The Treatment of Obesity


In some patients, obesity is the result of overconsumption of calories. In some, it is related to the underutilization of calories related due to inactivity. In others, it is caused by a defective appetite or food-hunger regulatory system. In still others, it may be related to psychosocial issues that have existed since childhood.

Regardless of its cause, there is only one form of treatment. However you vary the diet, all treatments of obesity depend upon a decrease in caloric intake to a level less than that needed for the body's metabolism. Increasing exercise is also an important part of management, but this increased activity is not usually sufficient, in itself, to cause significant weight loss.

A number of procedures have been devised to enable patients to reduce caloric intake. The variety of techniques suggests that none is invariably better than any other. Miracle diets are rarely miraculous. Food-based diets can be effective in weight loss, but these must be formulated for the individual patient, incorporating characteristics of the demands of the patient's life, preferences, and experiences.

We develop an individualized program for each patient. Some patients begin with an intensive weight loss period using meal replacements. Others initially work our dietitians to learn about nutrition and food selection. Others primarily concentrate on group therapy to address the underlying causes of overeating. Ultimately, we find that patients are most successful in the long-term when employing a range of options to address their weight.

In theory, the fewer calories you eat, the more rapidly you will lose weight, but this can be carried too far. Near-zero calorie diets are successful in weight loss, but they are dangerous because the body's survival depends on a daily source of protein and nutrients for many of its complicated metabolic functions. In near-zero calorie diets, a significant part of the weight loss involves the destruction of muscle tissue, bone, and other body organs.

However, the body's need for protein and nutrients can be met with as little as 700-800 total calories and 300-500 carefully selected protein calories per day. The use of a very low calorie diet (VLCD) has been shown in numerous scientific studies to be extremely effective in fat loss while preserving muscle tissue.

A major problem is how to maintain compliance on a very low calorie diet. Consuming food in this limited amount is usually not possible or practical. The solution appears to depend upon abstinence, not from nourishment, but from traditional food and from food decisions. The use of a food substitute in a precisely specified way appears to be effective. Abstinence from traditional food can be maintained comfortably and for long enough periods to enable patients to lose substantial weight. This program is then followed by a gradual transition to food with careful, structured support, and management.