Obesity 

Treating obesity 

Couch to 5K

Regular running can reduce the risk of chronic illnesses such as heart disease, type 2 diabetes and stroke, boost your mood and keep your weight under control. In this video, watch how Laura went from a fitness phobe to a keen runner with the Couch to 5K programme.

Media last reviewed: 15/06/2012

Next review due: 15/06/2014

Alcohol

As well as sticking to your recommended diet, it is important you moderate – or ideally avoid – consuming alcohol. Alcohol is an often overlooked source of calories that can quickly cause you to gain weight.

For example:

  • a glass of red wine contains 120 calories
  • a pint of premium lager (5% ABV) contains 250 calories
  • a single serving of a spirit such as vodka or gin contains 55 calories

Read more about calories in alcohol.

Other useful strategies

Evidence has shown that weight loss can be more successful if it involves other strategies. This could include things like:

  • setting realistic weight loss goals
  • eating more slowly
  • avoiding situations where you know you may be tempted to overeat
  • involving your friends and family with your attempts to lose weight, as they can help motivate you
  • monitoring your progress, for example with a diary

You may also find psychological support from a trained healthcare professional helps you change the way you think about food and eating through techniques such as cognitive behavioural therapy (CBT).

Find out how well your local NHS performs

If you are obese and you want to lose weight, you should see your GP.

They will recommend:

  • what type of diet you should be following
  • how much exercise you will need to do
  • whether you need further testing or treatments for obesity-related conditions
  • whether you need treatment for an underlying cause of obesity, such as polycystic ovary syndrome

Your GP may refer you to other services, such as local weight loss groups. These could be provided by the NHS or may be commercial services you pay for.

If it's appropriate, your GP may recommend exercise on prescription, where you are referred to a local active health team for a number of sessions under the supervision of a qualified trainer. Depending on where you live, the exercise programme may be free or at a reduced cost.

Read more about how your GP can help you lose weight.

Diet

While there is no single rule, most obese people are told they have to reduce the energy intake from their diet by 600 calories a day.

The best way to achieve this is to swap unhealthy and high energy food choices such as fast food, processed food and sugary drinks (including alcohol) for healthier choices.

A healthy diet should consist of :

  • plenty of fruit and vegetables
  • plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties)
  • some milk and dairy foods
  • some meat, fish, eggsbeans and other non-dairy sources of protein
  • just small amounts of food and drinks that are high in fat and sugar

Also avoid food that contains high levels of salt as this can raise your blood pressure, which can be dangerous in already obese people.

Read more about the dangers of salt.

You will also need to check calorie information for each type of food and drink you consume to make sure you do not go over your daily limit.

Read more about calorie counting.

Some restaurants, cafés and fast food outlets provide calorie information per portion, but providing this information is not compulsory. Be careful – some foods can quickly take you over the limit, such as burgers, fried chicken and some curries or Chinese dishes.

Avoid fad diets

You should avoid fad diets that recommend unsafe practices such as fasting (going without food for long periods of time) or cutting out entire food groups such as meat, fish, wheat or dairy products.

These are not sustainable, can make you feel ill, and may cause unpleasant side effects such as bad breath, diarrhoea and headaches.

Read more about the truth behind fad diets.

This is not to say that all commercial diet programmes are unsafe. Many are based on sound medical and scientific principles and can work well in some people. A responsible diet programme should:

  • educate you about issues such as portion size, making changes to behaviour and healthy eating
  • not be overly restrictive in terms of the type of food you can eat
  • be based on achieving gradual sustainable weight loss rather than short-term rapid weight loss, which is unlikely to last

Read the NHS Choices review of the top 10 diets.

Very low calorie diet

A very low calorie diet (VLCD) is where you consume less than 1,000 calories a day. An example of a VLCD would be:

  • a bowl of cornflakes for breakfast
  • a single jaffa cake as a mid-morning snack
  • a chicken salad sandwich for lunch
  • a low calorie lasagne for an evening meal
  • a pear for an after-dinner treat

This plan also assumes that you will be drinking water or diet drinks throughout the day, as most other popular drinks such as tea and coffee contain calories. 

Remember, excessive amounts of fizzy diet drinks can damage your teeth – they may not contain sugar, but they do contain high levels of certain acids.

While a VLCD can be an effective method of losing weight for some obese people, it is not a suitable or safe method for everyone. It would usually only be recommended if rapid weight loss was required to reduce the risk of an obesity-related complication, such as heart disease, or if you have failed to lose weight despite conventional treatment.

You should only ever undertake a VLCD under the supervision of a suitably qualified healthcare professional.

Further information

For more information on diet and weight loss, see:

Exercise

Reducing the amount of calories in your diet will stop you putting on more weight. But if you want to lose weight, you have to combine a calorie-controlled diet with regular exercise.

Your GP or weight loss adviser will be able to provide an exercise plan suited to your circumstances, which will probably recommend so many hours of moderate-intensity physical activity a week.

Moderate-intensity physical activity is any activity that increases your heart and breathing rate and may make you sweat, but you are still able to hold a normal conversation.

Examples include:

  • fast walking
  • jogging
  • swimming
  • tennis
  • using a step-trainer or similar at the gym

Choose physical activities that you enjoy, as you are more likely to continue doing them.

You should aim to start gradually – possibly 15-20 minutes of exercise five times a week – and then build on it.

Further information

For more information on exercise, see:

Medication

More than 120 different types of anti-obesity medication have been tested in clinical trials, but only one has proved to be both safe and effective. This medication is called orlistat.

Orlistat

Orlistat works by blocking the action of a protein used to digest fat. The undigested fat is not absorbed into your body and is passed out with your faeces (stools).

Orlistat will stop around one-third of the fat from the food you eat from being digested.

This will help you avoid gaining weight, but it will not necessarily cause you to lose weight. It is therefore still important to stick to your recommended diet and exercise plan.

One orlistat capsule is taken with each main meal (a maximum of three capsules a day). You can take the capsule either before, during, or up to one hour after each meal.

If you miss a meal or the meal does not contain any fat, you may not need to take the orlistat capsule. Your GP should explain this to you, or you can check the patient information leaflet that comes with your medication.

You must have made a significant effort to lose weight through diet, exercise or changing your lifestyle before taking orlistat. Even then, orlistat is only prescribed if you are on a low calorie diet and you have:

  • a body mass index (BMI) of 28 or more and other conditions related to weight, such as high blood pressure (hypertension)
  • a BMI of 30 or more

Treatment with orlistat must be combined with a low-fat diet and other weight loss strategies, such as doing more exercise. If you are prescribed orlistat, you will also be offered advice and support about diet, exercise and making lifestyle changes.

Treatment with orlistat should only continue beyond three months if you have lost 5% of your body weight. Orlistat usually starts to affect how you digest fat within one to two days. If orlistat has not worked after three months, it is unlikely to be an effective treatment for you.

If you have type 2 diabetes (a condition caused by too much glucose in the blood), it may take you longer to lose weight using orlistat. Your target weight loss after three months may therefore be slightly lower.

If orlistat is successful after three months, your prescription may be continued for up to a year. After that, your GP will review your condition and decide whether you should continue with orlistat or not.

Side effects of orlistat include:

  • fatty or oily stools
  • needing the toilet urgently
  • passing stools more frequently
  • oily discharge from your rectum (you may have oily spots on your underwear)
  • flatulence (wind)
  • stomach pain
  • headaches
  • upper respiratory tract infections, such as a cold or sore throat

Side effects are much less likely if you stick to a low fat diet.

Women taking the oral contraceptive pill are advised to use an additional method of contraception, such as a condom, if they experience severe diarrhoea while taking orlistat.

This is because the contraceptive pill may not be absorbed by your body if you have diarrhoea, and so may not be effective.

Orlistat is not suitable for pregnant or breastfeeding women.

Treating obesity in children

Treating obesity in children is based on much the same principles as treating obesity in adults – by combining a calorie-controlled diet with regular exercise.

The amount of calories your child should eat every day will depend on their age and height. Your GP should advise on a recommended daily limit.

It is recommended all children get at least one hour of moderately intense exercise a week, such as running, playing football or netball.

You should restrict sedentary activities such as watching television or playing computer games to less than two hours a day (14 hours a week).

It may be better to gradually introduce these changes to your child's behaviour and then try to get them to change.

Referral to a specialist in treating childhood obesity may be recommended if:

  • your child develops an obesity-related complication such as high blood pressure, sleep apnoea (interrupted breathing during sleep) and depression
  • it is thought there is an underlying medical condition causing the obesity, such as a hormonal condition

The use of orlistat in children is only recommended in exceptional circumstances, such as if a child is severely obese and also has an obesity-related complication.

Further information:

For more information on diet and exercise in children, see:

Page last reviewed: 05/03/2012

Next review due: 05/03/2014

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The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

User792502 said on 02 August 2013

I have been very overweight since childhood. Now, aged 28 and 'morbidly obese' I want to do something about it so I went to my GP for advice - bearing in mind that every method of calorie restriction or exercise insists that you speak to your GP first if you are as overweight as I am.

My GP's advice? I should pray more!

I went to my GP for medical advice, not spiritual.

No wonder the NHS is failing so miserably and we are facing an obesity epidemic if this is the advice they give to someone who needs help to start to manage their weight.

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jennyrobson85 said on 21 May 2013

taxpayers fund the nhs so they should take this into account when offering treatment for obese people. it doesn't matter why you haven't been able to prevent this from happening - you might not be able to afford healthy food and afford to go to the gym. it might not be your fault that you're obese. but it IS the nhs's fault for not helping people when they need help with their weight, that's what they're there for and we have paid into the system so why shouldn't we get something out of it.

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RandomCake said on 27 March 2013

"most other popular drinks such as tea and coffee contain calories." - this is nonsense, a cup of tea or coffee only contain around 2 calories, milk on the other hand has quite a bit of energy, but black tea or coffee are much easier alternatives to adapt to than just dropping tea or coffee and only drinking water.

There is also a growing body of research suggesting that it is the increase in sugar in our diets which has caused the increase in obesity, and not fat (as most diets suggest).

Also, what exactly is the risk caused by cutting out wheat or dairy products? As long as you are still getting fibre and calcium elsewhere, is there anything magical that means you *need* wheat or dairy?

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Jim_Nail said on 22 June 2012

It says above that the only medication currently prescribed is Orlistat, i.e. it is the only obesity medication approved by N.I.C.E.

UK Chemists have not been able to fill a prescription for Orlisat for over 5 months, and is now not available in the UK.

The Department of Health Foresight Report - Tackling Obesities Future Choices Project, quoted on 16 May 2011 by Prime Minister David Cameron, predicts that the current obesity cost to the NHS of £4 Billion will rise by £2.4 billion to £6.4 billion by 2015.

Why has the Government, Department of Health, the NHS, or anybody taken steps to make Orlistat, which can be bought over the counter in the USA and other countries, available in the UK? All the health professionals I have spoken to either do not know that Orlistat is not available in the UK, or just shrug their shoulders when I tell them.

Why has N.I.C.E not yet taken steps to approve an alternative obesity medication?

Alternatives to Orlistat are more expensive, but not as expensive as the £2.4 billion (50%) increase in the cost to the NHS.

Will somebody out there please take some action.

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User363614 said on 03 September 2011

The explanation of the use of orlistat is an admission that 'a calorie is a calorie, is a calorie' can't be true. Our body is reliant on the use of enzymes and hormones for digestion. It is therefore naive to think that all foods are digested with equal efficiency.

Focussing on eating foods with a low caloric content does not address the key issues of appetite control, and blood sugar control, which are essential for the prevention of obesity.

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