Weight Loss Treatment

The main treatment for obesity is exercise and a healthy, balanced diet. You can also use weight loss medication to help you lose weight. You may be eligible for weight loss surgery, but only if you have tried all other methods and they have not worked.

Obesity is a term used when someone has a lot of body fat. The best way to check your weight is by using a BMI calculator. You are classed as obese if you have a BMI of 30 or above, or overweight if you have a BMI between 25 and 29.9.

Exercise

Although a healthy and balanced diet can help you to lose weight, you also need to burn energy through regular exercise. The UK government recommends that adults do at least 150 minutes of moderate intensity exercise every week. This can be split into 30 minute sessions, 5 times a week. Some exercise is better than none, so if you struggle to exercise you can increase this slowly, starting with 10 minutes a day.

Exercise has many health benefits and can reduce the risk of other illnesses that can affect your weight. According to the NHS, regular exercise can reduce the risk of getting type 2 diabetes by 40%.

Moderate intensity exercise is anything that increases your breathing and heart rate, so this can be different for everyone. Some common examples are:

• cycling
• power walking
• dancing
• swimming

You can also do 75 minutes of vigorous exercise every week if you have less time, or a combination of both. Vigorous exercise is anything that causes your heart to beat rapidly and breathe very hard, so that you could not hold a conversation. This includes:

• competitive sports like rugby, gymnastics, and boxing
• circuit training
• running

To help with weight loss, you should also do strength and balance exercises 2 times a week. You can build strength by carrying shopping bags or doing a strength based exercise like yoga or tai chi. Your local gym will have everything you need to work on your strength and balance.

As we spend a lot of our time sitting down, it is also vital that you break up sedentary (sitting) time by standing up and moving around. If you need help with an exercise plan, your GP, a weight loss advisor, or a personal trainer at your local gym can help create a plan for you. It is better to make small achievable goals that you can stick to. If you have never exercised before, you do not need to jump in with 75 minutes a week straight away.

If you are or have been obese, you may need to exercise more. To prevent obesity, you should do moderate intensity exercise for 45 to 60 minutes a day. For those who have been obese, it is recommended to do 60 to 90 minutes of exercise a day, or you may regain any weight that you have lost.

To make exercise a part of your daily life, find something that you enjoy doing or add social elements, by working out with your partner, family, or friends.

Diet

To lose weight at a safe pace of 0.5 to 1 kg a week, you should reduce your calorie intake by 600 kcals a day. Your doctor will help you with a diet plan if you need it. This is not about following a ‘fad’ diet, but about making healthier long lasting choices that will improve your eating habits for the rest of your life.

For women, weight loss can be achieved by consuming no more than 1,400 calories a day. Men should be eating no more than 1,900 calories daily. To lose weight, you should swap high energy and unhealthy foods for healthier choices. This means lowering your intake of processed food, fast food, and sugary drinks like sodas and alcohol.

A healthy and balanced diet should include:

• some dairy foods and milk
• some sources of protein such as meat, eggs, fish, and beans
• lots of vegetables and fruits
• some rice, pasta, bread, potatoes, and other starchy foods (ideally these will be wholegrain)
• only small amounts of foods or drinks that contain a lot of sugar or fat

If you are overweight or obese, try to avoid any foods that contain a lot of salt. This can increase your blood pressure, which could cause hypertension.

Read food and drink labels so you can work out how many calories you are having in a day. Drinking lots of water is the best way to cut out unnecessary calories in drinks.

You should avoid any ‘fad’ diets, as these are not healthy or realistic and tend not to work. They can make you feel ill and cutting out an entire food group or not eating for a long period of time (fasting) is not sustainable. If you want to follow a diet programme, make sure it:

• is not overly restrictive on what foods you can have
• educates you about healthy eating and portion sizes
• is based on losing weight safely and gradually, to achieve long term weight loss goals that are likely to last

If you are considering a very low calorie diet, which means consuming less than 800 calories each day, you should speak to your doctor. Only some people are suitable for this and if you are, you should not do it for longer than 12 weeks.

Medication

We have a range of weight loss treatments available that can help you lose weight, including tablets and injections. These need to be prescribed for you and can be used if you are obese, or overweight and have other medical problems that are affected by weight, such as diabetes or high blood pressure.

Saxenda is a weight loss treatment that comes in the form of an injectable pen. It contains the active ingredient liraglutide which affects the receptors on your brain that control appetite. This makes you less hungry, so you can eat less. It is injected once a day. Your doctor will give you a treatment plan, as Saxenda should be increased slowly over 5 weeks or longer.

Orlistat is a weight loss tablet that contains the active ingredient orlistat. This changes how your body digests fat. You can take orlistat up to 3 times daily, with any meal that contains fat.

Xenical is a branded version of orlistat and contains the same active ingredient. They both work in the same way.

Mysimba is a weight loss tablet that contains 2 active ingredients, which are bupropion hydrochloride and naltrexone hydrochloride. They work on the area of the brain that controls your energy levels and food intake. You will start with one tablet a day and follow a treatment plan to gradually increase your dose over a 4 week period.

When you take any weight loss treatment, our doctors will review your weight regularly and make sure it is working as it should. Any weight loss medication must be taken alongside a healthy diet plan and regular exercise.

Surgery

Weight loss surgery can sometimes be used as a treatment for obesity. It is only available through the NHS if you are severely obese and:

• are fit enough to have surgery
• have a BMI over 40, or between 35 and 40 and certain health conditions that weight loss could improve, such as type 2 diabetes
• are committed to the long term follow up of your surgery
• you have tried all other weight loss strategies but they have not achieved or maintained weight loss
• you are receiving intensive management of your weight, usually through your GP

In rare cases, surgery may be recommended straight away if you have a BMI over 50.

Each prescription weight loss medication works in a slightly different way, as they contain different active ingredients. Saxenda and Mysimba both work on the brain, to reduce appetite levels and cravings, making it easier to eat less and lose weight. Orlistat and Xenical work by changing how your body digests fat.

Weight loss injections

Saxenda is a weight loss injection that contains the active ingredient liraglutide. This acts like another hormone in your body called glucagon-like peptide-1 (GLP-1). Usually, after you have eaten a meal, your intestines release GLP-1 to tell your brain that you have eaten. Saxenda works the same way and sends signals to your brain that you are full, so you can eat less and reduce your weight.

Weight loss tablets

Orlistat and Xenical contain the active ingredient orlistat. When taken with a meal that contains fat, it attaches to the enzymes in your digestive system, called lipases. Orlistat blocks lipase from breaking down fat in your food and absorbing it. This means some of the fat from your meal will turn into waste and be eliminated from your body.

Mysimba works differently than orlistat. Instead of working on the digestive system, it works on the areas of your brain that control energy levels and food intake. This can reduce your appetite so that you feel fuller when you eat less. The combination of both active ingredients can also control the pleasure you get from eating, reducing food cravings.

Weight loss treatment can have side effects, just like any other medication. Not everyone will get them and these usually only last for a few weeks. If you get side effects whilst taking weight loss treatment and it does not go away or bothers you a lot, you can speak to our doctors. Some treatments are increased gradually over time, like Saxenda and Mysimba, to reduce the chances of side effects.

Common Saxenda side effects

The most common side effects of Saxenda are:

• diarrhea or constipation
• nausea or vomiting (feeling or being sick)
• headaches
• dizziness
• low blood sugar
• dry mouth
• redness or itching at injection site

Saxenda is increased slowly to reduce the chances of nausea and vomiting, which is the most common side effect.

Common Mysimba side effects

Common Mysimba side effects include:

• hot flushes
• anxiety
• trouble sleeping
• headaches
• dizziness
• restlessness
• heart palpitations

These usually go away once your body gets used to the medication. You cannot take Mysimba if you have certain medical conditions, but our doctors will check your suitability before prescribing.

Common orlistat and Xenical side effects

The most common side effects of orlistat and Xenical are:

• needing to poo urgently and more frequently
• oily or fatty poo
• oily discharge from your rectum (anus)
• flatulence (farting)

Sticking to a low fat diet will decrease the risk of these side effects.

Weight loss treatment must be prescribed to you by a doctor, so it cannot be found over the counter. You can only take weight loss medication if you meet special conditions and some treatments cannot be taken if you take other medications or have certain health conditions. A doctor will make sure it is safe to take weight loss medication before you are prescribed it.