By Dr. Alisa Hideg.
Last month we had good news about obesity rates in the United States
– a significant decline among children 2 to 5 years old. Because
children who are overweight or obese are more likely to struggle with
weight as adults and are at a higher risk of developing conditions like
diabetes, stroke and cancer, this is good news.
But what about
adults who are overweight? Whether it has been an issue since childhood
or high school, controlling weight is a difficult and serious
health concern.
As the average weight of American adults has
increased, a booming weight loss industry has developed – with diet
schemes, exercise equipment and pills and supplements. It would be great
if there was an easy way to eat high-calorie, sugary and fatty foods
all of the time without gaining weight or hurting our health, but there
is not. The most effective way to avoid the complications of obesity and
be healthy (the most important goal), is to eat sensibly and be
physically active. I am not talking about a “diet,” but a lifestyle that
can and should be permanent.
But what if, despite your best efforts, this does not work?
Under
the supervision of a health care provider, some patients temporarily
use prescription weight-loss medication in conjunction with diet and
exercise changes. Because these medications have side effects, you will
probably not be advised to try one unless your body mass index (BMI) is
greater than 30 or is greater than 27 and you have serious medical
problems related to obesity.
While prescription weight-loss
medications combined with lifestyle changes can produce weight loss,
they are not safe enough to take long-term. It is also difficult to keep
weight off once you stop the medication unless your food choices and
the amount you are exercising have improved significantly.
Two
medications came out last year by the brand names Belviq and Qsymia.
These work by decreasing your appetite and/or increasing your feeling of
fullness. They have unpleasant and sometimes dangerous side effects
such as increased blood pressure and heart rate, nervousness, dry mouth,
insomnia and constipation. Such side effects can be serious if you have
other health concerns and as with many new medications, we do not know
enough about their long-term safety to recommend either one.
Orlistat,
an older weight-loss medication, blocks absorption of fat in your
digestive tract so you will absorb fewer calories. Orlistat is available
in both prescription and over-the-counter dosages. Side effects include
intestinal cramps, gas, diarrhea and oily stools. As with the other
medications, the side effects may decrease as your body gets used to it.
Before
prescribing any weight-loss medication, your health care provider will
want to evaluate your overall health, look for other problems like
diabetes and sleep apnea and talk with you about the risks of the
medication versus those of continued obesity.
Whether you and
your health care provider decide diet medications are worth trying, if
you are obese or significantly overweight, it is important to make
permanent, healthy changes to your diet and exercise habits. More fruits
and vegetables, less sugar, less fat, less meat, more exercise, less
television, joining a gym, and walking more are among the changes that
will help you attain your goal.
I find it helpful to begin with
one change. As that change becomes a normal part of your life, add
another healthy change. It means gradual weight loss and not the instant
results we all want, but it also means keeping the weight off in the
long term.
Dr. Alisa Hideg is a family medicine physician at
Group Health’s Riverfront Medical Center in Spokane. Her column appears
every other Tuesday in the Today section.
