|Step 11: Medication and surgery|
In general, your physician will only consider drugs or surgery if you are clinically obese (your BMI is at least 30) or you are at high risk for developing diseases associated with being overweight, and you have not been able to lose weight after at least 6 months of lifestyle changes. It is important to know that these methods do not replace diet and exercise, but can enhance them for some individuals.
Weight-loss drugs that require a physician's prescription include:
- Sibutramine (Meridia) -- boosts metabolism, enhances energy level, and promotes a feeling of fullness; studies have found it to be effective for weight loss, but side effects include dry mouth and insomnia. If you have a history of high blood pressure (hypertension), stroke, seizures, or heart, liver, or kidney diseases, you should talk to your doctor if your are considering this medication.
- Orlistat (Xenical) -- is taken with meals to prevent your body from absorbing the fat in food. However, it may also block the absorption of certain essential vitamins. If you are taking Orlistat, you should also take a vitamin supplement that contains vitamins A, D, E, K, and beta-carotene at least 2 hours before or after taking the medicine to replace these fat-soluble vitamins. Other side effects may include bloating, diarrhea, nausea, and other gastrointestinal symptoms. If you have a history of kidney stones, you should talk to your doctor when considering this medication.
- Phentermine (Adipex, Ionamin, Fastin, and many others) -- suppresses appetite. Serious potential side effects, including heart valve defects and pulmonary hypertension, have been reported when used in combination with fenfluramine (often called fen-phen). Medications containing fenfluramine have been removed from the market. Phentermine should NOT be taken with antidepressant medication.
- Amphetamine derivatives -- including benzphetamine, diethylpropion, phendimetrazine, and mazindol -- elevate mood and reduce weight moderately if taken for short periods of time (3 - 12 weeks). They can cause agitation, insomnia, and addiction. Therefore, these medications are not recommended.
The long-term effects of most of these medications have not been established. Many lose their effectiveness over time, and none of these drugs deal with the underlying problems that may be causing obesity. Except under rare circumstances, pregnant or nursing women should never take diet medications of any sort, including herbal and over-the-counter remedies.
Over-the-counter herbs and medications
There are several medications available without a prescription. However, the scientific evidence from medical studies regarding their effectiveness is not very convincing.
Formerly, phenylpropanolamine (PPA) was a popular over-the-counter appetite suppressant. The Food and Drug Administration (FDA) has removed PPA from drug products because it increases the risk of a bleeding stroke.
Another ingredient that used to be in some over-the-counter medicine is ephedrine, which the FDA no longer allows. Ephedrine was linked to severe side effects, such as high blood pressure, heart attacks, stroke, and seizures. As of May 2004, herbal products that contain ephedra became illegal as well. (Ephedra and ephedrine are essentially the same substance.)
Surgery for weight loss is recommended only if you are severely obese (your BMI is more than 40) and all other available options have been unsuccessful. Before weight loss surgery, you will undergo a psychological evaluation. After surgery, the doctor will require you to have appropriate social support.
Surgeries for weight loss include the following:
- Restrictive operations (often called gastric banding) -- These operations limit the amount of food you can eat by creating a small pouch at the top of the stomach. The pouch can hold about one ounce of food, and when it is full you do not feel physically hungry. Because the pouch fills up quickly and empties slowly, you eat less food than you would otherwise.
- Malabsorption operations (also called gastric bypass) -- These operations limit both how much you can eat and how much of what you eat is absorbed into your body. Like the restriction operation, the surgeon creates a small pouch in the stomach. Next, your digestive tract is re-routed, so it "bypasses" the first part of your small intestine. As a result, you are not able to use all the food you consume. And, after the surgery you will need regular replacement of certain nutrients, including calcium, folate, and vitamin B12.
- Liposuctions -- This procedure removes fat from specific areas of your body. Surgeons typically perform liposuction on people of normal weight who have pockets of fat (for example, under the arms). It is not recommended as a tool towards overall weight loss. It is used as a way to shape the body, not reduce weight.
- Abdominoplasty (also called abdominal wall surgery) -- This procedure is an optional surgery to treat flabby, stretched-out abdominal muscles and skin to improve appearance and strength. Excessive fatty tissue and loose skin are removed from the middle and lower sections of the abdomen and the abdominal muscles may be tightened. Abdominoplasty may be helpful when diet and exercise have not corrected severe muscle weakness (which may occur after multiple pregnancies), or the skin and muscle cannot regain its normal tone (which can occur with massive obesity in young people and slight obesity in older people). Abdominoplasty should not be used as a substitute for weight reduction.
Reviewed By: Jeffrey Heit, MD, Internist with special emphasis on preventive health, fitness and nutrition, Philadelphia VA Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.