Designing A Treatment Program - When To See A Doctor: Obesity

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Designing a treatment program

If you have a health problem related to being overweight, the doctor will recommend a treatment for that condition. You may need medication for high blood pressure, high cholesterol, type 2 diabetes, or other complications. If you have depression, your doctor may recommend an antidepressant, psychotherapy, or both before you start a weight-loss program. But treating the health problems associated with overweight cannot help you lose weight. You will need a weight-loss plan not only to reduce your weight, but also to aid in the treatment of any obesity-related problems.

The plan that your doctor recommends will depend on several factors, including your BMI, whether you have obesity-related health problems, and the degree of your past success in losing weight. If you are mildly overweight and in relatively good health, your doctor may be able to provide guidance on diet and exercise — having you come in for regular office visits to monitor your progress and helping you overcome the common weight-loss plateaus. Or your doctor may recommend weight-loss programs offered locally by self-help organizations, companies, registered dietitians, or hospitals. You can find a registered dietitian in your area by calling the American Dietetic Association (see "Resources").

But in some cases — for example, if you are extremely overweight or if you have obesity-related health problems and haven't been able to control your weight on your own — a weight-loss program that involves dieting, exercise, and social support may not be enough. In such cases, your doctor will probably refer you to a weight-disorders specialist or to a hospital-based weight-loss program to consider whether one or more of the medical options, such as a very low-calorie diet, weight-loss medication, or bariatric surgery (see "Weight-loss surgery"), might be appropriate for you.

In discussing the various weight-loss options, your doctor may ask you about your goals and expectations: How much weight do you expect to lose? How much of an improvement in health and emotional well-being do you expect this weight loss to provide? The purpose of these questions is to find out how realistic your expectations are. Don't be surprised or get discouraged if your doctor tells you to set more modest goals. Your doctor will help you set realistic goals about how much weight you need to lose, how much you can expect to lose, and how much you can expect to keep off in the long run — that is, for a year or more.

Such considerations are important because many overweight people begin a weight-loss program expecting to shed many more pounds than will be possible for them. In one study of women with obesity in a weight-loss program, the women said that they wanted to reduce their weight by 32%. That's significantly more than even the best weight-loss programs achieve with weight-loss drugs and diets. Most people who go through weight-loss programs lose 5%–10% of their initial weight. Moreover, the National Institutes of Health (NIH) now defines a successful weight-loss effort as one in which a person loses — and keeps off — 10% or more of his or her initial weight.

Last updated:	June 20, 2007