DIAGNOSIS
If your BMI is in the obese range, your health care provider will typically review your health history in detail, perform a physical exam and recommend some tests.
These exams and tests generally include:
- Taking your health history. Your doctor may review your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you’ve had, medications, stress levels and other issues about your health. Your doctor may also review your family’s health history to see if you may be predisposed to certain conditions.
- A general physical exam. This includes also measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
- Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your level of obesity. This should be done at least once a year. Your BMI also helps determine your overall health risk and what treatment may be appropriate.
- Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases, such as diabetes and heart disease. Women with a waist measurement (circumference) of more than 35 inches (80 centimeters, or cm) and men with a waist measurement of more than 40 inches (102 cm) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, your waist circumference should be checked at least once a year.
- Checking for other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure and diabetes.
- Blood tests. What tests you have depend on your health, risk factors and any current symptoms you may be having. Tests may include a cholesterol test, liver function tests, a fasting glucose, a thyroid test and others. Your doctor may also recommend certain heart tests, such as an electrocardiogram.
RECOMMENDED MEDICATIONS
The goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals — including a dietitian, behavior counselor or an obesity specialist — to help you understand and make changes in your eating and activity habits.
The initial treatment goal is usually a modest weight loss — 3 to 5 percent of your total weight.
All weight-loss programs require changes in your eating habits and increased physical activity.
Other treatment tools include:
- Dietary changes. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:
- Cutting calories. The key to weight loss is reducing how many calories you take in. You and your doctor can decide 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 on less. Foods such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
- Making healthier choices. 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 to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils.
- Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods.
- Meal replacements. These plans suggest that you replace one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that’s low in fat and calories.
- Exercise and activity. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week.
- Behavior change. A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity.
- Prescription weight-loss medications. Most weight-loss medicines for obesity work by making you feel less hungry or making you feel full sooner. They are used together with healthy eating habits and exercise.
Medicine is generally used only for those who have a body mass index (BMI) of 30 or higher. But they sometimes are used for those with a BMI of 27 or higher who are at risk for high blood pressure, high cholesterol, coronary artery disease, type 2 diabetes, and sleep apnea.1
Medicine choices
- Bupropion/naltrexone (Contrave) is a prescription medicine. Contrave may reduce your appetite. It may help you avoid overeating.
- Lorcaserin (Belviq) is a prescription medicine that you take twice a day. It can help you eat less and feel satisfied with eating smaller amounts of food.
- Orlistat (Xenical) is a prescription medicine that prevents some of the fat calories you eat from being absorbed in your intestines. Prescription orlistat is the only weight-loss medicine that is approved for children. It is meant to be used only in children over the age of 12.
- Orlistat (Alli) is also available over the counter. Alli contains half of the medicine that is in Xenical. Over-the-counter orlistat is not meant for use by anyone under the age of 18.
- Phentermine/topiramate (Qsymia) is a prescription medicine that combines the drugs phentermine and topiramate. Taking it once a day can help you eat less.
- Weight-loss surgery
In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery limits the amount of food you’re able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks.
Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven’t worked and:
- You have extreme obesity (BMI of 40 or higher).
- Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure.
- You’re committed to making the lifestyle changes that are necessary for surgery to work.
