Options For Weight Loss

Figuring out how to lose weight is not easy. There are so many options for weight loss to choose from, which can get confusing. This post will discuss the most popular options for weight loss (and weight maintenance) currently available and what you should look for when choosing a program.

Weight loss: Choosing a diet that’s right for you

Don’t fall for gimmicks when it comes to weight loss. Evaluate diets carefully to find one that’s right for you.

When it comes to weight loss, there’s plenty of advice. Magazines, books and websites promise that you can lose all the weight you want for good. To do this, they suggest that you use diets that get rid of fat or carbs. Or use superfoods or special supplements.

With so many options, how do you know which approach might work for you? Here are some suggestions for choosing a weight-loss program.

Talk to your health care provider about your weight-loss efforts

Before you start a weight-loss program, talk to your health care provider. Your health care provider can go over your medical issues and the drugs you take that might affect your weight. Your provider can guide you on a program that’s right for you. And you can discuss how to exercise safely. This is important if you have physical or medical challenges or pain with daily tasks.

Tell your health care provider about your past efforts to lose weight. Be open about fad diets that interest you. Your provider might be able to direct you to weight-loss support groups or refer you to a registered dietitian.

Think about your personal needs

There’s no one diet or weight-loss plan for everyone. Think about your preferences, lifestyle and weight-loss goals. Pick a plan that you can tailor to your needs.

Before starting a weight-loss program, think about:

• Diets you’ve tried. What did you like or dislike about them? Were you able to follow the diet? What worked or didn’t work? How did you feel physically and emotionally while on the diet?
• Your preferences. Do you prefer to do a weight-loss program on your own, or do you want support from a group? If you like group support, do you prefer online support or in-person meetings?
• Your budget. Some weight-loss programs require you to buy supplements or meals, visit weight-loss clinics, or attend support meetings. Does the cost fit your budget?
• Other considerations. Do you have a health condition, such as diabetes, heart disease or allergies? Do you have cultural, religious or ethnic requirements or preferences for food?

Look for a safe, effective weight-loss program

It’s tempting to buy into promises of fast and amazing weight loss. But a slow and steady approach is easier to keep up. And it often beats fast weight loss for the long term. A weight loss of 0.5 to 2 pounds (0.2 to 0.9 kilograms) a week is the typical recommendation.

Faster weight loss can be safe if it’s done right. Examples include a very low-calorie diet with medical supervision or a brief quick-start phase of a healthy-eating plan.

Successful weight loss requires a long-term commitment to making healthy lifestyle changes in eating, exercise and behavior. Behavior change is vital, and could have the greatest impact on your long-term weight-loss efforts.

Be sure to pick a plan you can live with. Look for these features:

• Flexibility. A flexible plan uses a variety of foods from all the major food groups. It includes vegetables and fruits, whole grains, low-fat dairy products, lean protein sources, and nuts and seeds. A flexible plan allows a treat now and then if you like. The plan should include foods you can find in your local grocery store and that you enjoy eating. But limit alcohol, sugary drinks and high-sugar sweets. The calories in those items don’t provide enough nutrients.
• Balance. Your plan should include the right amount of nutrients and calories. Eating large amounts of some foods, severely cutting calories or removing entire food groups can cause nutritional problems. Safe and healthy diets don’t need large amounts of vitamins or supplements.
• Likeability. A plan should include foods you like and that you would enjoy eating for life. If you don’t like the food on the plan, if the plan is too restrictive or if it becomes boring, you probably won’t stick to it. So long-term weight loss is unlikely.
• Activity. Your plan should include physical activity. Exercise plus fewer calories can help give your weight loss a boost. Exercise also offers many health benefits, including countering the muscle mass loss that occurs with weight loss. And exercise is an important factor in maintaining weight loss.

Ask yourself these questions when evaluating weight-loss plans

Before you dive into a weight-loss plan, take time to learn as much about it as you can. Just because a diet is popular or your friends are doing it doesn’t mean it’s right for you. Ask these questions first:

• What’s involved? Does the plan provide guidance that you can adapt to your situation? Does it require buying special meals or supplements? Does it offer online or in-person support? Does it teach you how to make positive, healthy changes in your life to help keep up your weight loss?
• What’s behind the diet? Is there research and science to back up the weight-loss approach? If you go to a weight-loss clinic, what expertise, training, certifications and experience do the providers, dietitians and other staff have? Will the staff coordinate with your regular provider?
• What are the risks? Could the weight-loss program harm your health? Are the recommendations safe for you, especially if you have a health condition or take medications?
• What are the results? How much weight can you expect to lose? Does the program claim that you’ll lose a lot of weight quickly or that you can target certain areas of your body? Does it show before and after photos that seem too good to be true? Can it help you keep up your weight loss over time?

Medical Options for Weight Loss

Your first line of attack against extra pounds is a healthy diet and exercise. But what if it doesn’t work? If the scale won’t budge, talk with your doctor. Medical weight loss options may be worth considering if your weight is affecting your health.

Medical options use medication for weight loss. It can’t guarantee weight loss, and it has risks. For some people, the health benefits may be worth the potential risks. Losing 5 to 10% of your weight is enough to lower your risk of obesity-related problems, such as heart disease and type 2 diabetes. 

Medical weight loss isn’t an easy way out. You’ll still need to eat well and be active to lose weight and keep it off. However, it may help you lose more weight than you would on your own. 

Prescription Medication

The U.S. Food and Drug Administration (FDA) has approved three weight loss medications for long-term use. This means your doctor may prescribe them for several months or years. They include:

• Lorcaserin (Belviq) is an appetite suppressant. When you feel less hungry, you should eat less. But you may still need to work on other reasons for eating, such as stress or anxiety. This medicine should help you lose about 5% of your body weight. If you haven’t reached that goal after 12 weeks, it’s unlikely this drug will work for you. You and your doctor should explore other options if this is the case. Common side effects include dizziness, headaches, fatigue, dry mouth, and nausea.
• Orlistat (over-the-counter Alli or prescription Xenical) stops your body from absorbing about 30% of the fat you eat. This means your body takes in fewer calories. The down side is that the unabsorbed fat tends to cause digestive problems. This includes stomach pain, gas, diarrhea, and leakage of oily stool. The other problem is it can also block the absorption of some vitamins. You’ll need to take a multivitamin while on orlistat.
• Phentermine and topiramate-ER (Qsymia) combines an appetite suppressant and an antiseizure medicine. Phentermine by itself is only approved for short-term use. Combining it with topiramate allows people to safely use it long-term. There are three doses available. If you haven’t lost 5% of your body weight after 12 weeks at the highest dose, this product is not likely to work for you. Talk with your doctor about other options. Common side effects include dizziness, taste changes, sleep problems, dry mouth, and tingling in the hands and feet.

Doctors sometimes use metformin (Glucophage)—a diabetes drug—and bupropion (Wellbutrin)—an antidepressant—for weight loss. However, these drugs do not carry official FDA indications for weight loss.

Results depend on the drug and the person. People who follow a diet and exercise program while taking a weight loss drug tend to have the best results. The usual amount of weight loss is 10% of body weight with most weight loss occurring in the first six months. 

Weight loss drugs can cause some rare—but serious—problems. This includes liver damage and serious whole-body reactions. That’s why medication is only recommended for people with obesity. The risks of these drugs make them inappropriate for someone looking to lose a modest amount of weight for cosmetic reasons.

The principles of weight management

Obesity is a chronic disease that results from complex interactions between genetic, metabolic, hormonal, behavioural and environmental factors.⁶ Key lifestyle interventions to promote weight loss include behaviour change strategies, reducing calorie intake, improving the nutritional value of the diet and increasing energy expenditure. The clinical benefits of weight loss begin once an overweight person loses as little as 5% of their body weight and benefits increase as the ideal weight range is approached. If lifestyle interventions alone are unsuccessful, treatment can be stepped up to include pharmacological or surgical treatment.

Key aspects of weight loss management include:

• Optimising the management of co-morbidities and considering other potential causes of weight gain, e.g. adverse medicine effects, undiagnosed conditions or psychosocial issues
• Developing an individualised plan with SMARTER^* goals (Specific, Measurable, Achievable, Relevant, Time-bound, Enjoyable and evaluate, Record and reward) and a plan for review and monitoring. Lifestyle changes should be sustainable so that reductions in body weight can be maintained. Individualising management based on cultural factors is also important to support weight loss; for example, a review of studies relating to obesity management in New Zealand primary care demonstrated that including whānau and values such as manaakitanga (enhancing the integrity of the person), pātaka mātauranga (sharing knowledge that leads to understanding and responsibility) and whanaungatanga (support or connectedness) aided the success of interventions.
• Recommending dietary interventions that are affordable and recognise the cultural and social significance of food, e.g. manaakitanga in Māori culture centres on generous hospitality often involving food, and this concept is shared by many other Pacific and Asian cultures
• Recommending behavioural interventions as appropriate, e.g. encouraging regular meals and meal planning, self-monitoring, stimulus control, stress management, slowing the rate of eating, ensuring social support, problem-solving, thought modification, relapse prevention and strategies to deal with weight regain.⁵ If additional support is needed, referral to weight loss support groups or counselling (depending on local availability).
• Recommending physical activity and exercise interventions that are appropriate for the patient’s fitness level and encouraging an increase in intensity as their fitness and mobility improves (see: “Exercise should be included in every weight loss regimen”)
• Re-framing the discussion to focus on improving the management of long-term conditions, e.g. type 2 diabetes or dyslipidaemia, rather than weight loss may motivate patients to engage with lifestyle changes or step treatment up to include weight loss medicines, if indicated⁸

Options If Medical Weight Loss Fails

So what happens if medical weight loss doesn’t work for you? You and your doctor should explore your options, including weight loss surgery—or bariatric surgery. In fact, most weight loss surgery programs want you to try medical weight loss before considering surgery.

Weight loss surgery involves an operation on the stomach, intestines or both. The most common bariatric surgeries in the United States are:

• Adjustable gastric band. In this procedure, a doctor places a band around the top of the stomach so that the stomach becomes smaller. As a result, your stomach becomes full more quickly and you eat less.
• Roux-en-Y gastric bypass. This operation also creates a small pouch at the top of the stomach so that you eat less. In addition, a surgeon will reroute your intestine to this pouch to change the way your body processes food.
• Biliopancreatic diversion (BPD). BPD is a complex surgery that involves removing part of the stomach and bypassing a lengthy portion of the small intestine. It significantly reduces the amount of food your body absorbs. One common variation of this surgery is BPD with duodenal switch.

Weight loss surgery is a big decision. Your life will change considerably after the surgery. For example, you will need to stick with a very specific eating plan that may be drastically different in your food choices and amounts. You may also need supplements to be sure you get enough nutrients. And keep in mind that even surgery isn’t a fail-safe. If you don’t stick with healthy lifestyle changes, it’s likely you will gain the weight back.