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There are four cornerstones for weight management. These include dietary intervention, recommendations for physical activity, behaviour modification, and, for some patients, pharmacological or surgical intervention.

All four factors are equally important in developing a successful weight management program. 

We need to have a more active role in evaluating the body mass index (BMI). For most people, Body Mass Index provides a reasonable estimate of body fat. However, BMI does not directly measure body fat, so some people, such as  athletes, may have a BMI in the obesity category even though they do not have excess body fat.

BMI is the weight in kilograms divided by the square of the height in meters;

Obesity is diagnosed when the body mass index (BMI) is 30 or more.

BMI                    Weight status

Below 18.5          Underweight

18.5-24.9             Normal

25.0-29.9             Overweight

30.0 and higher   Obesity

Before a doctor recommends weight loss for a patient, other problems must be addressed. A multifaceted approach to the obese patient should include identifying the possible causes of weight gain, describing the medical conditions that would benefit from weight loss [such as high blood pressure and cholesterol] and tailoring a weight loss program that is safe and effective for the individual.

  1. Dietary interventions

Often weight loss can happen quickly at first, long-term steady weight loss is considered the safest way to lose weight and the best way to keep it off permanently.

Avoid drastic and unrealistic dietary changes, such as fast diets, because they are unlikely to help you maintain excess weight in the long term.

Plan to participate in a comprehensive weight loss program for at least six months and in the maintenance phase of a program for at least one year to increase your chances of weight loss success.

  • Reduction of calories. The key to losing weight is to reduce the amount of calories you eat. The first step is to review your typical eating and drinking habits to see how many calories you normally consume and where you can reduce your consumption. You and your doctor can estimate how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
  • Feeling full with less. Some foods, such as desserts, sweets, fats, and processed foods, contain a high amount of calories per small serving. In contrast, fruits and vegetables provide a larger serving size with fewer calories. By eating larger portions of foods that have fewer calories, reduce hunger pangs, eat fewer calories, and feel better about your food.
  • Make healthier decisions. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables, and whole-grain carbohydrates. Also emphasize lean sources of protein, such as beans, lentils, and soy, and lean meats. If you like fish, try including fish twice a week. Limit salt and added sugar. Eat small amounts of fats and make sure they come from heart-healthy sources, such as olive, canola, and walnut oils.
  • Restrict certain foods. Certain diets limit the amount of a particular food group, such as foods high in carbohydrates or fats. Ask your doctor which diet plans have been found effective and which ones may be helpful to you.
  • Meal replacements. These plans suggest that you replace one or two meals with your products, such as low-calorie shakes or meal bars, and eat healthy snacks and a third healthy, balanced meal that is low in fat and calories. In the short term, this type of diet can help you lose weight.
  1. Recommendation for physical activity

Increasing physical activity or exercise is an essential part of the weight management program. Most people who can maintain their weight loss for more than a year exercise regularly, even just walking.

  • Exercise. People with obesity need to do at least 150 minutes a week of moderate intensity physical activity to avoid further weight gain or to maintain the loss of a moderate amount of weight. To achieve more significant weight loss, you may need to exercise 300 minutes or more a week. You probably need to gradually increase the amount of exercise as your endurance and fitness improve.
  • Keep moving. Making simple changes throughout the day can generate great benefits. A good recommended goal is to try to reach 10,000 steps every day. Gradually increase the number of steps to reach that goal.
  1. Behavioral changes

Each person is different and has different obstacles to managing weight, such as lack of time to exercise or eat late at night. Tailor your behaviour changes to address your individual concerns.

  • Advice. Talking to a mental health professional can help you address emotional and behavioral problems related to eating. Therapy can help you understand why you overeat and learn healthy ways to deal with anxiety. You can also learn how to control your diet and activity, understand food triggers, and deal with food cravings.
  • Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity.
  1. Prescription drugs for weight loss

For some people, prescription weight loss medications can help. You will still need to focus on diet and exercise while taking these medications, and they are not for everyone.

Doctors usually prescribe them only if your BMI is 30 or higher, or if it is at least 27 and you have a condition that may be related to your weight, such as type 2 diabetes or high blood pressure.

The most common FDA-approved prescription weight loss drugs are Liraglutide, Naltrexone-Bupropion, Orlistat, Phentermine, and Phentermine topiramate.

Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects.

  1. Endoscopic procedures to lose weight.

There are several different types of endoscopic procedures used to lose weight to help you feel faster by reducing stomach capacity. These procedures are generally approved for people with a BMI of 30 or more when diet and exercise alone have been unsuccessful. Expected weight loss varies between procedures from 5% to 20% of total body weight loss.

  1. Weight loss surgery

In some people, weight loss surgery, also called bariatric surgery, is an option. Weight loss surgery limits the amount of food you can eat comfortably, or decreases the absorption of food and calories, or does both. Although weight loss surgery offers the best opportunity to lose the most weight, it can present serious risks.

Weight loss surgery helps some people lose up to 35% or more of their excess body weight. But weight loss surgery is not a miracle cure for obesity.

It does not guarantee that you will lose all your excess weight or that you will keep it off in the long term. The success of weight loss after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.

Common weight loss surgeries include:

  • Gastric band surgery.
  • Adjustable gastric band.
  • Biliopancreatic deviation with duodenal switch.
  • Gastric sleeve.