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Case History-
I am a 16year old girl, with the problem of obesity (I weigh 93kgs, at a height of 5ft7in) for the past four years.I seem to be becoming fatter, inspite of me trying my best to keep a diet and keep myself active. I had my menarche, when I was 12years old, which are normal. Apart from being oviously obesse, I have no other medical complaints but I feel very embarrassed being like this; so could you help me know exactly, what I am to do to reduce my weight effectively and keep it off. I preferable would not like to take drugs to lose weight, for I have heard they are dangerous to your health and once stopped, you gain all the weight back again and even more so. I need your help, I am desperate!

1st reply-
Dear Anne (name fictitious), I have read your consultation request and would be grateful if you could please get the following laboratory tests done and send me the results by 'Attachment' EMail post, so that I can get a better insight into your particular type of obesity.

Tests required-

  • Abdominal and Gynaecological Ultrasound examination
  • 2Hour Post Prandial Blood Sugar (2Hr PPBS)
  • Thyroid Function Tests
  • Sex Hormone Profile-Serum Oestrogen, Progesterone, DHEA-S, Prolactin
  • Adrenal Profile-Serum Cortisol, ACTH
  • Lipid Profile

2nd reply-From Anne-

Dear DrMinas here -Enclosed are the Laboratory Results you requested:-

Ultrasound Report-

Both Abdominal and gynaecological Ultrasound examinations showed no evidence of any Adrenal or Ovarian masses or signs of Polycystic Ovarian disease. Liver, Gallbladder and Kidneys were within normal limits, with no changes in architecture or morphology.

Laboratory test Results-

2HrPPBS- 120mg%
LH- 2.45mu/ml
FSH-4.00 mu/ml
A.C.T.H - 12,20nmol/L
H.T.S.H-0.14 microg/ml
Total Triglycerides-60mg/dl

2nd Reply-

Dear Anne (name fictitoius). Thank you for the prompt reply and for forwarding your laboratory results for me to review. I have gone through the reports and have the good news to give you that, your results are completely normal. I find that after going through your detailed medical questionaire, that you need to know much more regards the prevention, statistics and various treatment modalities regards obesity, as knowledge is power and that is the ONLY way, for you to lose weight consistently and keep the lost weight off once and for all. It takes a lot of determined constant effort but once you have changed your daily way of living, the changes will be permanent. Being fit and slim, must become a way of life for you, so please read through the following discussion and if you have any futher questions, I will be happy to answer them.


America has become a nation of chronically overweight people. Today more than 61 percent of American adults are either overweight or obese, according to the U.S. Centers of Disease Control and Prevention. Between 1991 and 2002, the percentage of Americans who meet the criteria for obesity more than doubled. Why are these facts alarming?

Obesity results in 300,000 preventable deaths each year in the U.S. and $100 billion in health care costs. Overweight people are more likely to have high blood pressure and high blood cholesterol, major risk factors for heart disease and stroke. As people gain weight, their glucose tolerance declines putting overweight people at twice the risk for developing noninsulin-dependent diabetes mellitus (Type 2 diabetes). Diabetes is a major cause of early death, heart disease, kidney disease, stroke and blindness. Several types of cancer are associated with being overweight, including cancer of the uterus, gallbladder, cervix, ovary, breast and colon. Other conditions linked with obesity include sleep apnea, osteoarthritis, gout, gallbladder disease and infertility. Obesity-related conditions worsen as weight increases and often improve as the conditions are successfully treated.

Obesity is a complex disorder. It is caused by multiple factors, both environmental and inherited, including excessive calorie and food intake, decreased physical activity and genetic influences. The formula for weight gain is fairly straightforward, however. You gain weight when you consume more calories (energy) than your body uses or needs.

What's the difference between being obese and being overweight? The defining characteristic in both overweight and obese people is excess body fat. The difference is a matter of degree.

Health care professionals use a simple calculation called the body mass index (BMI) to determine body weight relative to height. In adults, the BMI sum strongly correlates with total body fat content in adults. (See the Treatment section at this Web site for information on how to calculate BMI.) Overweight is defined as having a body mass index (BMI) between 25 and 29.9. Obesity is defined as having a BMI of 30 or more.

Where excess body fat is distributed on your body also plays a role in your risk for disease. Weight gain around your waist (specifically in your abdominal area) is more of a health risk because it is more metabolically active than weight gained on your hips and thighs. Excess abdominal fat is associated with an increase in blood cholesterol and insulin resistance, which may result in diabetes. An apple shaped figure may also raise your risks for other life threatening illnesses, such as heart disease and stroke.


An excess of body fat the defining characteristic of obesity -- results from an imbalance between energy intake and energy expenditure (i.e., consuming more calories than are needed to support your body's energy needs). The reasons for this imbalance are unclear, and the relationship between energy intake/expenditure and body fat storage and distribution varies from person to person. Factors that promote obesity include:

* a genetic predisposition

* family history of obesity

* age

* behavioral factors (including a high-fat or high calorie diet and sedentary lifestyle)

* biochemical differences (lower metabolic rate or decreased ability to oxidize fat).

Measuring Obesity

Assessment of your weight to determine if you are obese involves three key measurements -- body mass index (BMI), waist circumference and consideration of risk factors for conditions associated with obesity, according to clinical practice guidelines issued by the National Heart, Lung, and Blood Institute (NHLBI).

* First your health care professional should determine your body mass index (BMI), which describes body weight relative to height and is strongly correlated with total body fat content in adults. Your BMI is your weight in pounds divided by your height in inches squared, and then multiplied by 705. The following chart shows body mass indices for people of various heights and weights. To determine your BMI, find the row that most closely approximates your weight. Read across the row until it crosses the column closest to your height.

(Height) 5’0” 5’3” 5’6” 5’9” 6’0” 6’3”
140 27 25 23 21 19 18
150 29 27 24 22 20 19
160 31 28 26 24 22 20
170 33 30 28 25 23 21
180 35 32 29 27 25 23
190 37 34 31 28 26 24
200 39 36 32 30 27 25
210 41 37 34 31 29 26
220 43 39 36 33 30 28
230 45 41 37 34 31 29
240 47 43 39 36 33 30
250 49 44 40 37 34 31

A woman or man with a BMI between 25 and 29.9 is considered overweight; 30 or more is considered obese and 40 or greater is considered severely obese. Women in the highest obesity category have four times the risk of hypertension and/or high blood cholesterol than women of normal weight.

Charts that use the same mathematical principles as the BMI can provide figures for your ideal weight based on your height. For example, a height-weight chart that shows lower and upper limits of overweight, obese and severely obese can be found at the Web site developed by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

* In addition to comparing your weight to a chart of established acceptable weight ranges, your health care professional can actually measure body composition, the most accurate assessment technique because it differentiates between weight that is attributable to fat accumulation and weight that represents muscle development. Women with more than 30 percent body fat (25 percent for men) are considered obese. However, it is difficult to measure body fat precisely. The most accurate method has been to weigh a person underwater, but this procedure is limited to laboratories with special equipment. Your health care professional is more likely to conduct one or both of these tests:

* Measuring skin-fold thickness and subcutaneous fat, which lies just under the skin, at targeted areas such as the back of your upper arm, waist or thigh using calipers, an instrument that looks like tongs. Measurements of skin-fold thickness depend on the skill of the examiner and may vary widely when measured by different examiners.

* Bioelectrical impedance: using a handheld instrument called an impedance analyzer that transmits a non-invasive low frequency electrical current through electrodes placed on your hand and/or foot using a gel. Sophisticated software analyzes your body composition in seconds.

* Waist circumference is strongly associated with abdominal fat, which is an independent predictor of disease risk. Unlike fat around the thighs, which is more common in women and is more likely to serve as an energy reservoir, abdominal fat deposits are metabolically active: they deliver fatty acids directly into the bloodstream for immediate short-term energy; health care professionals remain uncertain why this can prove to be detrimental to your health. Higher proportions of this visceral fat are associated with higher risks of insulin resistance, diabetes, high blood pressure and cardiovascular disease (heart disease and stroke).

How can you estimate your body fat distribution? Look at yourself in the mirror. If you are more apple-shaped than pear-shaped, you probably have visceral fat accumulation. Women with a waist circumference over 35 inches (and men over 40 inches) are at greater risk.

Your health care professional also should ask you about or conduct tests to determine other risk factors for disease and conditions associated with obesity, and may do the following:

* look at your personal weight history

* ask whether you have relatives with illnesses related to being overweight, such as Type 2 diabetes mellitus or heart disease

* discuss the methods you have used to lose weight in the past

* evaluate your risk for obesity-related health problems by measuring your blood pressure and doing blood tests

It is important that you tell your physician if you have any of the following as he or she assesses your condition:

* pregnancy or are breast feeding

* history of gout or gallstones

* history of drug or alcohol abuse

* history of an eating disorder

* history of depression or bipolar disorder

* use of monoamine oxidase (MAO) inhibitors or antidepressant medications

* migraine headaches requiring medication

* glaucoma

* diabetes

* heart disease or heart condition, such as an irregular heart beat

* high blood pressure

* planning on surgery that requires general anesthesia

The types of health care professionals you might consult to diagnose and treat obesity include:

* A nutritionist. Nutritionists evaluate the diets and nutritional habits of clients and help to structure more healthful eating patterns and weight management strategies based on health needs, food selection and calorie goals. They usually have a bachelor's degree with a major in dietetics, food and nutrition, or a related subject. However, since there is no federal licensing requirement for nutritionists, it is up to the individual states to license them. Make sure any nutritionist you see is licensed by a state agency.

* A registered dietician (RD). An RD is a dietician who has completed academic and experience requirements established by the American Dietetic Association, including a bachelor's degree, an accredited preprofessional experience program, successful completion of a national credentialing exam, and ongoing continuing professional development.

* An endocrinologist. Endocrinology is the field of medicine involving the body's chemical messengers, or hormones, and its biochemical control mechanisms, or metabolism. Endocrinologists are physicians who care for patients with complex hormonal disorders and metabolic conditions, including obesity, diabetes, thyroid disorders, metabolic bone disease, pituitary and adrenal conditions, and growth and gonadal disorders.

Health Risks

A number of health risks are associated with being overweight. These include diabetes, cardiovascular problems, kidney and liver disease, osteoarthritis, and urinary stress incontinence. In addition to health factors, other potential consequences include psychological problems such as low self-esteem, social withdrawal, depression and eating disorders.

In assessing your risk of developing secondary health conditions, your doctor will look at your family history and existing medical conditions, ask questions about habits and behavior, take a measurement of your waist circumference to determine abdominal fat, and calculate your body mass index (BMI). Obesity is defined as a BMI of greater than 30. A waist circumference of greater than 40 inches (102 cm) for men or 35 inches (88 cm) for women indicates an increased risk of health problems. If you are obese and have a high waist circumference, even a ten-pound weight loss can reduce your risk of developing diseases associated with obesity.

People who suffer from obesity have a:

  • 46 percent rate of Type II diabetes
  • 38 percent rate of hypertension among adult men
  • 32 percent rate ofhypertension among adult women
  • 20 to 25 percent rate of high blood cholesterol.

Childhood Obesity

Childhood obesity is a leading concern among health care workers. Type II diabetes, once thought a disease of center age, is growing at an alarming rate amongst children. The root is believed to be childhood obesity. Childhood is the best time to instill healthy lifestyle and eating habits.

Weight Loss vs. Prevention

Fifty million Americans diet every year, spending 33 billion dollars on weight loss programs, diets and other products. In spite of the effort and expense, only five percent of dieters succeed in maintaining their weight loss. Losing weight is a long-term struggle that requires major changes in lifestyle and diet. Losing weight is not impossible, but it is often an uphill battle with no quick fixes.

That's why prevention is so important. Learning to maintain a healthy weight is essential to a healthy life. Healthy does not mean the super-skinny models that popular culture portrays as the ideal. Healthy means combining proper eating habits, lifestyle changes, and a realistic view of what a healthy body weight is. These are lessons best learned in childhood, but can be learned at any stage of life. Losing extra pounds is great, but it's even better not to gain them at all!

Effective Weight Loss: Is there a Silver Bullet?

Does some big weight loss secret exist? Some silver bullet that not only leads to effective weight loss, but permanent weight loss? If the silver bullet exists, obesity research has yet to find it. Indeed, the idea that some great weight loss secret exists is what fuels the less scrupulous members of the dieting market. People who've tried exercise, dieting, support groups and other options begin to get desperate, and are willing to try just about anything. An effective weight loss secret has become the Holy Grail of modern times, and it's about as elusive.

Losing weight takes a huge effort. If you're determined to lose weight, you must:

  • take the time to read food labels
  • calculate fat grams, carbohydrates, protein and calories
  • burn more calories than you take in
  • stick to a reasonable exercise plan
  • learn how to make good food choices when you eat out
  • refuse to allow friends and family to sabotage your plan
  • embark on a regular exercise regimen
  • do everything necessary to improve your self concept.

People who have more than 100 pounds to lose must prepare to make lifetime changes. This kind of change takes a long time and the pervasive dominance of a weight loss program can be both overwhelming and lonely. Many people suffer from depression when they're overweight or dieting. For very heavy people, many months go by before anyone begins to notice the changes. In the meantime, the temptation to give up is great.

Hospital and clinic programs are the safest and the most realistic. We recommend that you contact your medical provider to determine which programs you might be eligible for. Having a combination of resources, advice, medical supervision, regular weigh-ins, nutrition plans, psychological support and therapy, and regular encouragement, all combined into a planned clinical program, is more likely to help you succeed. Indeed, you'll even learn how your body works and how you can develop personal strategies for success, one step at a time.


A further benefit of a comprehensive clinical program is the likelihood of getting help establishing a maintenance plan once you reach your weight goal. One of the greatest barriers to successful weight loss is the return to old habits. Very, very few people lose weight and keep if off for more than three years!

Research studies explain how successful people lose weight and maintain the loss beyond the critical three-year point.

One study, for example, shows that people who substitute diet shakes for meals seem to have some success at keeping weight off after they've reached their target weight. First, the use of nutritional diet shakes to substitute for one or two meals a day works well for people who tend to nibble when they're cooking a meal. Furthermore, the likelihood of overeating is eliminated when you carry a fixed portion with you.

Once the weight goal is reached, successful dieters continue to monitor their weight. As soon as they notice a slight gain, they return to a regimen of substituting a shake for one meal a day until the weight has stabilized at or slightly below their ideal weight.


Losing as little as a five to 10 percent of body weight and maintaining that loss can significantly improve the health of obese patients by increasing glucose tolerance and lowering blood pressure and cholesterol levels. Therefore, if you are obese, you should seek medical help to lose weight as well as to maintain it. To be successful at achieving weight loss goals to improve your health, experts recommend losing weight a rate of no more than one to two pounds per week, and then maintaining that loss for six months before losing more. Maintaining weight loss can be more difficult than losing the weight to begin with, so long-term lifestyle change is key.

A 1999 study of 2,800 individuals who lost at least 30 pounds and maintained the weight loss for more than a year reported the following:

* about 55 percent had been involved in a formal weight loss program

* 20 percent succeeded with liquid diets

* 4.3 percent used medications

* 1.3 percent had surgery.

* 81 percent reported that they exercised more often and more vigorously than with previous attempts

The good news is that by burning off more calories than you're taking in will cause you to lose weight. The bad news is, there's no magic formula. Studies have found that if you lose the weight slowly, you'll be much more effective at keeping it off, especially if you incorporate exercise into your routine and reduce other sedentary behavior, such as watching TV.

The safest way to lose weight is to eat a nutritionally complete diet that is moderate in calories and fat and add exercise to your daily routine. In some cases, for example, if your health is being immediately and severely compromised because of your weight, faster weight loss may be appropriate. In these cases, your health care professional may recommend drug therapy or surgery.

Changing Your Diet

The first element of treatment is changing your diet. Your health care professional should provide detailed guidance on the number and types of calories you should eat. But as a rule of thumb, if you take in about 250 calories per day less than is needed to maintain your current weight, combined with an exercise regime that burns an additional 250 calories a day, you will lose about a pound per week.

To determine how many calories your body needs to maintain its basic functions known as your basal metabolic rate, multiply your current weight by 10. For example, a woman who weighs 200 pounds requires 2,000 calories per day to maintain bodily functions like breathing and digestion. You need additional calories about 30 percent to 50 percent more if you are moderately active to provide energy for daily activities like walking, vacuuming, even sitting at the computer.

It's difficult to determine exactly how many calories you need to maintain your weight at your current level of physical activity. You may want to take your basal metabolic rate and add about 10 percent if you're relatively sedentary, 20 percent if you're lightly active, and 30 percent if you're moderately active, and then subtract the 250 calories to arrive at your new recommended daily total. A slightly more accurate method is to keep a detailed food diary over the course of a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day several books and web sites provide calorie counts for thousands of different foods and use that figure as a starting place from which you would subtract 250 calories.

After you've determined how many calories per day you should eat, you need to plan daily menus. A dietician or nutritionist can help you plan menus that include the types and amounts of food you should eat, which, in most cases, should be based on guidelines developed by the federal government in its Dietary Guidelines and Food Pyramid. The guidelines emphasize balance, moderation and variety in food choices, with a special emphasis on whole grain products, vegetables and fruits.

To satisfy basic nutritional needs, eat a variety of foods every day by choosing from each of the five food groups milk, meat, fruit, vegetable and bread and allow for an occasional treat. While you should try to cut back on fats and sugars, all foods and beverages can be consumed in moderation. As soon as you label a food as off limits, chances are you will crave and perhaps even binge on it.

Balanced food plans encourage making wise choices about everyday food choices you can make to stay at your proper weight for life. Many popular diet plans the high protein/low carbohydrate diet, for example don't include balanced choices. While women can lose weight on these diets, they can be dangerously deficient in certain required nutrients or food groups and dangerously high in others. In most cases, women who go on these diets tend to regain any lost weight after they go off the diet. That's because these diets don't help you change your lifestyle and your way of handling food and temptation in the long run.

Most successful weight-loss plans call for a reduction in both calories and fat, although fat is probably not a critical component in obesity. Instead, overall calories and lack of physical activity, coupled with a sedentary lifestyle, are. Still, health care professional and dietary guidelines recommend women moderate their fat consumption to 25-35 percent or less of your total calorie intake, with saturated fats accounting for only about 10 percent of intake and comprised of equal amounts of monounsaturated fat and polyunsaturated fats that is, more vegetable-source fats. Also, reduce cholesterol intake to about 300 mg per day. Strategies for reducing saturated fat and cholesterol intake include:

* reduce your consumption to three servings or less per week of red meats, organ meats, eggs and high-fat dairy products

* choose low-fat protein sources, such as fish, turkey, chicken and legumes (dried peas and beans)

* when consuming meats, use lean cuts and trim excess fats

* substitute skim and low-fat milk products for high-fat dairy foods

* broil, bake or boil foods instead of frying

* increase your consumption of fruits, vegetables and whole grains

Don't Punish Yourself!

Healthy eating doesn't mean that you bid farewell to all your favorite foods. Nothing tempts more than the forbidden! If you love a certain food, you can probably still eat it: you just have to eat it in smaller amounts and less frequently. Nothing tasty has to be completely removed from your new eating plan, although high-fat foods such as fast food and French fries must be kept to a minimum. Minimum does not, however, mean never!

Be Gentle With Yourself

If you do give in to temptation, learn how to forgive yourself immediately. This is easier said than done. Guilt is a powerful emotion. It's also one that often leads to compulsive eating. Eating that little extra on your lunch break can set off feelings of guilt that lead to an all-day eating binge. Instead, accept that you will have setbacks. You will slide back into old habits occasionally. That's fine. Try not to dwell on them.

The Japanese have a wonderful saying: fall down seven times, get up eight. It means the obstacles on the way to a goal don't matter, nor do the number of times you falter along the way. What matters is that you keep going after every stumble.

Increasing Physical Activity

The second element of treatment is to add exercise to your daily routine. Exercise not only burns calories, it also tempers the appetite. Exercise boosts metabolism, which dieting can impair, improves sleep and provides psychological benefits, such as an increased feeling of control and self esteem, as well as stress reduction.

If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or suffer from a chronic condition, you should consult a physician before you begin your effort to increase your physical activity. Be sure to notify your physician about any chest pain, faintness or dizziness, bone or joint pain and any medications you may be taking.

The best kinds of exercises for burning calories are aerobic activities, which involve using the large muscles of your body in a rhythmic, continuous activity. Aerobics not only help to reduce body fat but also improve cardiovascular conditioning. While you and your health care professional should set up a detailed exercise plan based on your individual health status, the U.S. Centers for Disease Control and Prevention and other professional groups recommend healthy women do some sort of moderate-to-vigorous aerobic exercise on most or all days of the week for 30 to 45 minutes. These minutes can be accumulated 15 minutes of an aerobics video in the morning and 15 minutes of brisk walking in the evening, for example. However, a single sustained exercise session may be more effective in helping you to lose weight.

If you have been inactive, you need to work up slowly to this amount so you don't get injured or overly fatigued and then discouraged. Start with five or 10 minutes or whatever you're comfortable with every other day, and add one minute every other session. Low- to moderate-intensity aerobic exercise, like housework, gardening and walking the dog, provide a great deal of general health benefits, but for weight loss, you need to up the ante and exercise at a higher intensity with vigorous activities like brisk walking or jogging, singles tennis/racket sports, aerobics classes, ice or roller skating, swimming or cycling.

Because the goal of aerobic exercise is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and then sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the carotid artery on the side of your neck, just under your jaw line and about one to two inches in front of your ear. Count the beats for 10 seconds. Your heart rate should be about 70 percent to 85 percent of its maximum, which is your age subtracted from 220. The following chart illustrates recommended 10-second heart rate counts; the number of beats you count should fall between the two numbers listed beside your age.

(Age) 70 % of maximum 85 % of maximum
20 23 28
30 22 27
40 21 26
50 20 24
60 18 23

If you are out of shape or older than 60, you should aim for an intensity at 50 to 70 percent of your maximum heart rate. To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.6 for the lower end of the range and 0.73 for the higher end. For example, if you're 70:

* 220 — 70 = 150 (this would be your maximum heart rate for one minute)

* 150 ź 6 = 25 (this would be your maximum heart rate for 10 seconds)

* 25 x 0.60 = 15 (this would be 60 percent of your maximum, or the lower end of where your 10-second heart rate should be when you're exercising)

* 25 x 0.73 = 18 (this would be 73 percent of your maximum, or the higher end of where your 10-second heart rate should be when you're exercising).

An easier way to judge intensity is the talk test. You shouldn't be exercising so hard that you can't talk with a friend or recite a poem. If you can't talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.

Another type of exercise has received much attention over the past several years for its contribution to weight loss efforts. Strength training which includes weight lifting and isometrics, or using your own body weight as resistance such as in push ups not only improves muscular strength and endurance, it also raises metabolism, causing you to burn more calories.

Make sure you take a few minutes to stretch and warm up before doing any kind of exercise.

It's best to incorporate a combination of both types of exercise into your lifestyle aerobics to burn fat and strength training to build muscle, because neither type is as effective alone.

At the same time, you need to reduce the amount of television you watch, since TV watching is independently associated with obesity.

Exercise Tips

Here are a few other low-impact exercises you can do:

  • Mow the lawn.
  • Go play a few holes of golf.
  • Shoot some hoops.
  • Aquacise.
  • Swim.
  • Take the stairs instead of the escalator.

FDA-Approved Medications for Treating Obesity

Weight-loss medications may be recommended for patients who are at increased medical risk because of their obesity. Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight loss program that includes dietary therapy and physical activity. Currently available prescription medications include:

* Phentermine (Adipex, Fastin, Ionamin, Oby-trim)

* Diethylpropion (Tenuate, Tenuate dospan, Tepanil)

* Mazindol (Sanorex, Mazanor)

* Phendimetrazine (Adipost, Bontril, Plegine, Prelu-2, X-Trozine)

* Benzphetamine (Didrex)

* Sibutramine (Meridia)

* Orlistat (Xenical)

Most of these appetite-suppressants have been approved for short-term use, meaning a few weeks or months. Sibutramine and orlistat are the only weight-loss medications approved for longer-term use in significantly obese patients, although the safety and effectiveness have not been established for use beyond one year. Most of these drugs decrease appetite by affecting levels of the brain neurotransmitters catecholamine, serotonin and/or noradrenaline -- brain chemicals that affect mood and appetite. Orlistat (Xenical) does not act directly on the central nervous system but inhibits an enzyme essential to fat digestion. In general, these medications are modestly effective, leading to an average weight loss of five to 22 pounds above that expected with non-drug obesity treatments.

If you are, may be or could become pregnant or are nursing, be sure to tell your healthcare professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite-suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.

You also will need to tell your health care professional about any existing medical problems before taking these medications, especially thyroid problems, anxiety disorders, epilepsy or other seizure disorders, diabetes, heart disease, high blood pressure, arteriosclerosis, or glaucoma. Also, your healthcare professional needs to be aware of any other medications you are taking or have taken within the last 14 days, especially monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), tranylcypromine (Parnate), or phenelzine (Nardil). Mention any existing or previous problems with alcohol or drug abuse as well. Side effects of anti-obesity drugs can range from mild to serious and should be discussed in detail with your health care professional before making a decision to use these medications.

Meridia® and Appetite Suppressants

By far the most common types of prescription diet pills are the appetite suppressants, a family of drugs that includes Meridia (sibutramine) and Adipex-P® (phentermine). Appetite suppressants increase the amount of serotonin and catecholamine in the brain. The two chemicals are responsible for both mood and appetite. At sufficient levels, they reduce hunger and give you a feeling of fullness.

Most appetite suppressants can only be used for short periods: weeks, or sometimes months. Meridia is an exception, and can be prescribed for up to a year. Meridia's safety for longer periods than a year has yet to be determined, and claims of serious side effects, including possible heart disease, have been made.

Xenical® and Lipase Inhibitors

Xenical (orlistat) is a lipase inhibitor. That is, rather then working on brain chemicals as appetite suppressants do, lipase inhibitors block the absorption of dietary fat in the intestines. Up to a third of all ingested fat may be blocked. Unlike most appetite suppressors, Xenical can be prescribed for up to a year.

Most side effects involve changes in bowel movements. You may have urgent bowel movements, or need to use the restroom more frequently. Gas, orange-colored stools and oily bowel movements are also common. Women may experience irregular menstrual periods. If you experience itching, swelling, breathing problems or fever while on Xenical, call your doctor immediately.

Dietary Supplements and Other Weight Loss Products

In the absence of effective prescription diet pills, a staggering range of non-prescription diet pills, herbal weight loss products and dietary supplements have flooded the market. The claims made by these products are only loosely based in scientific research, if at all. Very few have been subjected to clinical trials to determine either their effectiveness or their safety.

Many such products claim to burn fat by boosting the body's metabolism. In many cases, this apparent metabolism boost is due to high amounts of caffeine or other stimulants in the product. Long-term use of weight loss products high in stimulants may increase the risk of hypertension and heart disease.

Other common ingredients in weight loss dietary supplements include chromium picolinate, chitosan, pectin, and Siberian ginseng.


For clinically severe obesity, surgery may be an element of treatment. Many people, some physicians included, wrongly believe that obese people merely need to stop eating so much and they will lose weight. In reality, severe obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a physician who:

* have tried other methods of weight loss (changes in eating, behavior, increased physical activity and/or drug therapy) and are still severely obese

* are unable to physically perform routine daily activities (work-related and family functions) and have a seriously impaired quality of life due to the severity of obesity

* understand the procedure, risks of surgery and effects after surgery

* are motivated to make a lifelong behavioral commitment that includes well-balanced eating and physical activity needed to achieve and maintain desired results

There are two types of obesity surgery restrictive and combined restrictive/malabsorptive. Different ways of performing each surgery have been developed. Each type of surgery has its own risks and side effects. Your physician can help you decide which is best for you.

* Restrictive surgery also called a gastric bypass uses surgically placed bands or staples to decrease the size of your stomach, creating a restriction in the amount of food you can eat. Possible complications include leaking of stomach juices into the abdomen, injury to the spleen, erosion of the band, breakdown of the staple line and the sectioned portion stretching from overeating.

Infection or death has been reported in less than one percent of patients. After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly; if you dont adjust your eating habits, your weight loss will be inhibited. In addition, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins, often with the help of a nutritionist or other health care professional.

Eighty percent of restrictive surgery patients lose some weight; 30 percent reach normal weight. Equally important, the operation appears to resolve a variety of serious weight-related health problems. Diabetes, which is common in obese people and which can lead to blindness, nerve degeneration and death, is often much improved or even cured by the weight loss that occurs after a gastric bypass.

The procedure can also stop idiopathic intracranial hypertension (IIH), or high pressure in the fluid surrounding the brain and spinal cord, a potentially fatal problem that may be related to obesity.

* Combined restrictive and malabsorptive surgery is a combination of restrictive surgery as described above with bypass or malabsorptive surgery, in which the stomach is connected to the small intestine, bypassing the duodenum, which is the beginning portion of the small intestine. The longer the segment of small intestine bypassed, the greater the malabsorption component that is, the fewer the calories absorbed from the food you eat and the greater the weight loss.

There is a risk from this procedure for nutritional deficiencies including malabsorption of vitamin B12, leading to anemia and iron deficiency. The reduction in vitamin D and calcium absorption can cause osteoporosis and other bone disease. Other complications are similar to those of restrictive surgery and are due to creating the stomach pouch. After surgery, lifelong use of nutritional supplements such as multivitamins, vitamin B12, vitamin D and calcium is necessary, as is nutritional counseling. The dumping syndrome in which food moves too quickly through the small intestine can cause nausea, weakness, sweating, faintness and sometimes diarrhea after eating. There can also be an inability to eat sweets without severe weakness and sweating. Dairy intolerance, constipation, headache, hair loss and depression are other possible side effects.

The average weight loss in patients undergoing this kind of surgery, depending on the specific operative procedure, is between 67 and 93 pounds in one year, and 66 percent to 75 percent of excess body weight over three years.

Behavioral Strategies

Another key to successful weight loss is incorporating into your new eating and exercise plan behavioral strategies designed to improve eating and physical activity habits. Learning about nutrition, planning what to eat, and making sure you eat regularly help put an end to impulsive and thoughtless eating.

Some specific and helpful behavioral strategies include:

* Set the right goals. Your goals should focus on specific dietary and exercise changes, such as I will eat five servings of fruits and vegetables every day this week, or I will work up to being able to walk briskly for 30 minutes at a time, rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once. Effective goals are specific, attainable and forgiving, which means that you don't have to be absolutely perfect. Remember, too, in setting your goals, that losing more than one to two pounds per week can be unhealthy and greatly increases the chances of the gaining the weight back.

* Reward success. To encourage yourself to attain your goals, reward yourself for successes. An effective reward is something that is desirable and timely. Do NOT use food as a reward.

* Keep a food and exercise diary. Many behavioral psychologists believe it's necessary to track your daily food consumption to achieve long-term weight loss. From a simple pad of paper to a computerized program that provides reports and analyses of your progress, the best tool is the one you will actually use every day. Incorporate your goals, such as eating five servings of fruits or vegetables each day, into your self-monitoring efforts.

* Monitor your weight sensibly. Keep track of your weight, but don't weigh too often. One day's diet and exercise patterns won't have a measurable effect on the scale the next day, and your body's water weight can change from day to day, which may frustrate you and derail your efforts.

* Join a support group. Weekly meetings at a nearby support group or even over the Internet can help in a variety of ways. They provide accountability, helpful ideas, emotional support, an outlet for sharing frustrations and a variety of other psychological benefits.

* Use positive self-talk. Take responsibility and see yourself as in control, able to talk yourself into exercising every day rather than being angry, hopeless or in denial.

* Find ways other than food to respond to stress and other situations in your life. Certain cues, from stress to watching television, may stimulate you to eat in an unhealthy way. In some cases, you can avoid those cues; don't go to that Mexican restaurant where you always eat too many chips, for example. But for situations that can't be avoided, from the business lunch to the argument with your spouse, relearn new ways to respond. If you track the situations surrounding your overeating in your food diary, you can more easily determine the cues you need to be aware of.

* Change the way you go about eating. There are a variety of tricks, from using a smaller plate to eating more slowly, that can help you eat less. Setting an eating schedule, starting meals with a broth-based soup, only buying foods on a pre-planned menu and other tricks can all be helpful.


Health care professionals and researchers stress that if you are obese, losing as little as five to 10 percent of your body weight can improve or prevent many of the health problems linked to your condition, such as high blood pressure and diabetes. For more information about preventing weight gain, visit the Fitness, Nutrition and Weight Management topics at this Web site.


Researchers in Finland have recently found that losing only a few pounds of weight can ease breathing difficulties in overweight people who have asthma. Although the mechanisms behind this improvement are not clear, the investigators suggest that improved lung volume is probably involved. Asthma also involves inflammation in the airways, and losing weight possibly may improve this complication.


1. While Americans fat consumption has decreased over the past several decades from 40 percent to 34 percent, their rate of obesity has risen from 12 percent in 1991 to as much as 35 percent today. One reason: Americans have increased the amount of calories they eat each day by as many as 300.

2. Another contributing factor to obesity: 60 percent of Americans don't meet basic activity level recommendations and 25 percent are completely sedentary.

3. Obesity results in 300,000 preventable deaths each year in the U.S. and $100 billion in health care costs.

4. One measure of obesity is your body mass index (BMI), which can be determined by dividing your weight in pounds by your height in inches squared and then multiplying by 705. For example, a woman who is 5'6" and weighs 190 would have a BMI of 31, as follows:

5'6" = 66 inches
66 squared = 4356
190 divided by 4356 = 0.0436
0.0436 x 705 = 30.75 (rounded up to 31)

5. If a woman's BMI is 30 or greater, she is considered obese. Forty or more puts her in the severely obese category. However, if she has more muscle mass than normal, these numbers won't apply, and her health care professional should measure her body composition to determine her degree of overweight.

6. If a woman's waist circumference is more than 35 inches, she is considered to have a high amount of visceral fat, which is the type of fat that surrounds the internal organs. This type of fat is associated with higher risk of certain diseases and conditions like diabetes and heart disease.

7. If you eat 250 calories per day fewer than needed to maintain your weight, and exercise enough to burn an additional 250 calories a day, you will lose about a pound per week.

8. Your basal metabolic rate, or the number of calories your body needs just to maintain its basic functions, is determined by multiplying your current weight by 10. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.

9. Obesity surgeries are usually quite successful, resulting in a weight loss of 67 to 93 pounds in the first year and 66 to 75 percent of excess body weight over three years for the combined restrictive and malabsorptive surgery. Restrictive surgery alone results in 80 percent of patients losing some weight and 30 percent reaching normal weight. However, surgery is only recommended in extreme cases of obesity.