbed into your body and is passed out with your faeces (stools). This will help you avoid gaining weight, but won't necessarily cause you to lose weight.

A balanced diet and exercise programme should be started before beginning treatment with orlistat, and you should continue this programme during treatment and after you stoptaking orlistat.

When orlistat should be used

Orlistat will usually only be recommended if you've made a significant effort to lose weight through diet, exercise or changing your lifestyle.

Even then, orlistat is only prescribed if you have a:

  • body mass index (BMI) of 28 or more, and other weight-related conditions,such as high blood pressure or type 2 diabetes
  • BMI of 30 or more

Before prescribing orlistat, your doctor will discuss the benefits and potential limitations with you, including any potential side effects (see below).

Treatment with orlistat must be combined with a balanced low-fat diet and other weight loss strategies, such as doing more exercise.It's important that the diet is nutritionally balanced over three main meals.

If you're prescribed orlistat, you'll also be offered advice and support about diet, exercise and making lifestyle changes.

Orlistat isn't usually recommended for pregnant or breastfeeding women.

Dosage and duration of treatment

One orlistat capsule is taken with water immediately before, during or up to one hour after, each main meal (up to a maximum of three capsules a day).

If you miss a meal, or the meal doesn't contain any fat, you shouldn't take the orlistat capsule. Your doctor should explain this to you, or you can check the patient information leaflet that comes with your medicine.

Treatment with orlistat should only continue beyond three months if you've lost 5% of your body weight. It usually starts to affect how you digest fat withinone to twodays.

If you haven't lost weight after taking orlistat forthree months, it's unlikely to be an effective treatment for you. Consult your doctor or pharmacist, as it may be necessary to stop your treatment.

Taking orlistat with other health conditions

See your GP before starting treatment with orlistat if you have another serious health condition, such as type 2 diabetes, high blood pressure, or kidney disease, which you're taking medication for. It may be necessary to change the dose of your medicine.

If you havetype 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after three months may therefore be slightly lower.

You'll have a review after you've been using orlistat for three months. If you've lost weight, your GP may suggest continuing to use orlistat for 12 months or more. They'll discuss the benefits, limitations and side effects with you.

Side effects

Common side effects of orlistat include:

  • fatty or oily stools
  • needing the toilet urgently
  • passing stools more frequently
  • an oily discharge from your rectum (you may have oily spots on your underwear)
  • flatulence (wind)
  • stomach pain
  • headaches
  • upper respiratory tract infections , such as a cold

These side effects are much less likely to occur if you stick to a low-fat diet.

Women takingthe oral contraceptive pill should use an additional method of contraception , such as a condom , if they experience severe diarrhoea while taking orlistat. This is because the contraceptive pill may not be absorbed by your body if you have diarrhoea, so it may not be effective.

Surgery

Weight loss surgery , also called bariatric surgery, is sometimes used to treat people who are severely obese.

Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria:

  • they have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetes or high blood pressure
  • all appropriate non-surgical measures have been tried, but the person hasn't achieved or maintained adequate, clinically beneficial weight loss
  • the person is fit enough to have anaesthesia and surgery
  • the person has been receiving, or will receive, intensive management as part of their treatment
  • the person commits to the need for long-term follow-up

Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes.

In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a person's BMI is 50 or above.

Treating obesity in children

Treating obesity in children usually involves improvements to diet and increasing physical activity using behaviour change strategies.

The amount of calories your child should eat each day will depend on their age and height. Your GP should be able to advise you about a recommended daily limit, and they may also be able to refer you to your local family healthy lifestyle programme.

Children over the age of five should ideally get at least one hour (60 minutes) of vigorous-intensity exercise a day, such as running or playing football or netball. Sedentary activities, such as watching television and playing computer games, should be restricted.

Referral to a specialist in treating childhood obesity may be recommended if your child develops an obesity-related complication, or there's thought to be an underlying medical condition causing obesity.

The use of orlistat in children is only recommended in exceptional circumstances, such as if a child is severely obese and has an obesity-related complication.

Bariatric surgery isn't generally recommended for children, but may be considered for young people in exceptional circumstances, and if they've achieved, or nearly achieved, physiological maturity.

Further information

For more information about diet and exercise in children, read:

Content supplied by the NHS Website

Medically Reviewed by a doctor on 23 Aug 2016