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Obesity
Written by Professor Arne Astrup,
When is medical treatment necessary?
Your doctor will usually only consider medicines for weight-loss if changes to diet and exercise are not effective.
Two medicines for weight-loss are available on the NHS: orlistat (Xenical) and sibutramine (Reductil).
Another weight-loss drug called rimonabant (Acomplia) has been recently launched, but until its cost-effectiveness has been assessed it is unlikely to be widely available on the NHS.
You will still need to follow a calorie-controlled diet and start an exercise plan while taking these drugs.
Treatment with Xenical and Reductil will only be continued after three months if you have lost 5 per cent of your body weight in that time.
While these medicines can help you to lose weight, there may be a gradual reversal of any weight loss after you stop treatment. To help avoid this, you will need to continue with changes to your diet and exercise levels.
Medicines for obesity are not yet recommended for young people under the age of 18 because we have no knowledge of possible negative effects on puberty and later eating behaviour.
Your doctor can prescribe this drug if you are obese, or if your BMI is higher than 28 and you have a related risk factor such as high blood pressure, high cholesterol or diabetes.
Common side-effects include headache, urgent or increased need to open the bowels, flatulence (wind) with discharge, and oily or fatty stools.
Sibutramine (Reductil)
Your doctor can prescribe this drug if you are obese or have a BMI higher than 27 with a risk factor for heart disease, and you haven't been able to lose weight through lifestyle change within the last three months.
Common side-effects include loss of appetite, constipation, dry mouth and problems sleeping.
Rimonabant (Acomplia)
A doctor can prescribe this drug if you are obese or have a BMI higher than 27 with a risk factor for heart disease.
Common side-effects include nausea and infections of the upper airways.
What about weight reduction surgery?
This type of surgery is known as bariatric surgery.
Keyhole surgery is used to tie an inflatable band around the top part of the stomach, creating a small pouch at the top. This limits the amount of food your stomach can hold.
Food then slowly passes from the pouch into the lower part of your stomach and on into your digestive system.
The operation is reversible.
Gastric bypass
A small pouch is created at the top of the stomach.
Part of the intestine is then grafted to the top of this pouch so food bypasses the stomach and much of the intestine, meaning it can't be digested.
Gastric balloon insertion
A balloon is placed on the end of a thin, flexible tube called an endoscope. It is inserted into your stomach via your mouth.
Liquid or air is then pumped into the balloon so it partially fills the stomach. This creates a feeling of fullness.
The balloon is usually removed after six months.
In the long term
Treatment such as diet and exercise may need to continue for years.
Weight-loss plans from a GP or dietician are an effective way to lose weight, but a greater challenge is to achieve a way of life that maintains weight and reduces the chances of putting it back on.
This can only be achieved by permanently changing your eating and exercise habits.
Further information
Reductil acts on chemicals in the brain called serotonin and noradrenaline to make you feel fuller for longer.
Acomplia is a new drug that blocks CB1 receptors in the brain and fat tissues that control appetite and the desire for sweet and fatty foods. This reduces appetite and cravings for these types of foods.
You can be considered for weight-loss surgery if you are morbidly obese, or if you have a BMI between 35 and 40 and have a risk factor for an obesity-related disease.
Gastric bypass is permanent surgery on the stomach to reduce the length of the digestive tract and stop food being absorbed.
Gastric balloon insertion is a less permanent type of surgery. It is not widely available on the NHS.
While plenty of diets and slimming products claim to offer quick fixes, obesity is not something that can be cured or brought under clinical control within a few weeks or months.
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