Whether it’s behavioural therapy, anti-obesity medication, or
bariatric surgery, there are a number of different ways to treat
obesity. A trained healthcare provider can help to design a weight
management plan specifically for you, by combining a number of
different treatments that work in different ways.
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.*
eating - Understanding "How" and "Why" when it
comes to your relationship with food
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.
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 / low energy diet
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
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
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
your doctor may adjust your weight management plan along the way,
depending on your body’s response and your health needs.
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
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
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.
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:
[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.
& 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;
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.
Your Body Mass Index (BMI) is a number calculated from your weight and
height. It’s not a precise calculation of percentage of body fat, but it
is an easy way to determine where your weight falls in the range from
healthy to unhealthy.