Clinical Approaches to Weight Loss

When dieting isn’t enough, it may be time for clinical intervention – what what are the options?

It’s no secret that being seriously overweight can have a negative impact on your quality of life. Obesity can lead to further physical and mental health issues, such as diabetes, coronary heart disease and increased risk of stroke.

Many people are able to lose weight by making simple changes to their diet, maintaining careful calorie control, or by getting more exercise. But once somebody’s BMI (body mass index) reaches 30 or higher they are considered obese, and the need to lose weight becomes urgent.

Preventable

Obesity isn’t just a number on your bathroom scales—it’s regarded as a chronic condition requiring treatment. Often, diet and exercise alone don’t to the trick, or the subject isn’t able to maintain them, so a clinical approach to weight loss may be needed.

Clinical approaches to weight loss refer to methods of helping a person lose weight through medical procedures under the guidance of a clinician. There are a variety of different methods, ranging from weight loss medications to surgery.

In 2018, a study by Warwick Medical School showed that 3.6 million people in the UK were eligible for weight loss surgery—however only 6,627 actually went ahead with it. Possibly it’s still felt that obesity is in some ways a taboo subject, or that the condition is preventable and so it should be the responsibility of the individual, rather than becoming a burden on the NHS. Nevertheless weight loss surgery, also called bariatric or metabolic surgery, is regarded as a wide investment of resources as it can improve many expensive obesity-related conditions, such as type 2 diabetes or high blood pressure.

See Also: Guide to Weight Loss

Drugs

Weight loss pills can be an option before surgery is considered, but they must be used along with lifestyle changes (such as changing your diet). Many so-called ‘fat-burning’ pills have not been properly tested and so should be approached with caution. The NHS regards only one pill, Orlistat, to be proven safe and effective in clinical trials in the UK.

Orlistat is a prescription-only drug and comes in 120mg doses. It works by blocking certain chemicals in the gut which digest fat, so that nearly a third of the fat in blocked by the drug. The undigested fat is then passed straight into the stools. It is important to remember that while the drug helps to avoid gaining weight, it does not necessarily help you lose weight.

Other weight loss pills available in the UK include Xenical, which is essentially a branded version of the same drug and of the same dosage.

The only weight loss pill which is available over the counter in the UK is Alli, which is also a version of Orlistat, although it is a lower dosage (60mg instead of 120mg).

People taking weight loss pills should bear in mind that they can create side effects, such as wind, needing to go to the toilet urgently and headaches. These side effects are less likely to occur, however, if you stick to a low-fat diet.

See Also: Weight Loss Surgery

Surgery

Surgery is used to treat severe obesity, usually people who have a BM1 of 40 or more. People who have a BMI of around 35 and also have a condition such as type 2 diabetes and high blood pressure are automatically eligable for surgery. There are several different types of procedure, including:

  • Gastric Band: A gastric band creates a smaller pouch in the stomach which takes in less food. This works to make the patient feel full without eating as much. The band can be tightened and loosened once it is put into place – it usually takes a while for people to find the right tightness for them.
  • Gastric Bypass: A gastric bypass uses staples to create a small pouch at the top of the stomach and then connects the small intestine, missing out the rest of the stomach. This works to not just take in less food, but also absorb less calories.
  • Intra-Gastric Balloon: This is a temporary procedure, where a soft balloon is put into the stomach. The balloon makes somebody feel full without eating as much and is usually removed after a maximum of six months.
  • Sleeve Gastrectomy: Alternatively, in more severe cases, clinicans will decide to remove around 80 percent of the stomach which is called a sleeve gastrectomy

This feature was originally published in Live to 100 with Dr Hilary Jones, which you can read here. 

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