Treatment for obesity

The treatment for obesity is established in relation to the degree of severity of the condition, its causes and its stage of progression.

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Obesity is a multi-factor condition and patients must be treated on a case-by-case basis. Medical management of obesity is relatively new. Until recently, the physical, psychological and social complications faced by obese patients were rarely taken into account, with the discourse focusing above all on weight loss. Multi-disciplinary medical teams have been set up to treat all factors of the condition. Weight, medical problems, family history, physical activity, lifestyle, dietary habits and motivation are all subjects that need to be taken into account when managing these patients.

The success of a treatment for obesity relies on the association of several elements:

- A balanced diet: One of the main objectives is weight loss. Nutrition is obviously a key element in the management of the patient. Dietary advice focuses on eating habits, the distribution of nutrients and the caloric density of food. The aim is to establish new eating habits by limiting forbidden foods, bringing variety to food intake whilst taking into consideration the patient’s traditions, tastes and economic possibilities. A nutritionist or a dietician can help patients adopt new habits.

- Physical exercise: physical activity is extremely beneficial. It is above all the regularity of the exercise that counts (rather than the intensity of the effort), and at least 30 minutes of physical exercise is recommended every day: walking, sports activities (cycling, running, etc.), household chores, etc. It is important to set realistic objectives and to increase the duration of the daily physical exercise progressively, up to 30 minutes.

- Psychological support: depression is believed to foster obesity, even if it is difficult to differentiate between the cause and the consequence of the depression.

- Treating the associated complications

Generally speaking, the recommendations must be progressive and prioritised as it is unreasonable to believe that the patient can change his or her lifestyle in the first six months following the start of the management protocol. For this reason, it is necessary to find the appropriate moment in the patient’s life to ask him or her to lose weight, stop smoking or take up physical exercise. It is unrealistic to expect a patient to lose 30 kg in 6 months. It is necessary to know how to set short term objectives, such as losing 500 grams per month, and maintaining motivation. Thus someone who loses 500 grams a month for 2 years will have lost 12 kg by the end. Taken this way, the objective becomes interesting and realistic.

NO MIRACLE DRUG TO TREAT OBESITY

In order to avoid the abuses and accidents encountered with the first drugs (in particular those derived from amphetamines), the new active ingredients developed to combat obesity are prescribed under strict conditions. Sibutramine, a prescription-only appetite suppressant was used for many years but was withdrawn from sale in May 2010.

Orlistat is one of the most commonly-used drugs available today. It blocks the action of the enzymes that play a part in the digestion of fats and thus prevents their absorption. As a result of its mode of action, most of the side effects are undesirable digestive effects.

Several recent studies have highlighted new compounds in the mechanisms of hunger and the treatment of excess weight and obesity, including Ghrelin, C 75, etc. Certain hormones, such as GIP and PYY 3-36, may make it possible to decrease the appetite by a third, and thus decrease the quantity of food ingested at each meal. However, the mechanisms of hunger are very complex and one compound alone will not make it possible to treat excess weight effectively. It will thus be necessary to envisage an association of compounds acting at different levels.

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