- Puhl RM & Heuer CA. Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health 2010; 100:6:1019-1028.
- Freedhoff Y. & Sharma A.M. Best Weight – A practical guide to office-based obesity management. Canadian Obesity Network 2010.
- Wadden TA et al. Overview of the Treatment of Obesity in Adults. In: Thomas A. Wadden & George A. Bray (eds.). Handbook of Obesity Treatment. New York: Guilford Press 2018;283-308.
- Kushner RF & Kahan S. The Emerging Field of Obesity Medicine. In: Thomas A. Wadden & George A. Bray (eds.). Handbook of Obesity Treatment. New York: Guilford Press 2018;413-452.
- Berthoud H, Münzberg H., & Morrison, C.D. Blaming the brain for obesity. Gastroenterology 2017;152(7):1728-1738.
- American Association of Clinical Endocrinologists. Empower your health: Guide to physical activity: https://www.empoweryourhealth.org/sites/all/files/EmPower-Physical-Activity-Guide.pdf [Accessed July 2019].
- Gomez-Rubalcava S, Stabbert K & Phelan S. Behavioral Treatment of Obesity. In: Thomas A Wadden & George A Bray (eds.). Handbook of Obesity Treatment. New York: Guilford Press 2018.
- Forman E & Butryn M. Effective Weight Loss: An Acceptance-Based Behavioral Approach - Treatments That Work (Workbook Ed.). New York: Oxford University Press 2016.
- Butryn ML, Webb V & Wadden TA. Behavioral treatment of obesity. Psychiatric Clinics 2011; 34(4):841-859.
- Li M & Cheung BMY. Pharmacotherapy for obesity. British Journal of Clinical. Pharmacology 2009; 68:804–810.
- Stefanidis A & Oldfield BJ. Neuroendocrine mechanisms underlying bariatric surgery: Insights from human studies and animal models. Journal of Neuroendocrinology 2017; 29:e12534.
- Schmidt JB et al. Effects of RYGB on energy expenditure, appetite and glycaemic control: a randomized controlled clinical trial. International Journal of Obesity 2016; 40:281–290.
- Xulong S et al. From Genetics and Epigenetics to Precision treatment of obesity: Gastroenterology Report 2017; 5(4):266–270.
- Vanwormer FM et al. Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-Up. J Am Diet Assoc. 2007. 107:1755-1767.
- Rosenbaum M et al. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008; 88:906–912.
- Schwartz A & Doucet É. Relative changes in resting energy expenditure during weight loss: a systematic review. Obesity Reviews. 2010; 11:531–547.
- Hall KD & Kahan S. Maintenance of lost weight and long-term management of obesity. Medical Clinics of North America 2018; 102(1):183-197.
- Tsai AG & Wadden TA. Treatment of Obesity in Primary Care. In: Thomas A Wadden & George A Bray (eds.). Handbook of Obesity Treatment. New York: Guilford Press 2018; 453-465.
Scientifically proven weight management options
Obesity is a complex disease with many causes. That’s why, according to Professor Arya Sharma: “No single management strategy will work for all patients.” He’s the scientific director of Obesity Canada and a clinician who has specialised in obesity treatment for the past 20 years.
“Any successful management plan involves long-term coping strategies that help patients reduce their body weight and prevent weight regain,” he adds. People living with obesity, therefore, need a personalised treatment plan, designed specifically for them.
The plan might include a number of different treatment options. And as you progress through your weight management journey, different types of treatments might become more or less relevant. That’s why your weight management plan should be tailored to your needs and may evolve over time.
Finding a healthcare provider who has been trained in obesity is the first step. More and more healthcare providers understand the science behind the disease and how to treat it effectively, so don’t give up if it takes a little time to find one. If you’re unsure of how to start a conversation, this guide can give you an idea on how to do it.
So, let’s take a look at some of the scientifically-proven treatment options that healthcare providers have in their toolboxes.*
Forget the miracle diet. When it comes to obesity, changing how you eat means much more than just eating less calories by any means necessary. Instead, your doctor will take your eating patterns into consideration when developing your weight management plan.
For example, is there a specific time of day that you are most at risk of overeating, or eating unhealthy food?
Where do you normally eat? Do you eat when you feel tired, stressed or sad? And how do you experience the feeling of fullness after a meal? These questions all provide clues for helping you move toward a more sustainable relationship with food.
You don’t need to run a marathon every day. To start with, adding just a little extra movement into your everyday life can mean a lot. If you sit a lot during the day, standing up and moving around for a few minutes each hour can make a difference. So can walking to the shops or taking the stairs, if possible.
What matters is that you find ways of being physically active that you enjoy every day. The goal is 150 minutes of physical activity a week. Build up toward this slowly by gradually adding new activity routines to your life that you enjoy and can sustain over time.
Our body and mind are deeply connected. Behavioural therapists work with the psychological aspects of weight management, helping you to identify patterns of thought, emotions, and behaviour that, for example, drive food intake and subsequent weight gain. This could be large portions, and/or frequent snacking, and/or eating/drinking when you are not hungry.
The focus here is to empower you in developing skills to alter these patterns and help you to sustain long-term weight loss and health gains.
Meal replacements are calorie-controlled products that contain essential nutrients, vitamins and minerals. Meal replacements are usually high in protein and low in fat and carbohydrates.
Meal replacements can be part of a clinically supervised diet plan that involves replacing one or more meals each day with foods or formulas that provide a specified number of calories, for example between 800 and 1200 calories per day.
Just like we cannot control our body temperature with the power of our thought, we also cannot consciously control some of the biological processes that affect our appetite. This is where anti-obesity medications play a role, by working with these different biological processes.
Different medications work in different ways. Some anti-obesity medications help to regulate appetite and reduce food portions. This helps you to eat less and makes lifestyle modifications easier.
Anti-obesity medications can also help to prevent weight regain by managing your body’s biological responses to weight loss, such as persistent increase in hunger. Other medications help you lose weight by changing the way your body absorbs food. For example by decreasing the amount of fat that is absorbed by your body.
Generally speaking, these operations reduce appetite and the amount of food a person can eat comfortably at one sitting. They have been shown to make metabolic and hormonal changes, which play a major role in weight regulation. The hormonal changes that occur work to prevent weight regain.
Finding treatments that work for you
Your doctor will help to create your personalised weight management plan. But they cannot predict how you will respond to the different treatments that they recommend. We are all different, and that also means our response to the treatments will be highly individual too.
The weight plateau
No matter which treatment approaches make up your weight management plan, at some point the weight loss will stop and level off. This is known as reaching a ‘weight plateau’. It’s an inevitable part of the weight journey that can lead to frustration and discouragement.
The weight plateau, however, is a result of natural adaptations to weight loss (in evolutionary terms, weight loss is not good for survival and reproduction). So, the body responds to it by gradually and often unconsciously increasing food intake as well as slowing down energy expenditure. Studies have shown that this may last for years. It’s no wonder that 8 out of 10 people end up regaining lost weight in the long run. This is one more proof that despite our best intentions, our biology often has its own agenda crafted by millions of years of natural selection.
People who experience the weight plateau often remark: “What's the point? This is not working anymore!” or “I'm stuck. As my efforts no longer produce results, I might as well stop”.
However, what we often do not realise is that maintaining weight loss is an equally tremendous effort and a huge achievement given all the forces at play. That’s why many physicians suggest that weight plateaus must be celebrated.
And remember that treatments you are on might still be working behind the scenes to ‘tame’ the roaring biology, even if you do not see the ever-improving results on the scale. But, what if the weight loss that you have achieved is not enough to see the improvements to health or quality of life you are after? Well, you should be equally proud of the efforts and determination you have put in to get where you are today. Keep up the good work and book a time with your doctor to review your weight management plan to see if the treatment approach needs to be intensified or adjusted.
* Some treatments may cause side effects. This information shall not be understood as treatment advice or recommendations. Always consult your healthcare provider for treatment advice.