Weight loss pills obesity

Contents

Prescription Medications to Treat Overweight and Obesity

What are overweight and obesity?

Health care providers use the Body Mass Index (BMI), which is a measure of your weight in relation to your height, to define overweight and obesity. People who have a BMI between 25 and 30 are considered overweight. Obesity is defined as having a BMI of 30 or greater. You can calculate your BMI to learn if you are overweight or obese. Being overweight or obese may increase the risk of health problems. Your health care provider can assess your individual risk due to your weight.

Obesity is a chronic condition that affects more than one in three adults in the United States. Another one in three adults is overweight. If you are struggling with your weight, you may find that a healthy eating plan and regular physical activity help you lose weight and keep it off over the long term. If these lifestyle changes are not enough to help you lose weight or maintain your weight loss, your doctor may prescribe medications as part of your weight-control program.

How do weight-loss medications work?

Prescription medications to treat overweight and obesity work in different ways. For example, some medications may help you feel less hungry or full sooner. Other medications may make it harder for your body to absorb fat from the foods you eat.

Who might benefit from weight-loss medications?

Weight-loss medications are meant to help people who may have health problems related to overweight or obesity. Before prescribing a weight-loss medication, your doctor also will consider

  • the likely benefits of weight loss
  • the medication’s possible side effects
  • your current health issues and other medications
  • your family’s medical history
  • cost

Health care professionals often use BMI to help decide who might benefit from weight-loss medications. Your doctor may prescribe a medication to treat your overweight or obesity if you are an adult with

  • a BMI of 30 or more or
  • a BMI of 27 or more and you have weight-related health problems, such as high blood pressure or type 2 diabetes.

Weight-loss medications aren’t for everyone with a high BMI. Some people who are overweight or obese may lose weight with a lifestyle program that helps them change their behaviors and improve their eating and physical activity habits. A lifestyle program may also address other factors that affect weight gain, such as eating triggers and not getting enough sleep.

Can children or teenagers take weight-loss medications?

The U.S. Food and Drug Administration (FDA) has approved most weight-loss medications only for adults. The prescription medication orlistat (Xenical) is FDA-approved for children ages 12 and older.

Can medications replace physical activity and healthy eating habits as a way to lose weight?

Medications don’t replace physical activity or healthy eating habits as a way to lose weight. Studies show that weight-loss medications work best when combined with a lifestyle program. Ask your doctor or other health care professional about lifestyle treatment programs for weight management that will work for you.

Weight-loss medications don’t replace physical activity and healthy eating habits.

What are the benefits of using prescription medications to lose weight?

When combined with changes to behavior, including eating and physical activity habits, prescription medications may help some people lose weight. On average, people who take prescription medications as part of a lifestyle program lose between 3 and 9 percent more of their starting body weight than people in a lifestyle program who do not take medication. Research shows that some people taking prescription weight-loss medications lose 10 percent or more of their starting weight.1 Results vary by medication and by person.

Weight loss of 5 to 10 percent of your starting body weight may help improve your health by lowering blood sugar, blood pressure, and triglycerides. Losing weight also can improve some other health problems related to overweight and obesity, such as joint pain or sleep apnea. Most weight loss takes place within the first 6 months of starting the medication.

What are the concerns with using prescription medications to lose weight?

Experts are concerned that, in some cases, the side effects of prescription medications to treat overweight and obesity may outweigh the benefits. For this reason, you should never take a weight-loss medication only to improve the way you look. In the past, some weight-loss medications were linked to serious health problems. For example, the FDA recalled fenfluramine and dexfenfluramine (part of the “fen-phen” combination) in 1997 because of concerns related to heart valve problems.

Possible side effects vary by medication and how it acts on your body. Most side effects are mild and most often improve if you continue to take the medication. Rarely, serious side effects can occur.

Tips for Taking Weight-loss Medication

  • Follow your doctor’s instructions about weight-loss medications.
  • Buy your medication from a pharmacy or web distributor approved by your doctor.
  • Take weight-loss medication to support your healthy eating and physical activity program.
  • Know the side effects and warnings for taking any medication.
  • Ask your doctor if you should stop taking your medication if you are not losing weight after 12 weeks.
  • Discuss other medications, including supplements and vitamins, you are taking with your doctor when considering weight-loss medications.
  • Avoid taking weight-loss medications during pregnancy or if you are planning a pregnancy.

Which weight-loss medication might work for me?

Choosing a medication to treat overweight or obesity is a decision between you and your doctor. Important factors to consider include

  • the likely benefits of weight loss
  • the medication’s possible side effects
  • your current health issues and other medications
  • your family’s medical history
  • cost

Talk with your doctor about which weight-loss medication might be right for you.

How long will I need to take weight-loss medication?

How long you will need to take weight-loss medication depends on whether the drug helps you lose and maintain weight and whether you have any side effects. If you have lost enough weight to improve your health and are not having serious side effects, your doctor may advise that you stay on the medication indefinitely. If you do not lose at least 5 percent of your starting weight after 12 weeks on the full dose of your medication, your doctor will probably advise you to stop taking it. He or she may change your treatment plan or consider using a different weight-loss medication. Your doctor also may have you try different lifestyle, physical activity, or eating programs; change your other medications that cause weight gain; or refer you to a bariatric surgeon to see if weight-loss surgery might be an option for you.

Because obesity is a chronic condition, you may need to continue changes to your eating and physical activity habits and other behaviors for years—or even a lifetime—to improve your health and maintain a healthy weight.

Will I regain some weight after I stop taking weight-loss medication?

You will probably regain some weight after you stop taking weight-loss medication. Developing and maintaining healthy eating habits and increasing physical activity may help you regain less weight or keep it off. Federal physical activity guidelines (PDF, 14.2 MB) recommend at least 150 minutes a week of moderate-intensity aerobic activity and at least 2 days a week of muscle-strengthening activities. You may need to do more than 300 minutes of moderate-intensity activity a week to reach or maintain your weight-loss goal.

Will insurance cover the cost of weight-loss medication?

Some, but not all, insurance plans cover medications that treat overweight and obesity. Contact your insurance provider to find out if your plan covers these medications.

What medications are available to treat overweight and obesity?

The table below lists FDA-approved prescription medications for weight loss. The FDA has approved five of these drugs—orlistat (Xenical, Alli), lorcaserin (Belviq), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), and liraglutide (Saxenda)—for long-term use. You can keep taking these drugs as long as you are benefiting from treatment and not having unpleasant side-effects.

Some weight-loss medications that curb appetite are approved by the FDA only for short-term use, or up to 12 weeks. Although some doctors prescribe them for longer periods of time, not many research studies have looked at how safe and effective they are for long-term use.

Pregnant women should never take weight-loss medications. Women who are planning to get pregnant also should avoid these medications, as some of them may harm a fetus.

Prescription Medications Approved for Overweight and Obesity Treatment

Weight-loss medication Approved for How it works Common side effects Warnings
Orlistat (Xenical)
Available in lower dose without prescription (Alli)
Adults and children ages 12 and older Works in your gut to reduce the amount of fat your body absorbs from the food you eat
  • diarrhea
  • gas
  • leakage of oily stools
  • stomach pain
Rare cases of severe liver injury have been reported. Avoid taking with cyclosporine. Take a multivitamin pill daily to make sure you get enough of certain vitamins that your body may not absorb from the food you eat.
Lorcaserin (Belviq) Adults Acts on the serotonin receptors in your brain. May help you feel full after eating smaller amounts of food.
  • constipation
  • cough
  • dizziness
  • dry mouth
  • feeling tired
  • headaches
  • nausea
Tell your doctor if you take antidepressants or migraine medications, since some of these can cause problems when taken together. May increase the risk of cancer based on early results from a clinical trial.
Phentermine-topiramate (Qsymia) Adults A mix of two medications: phentermine, which lessens your appetite, and topiramate, which is used to treat seizures or migraine headaches. May make you less hungry or feel full sooner.
  • constipation
  • dizziness
  • dry mouth
  • taste changes, especially with carbonated beverages
  • tingling of your hands and feet
  • trouble sleeping
Don’t use if you have glaucoma or hyperthyroidism. Tell your doctor if you have had a heart attack or stroke, abnormal heart rhythm, kidney disease, or mood problems.
MAY LEAD TO BIRTH DEFECTS. DO NOT TAKE QSYMIA IF YOU ARE PREGNANT OR PLANNING A PREGNANCY. Do not take if you are breastfeeding.
Naltrexone-bupropion (Contrave) Adults A mix of two medications: naltrexone, which is used to treat alcohol and drug dependence, and bupropion, which is used to treat depression or help people quit smoking. May make you feel less hungry or full sooner.
  • constipation
  • diarrhea
  • dizziness
  • dry mouth
  • headache
  • increased blood pressure
  • increased heart rate
  • insomnia
  • liver damage
  • nausea
  • vomiting
Do not use if you have uncontrolled high blood pressure, seizures or a history of anorexia or bulimia nervosa. Do not use if you are dependent on opioid pain medications or withdrawing from drugs or alcohol. Do not use if you are taking bupropion (Wellbutrin, Zyban).
MAY INCREASE SUICIDAL THOUGHTS OR ACTIONS.
Liraglutide (Saxenda)
Available by injection only
Adults May make you feel less hungry or full sooner. At a lower dose under a different name, Victoza, FDA-approved to treat type 2 diabetes.
  • nausea
  • diarrhea
  • constipation
  • abdominal pain
  • headache
  • raised pulse
May increase the chance of developing pancreatitis. Has been found to cause a rare type of thyroid tumor in animals.
Other medications that curb your desire to eat include

  • phentermine
  • benzphetamine
  • diethylpropion
  • phendimetrazine
Adults Increase chemicals in your brain to make you feel you are not hungry or that you are full.
Note: FDA-approved only for short-term use—up to 12 weeks
  • dry mouth
  • constipation
  • difficulty sleeping
  • dizziness
  • feeling nervous
  • feeling restless
  • headache
  • raised blood pressure
  • raised pulse
Do not use if you have heart disease, uncontrolled high blood pressure, hyperthyroidism, or glaucoma. Tell your doctor if you have severe anxiety or other mental health problems.

How do doctors use prescription medications “off-label” to treat overweight and obesity?

Sometimes doctors use medications in a way that’s different from what the FDA has approved, known as “off-label” use. By choosing an off-label medication to treat overweight and obesity, your doctor may prescribe

  • a drug approved for treating a different medical problem
  • two or more drugs at the same time
  • a drug for a longer period of time than approved by the FDA

You should feel comfortable asking your doctor if he or she is prescribing a medication that is not approved just for treating overweight and obesity. Before using a medication, learn all you need to know about it.

What other medications for weight loss may be available in the future?

Researchers are currently studying several new medications and combinations of medications in animals and people. Researchers are working to identify safer and more effective medications to help people who are overweight or obese lose weight and maintain a healthy weight for a long time.

Future drugs may use new strategies, such as to

  • combine drugs that affect appetite and those that affect addiction (or craving)
  • stimulate gut hormones that reduce appetite
  • shrink the blood vessels that feed fat cells in the body, thereby preventing them from growing
  • target genes that affect body weight
  • change bacteria in the gut to control weight

Weight loss pills

The spruik

You’ve seen the ads – you know, the ones that say “I lost eight kilograms with this product!” or “Yes, I want my body to absorb less fat!” They can be pretty convincing, especially when supported by “scientific evidence” and amazing “testimonials”, complete with before and after shots.

It used to be that such dramatic testimonials came with the fine print that these people are “exceptional” and that “individual results may vary”. But in 2005, the law changed so that testimonials and photos must be of typical cases. However, in the testimonial pages of some websites, many cases still seem exceptional. If you look at the fine print, it’s often explained that their results are due to a lot more than taking product X, such as changes in diet and activity levels.

The reality

You’ll typically find that weight loss pills are designed to be used in conjunction with an energy-controlled diet and regular exercise. But isn’t that what we’re trying to avoid by taking the pills in the first place? The truth of the matter is that these products may or may not assist with weight loss, but whatever their impact, it seems that we can’t escape actually doing the hard yards if we want to see results.

The active ingredients

Weight-loss pills tend to contain a mix of herbs and vitamins, and often stimulants such as caffeine, which can result in high blood pressure and heart palpitations. Herbs contain many chemicals, the presence and concentration of which can vary according to the source and the preparation. And in most of these weight-loss pills, ingredients are only individually tested for safety, but they may interact with one another or with other medications differently than they do on their own.

Amazingly, two products we looked at contained both bitter orange and panax ginseng, which aren’t recommended to be taken together due to an increased risk of fatal heart arrhythmias.

Hydroxycitric acid (HCA)

What is it?

A derivative of the fruit from the plant Garcinia cambogia. May also be listed as brindleberry, Malabar tamarind, or Garcinia quaesita.

What they say it does

Modifies metabolism, reduces fat synthesis and decreases appetite.

Can they prove it?

Studies provide contradictory evidence. Some show positive results, while others show no difference between the group taking HCA and the placebo. More comprehensive studies are needed.

Side effects and interactions

None known. It appears to be safe over the short term in the doses studied.

Products its been found in: Naturopathica FatBlaster Max, Supprexxa Metabolism Formula.

Bitter orange

An extract of the Seville orange, it’s also known as Citrus aurantium. Used in place of ephedra, as it contains similar compounds.

Increases metabolism and fat burning while decreasing appetite.

Limited promising evidence; more research is needed on its safety and effectiveness.

Has been linked with fainting, heart attack and stroke. It’s advised that you avoid bitter orange if you have a heart condition or are taking other medications.

Products its been found in: Rapid Burn Dual Action Weight-loss System, FatBlaster and FatBlaster Max, Hershel-Beck Laboratories Xantrax.

Capsicum annum

Capsaicin from chillies.

Increases metabolic rate and reduces appetite.

Studies on capsaicin are interesting but mixed – one shows that having a spicy entrée can reduce your total food intake over the whole meal.

Short-term burning pain.

Products its been found in: Supprexxa Metabolism Formula.

Green coffee extract

An extract of raw coffee beans – it’s believed that chlorogenic acid is the active ingredient.

Increases metabolism and glucose control.

There are some positive results from studies. However, the quality of the studies is poor, so more rigorous trials are needed.

None known, but the product’s safety hasn’t been confirmed in a large analysis. Has the potential to increase heart rate and blood pressure.

Products its been found in: Hydroxycut Advanced, Xantrax, FatBlaster Max.

Green tea extract

The catechins extracted from green tea.

Reduces fat synthesis and absorption and increases metabolism.

Conflicting results. Some studies suggest it needs to be taken with caffeine to be effective.

Side effects and interactions?

Deemed safe when formulated and taken appropriately. There’s some concern that green tea extracts may cause liver toxicity, especially if taken on an empty stomach.

Products its been found in: Xantrax, FatBlaster, FatBlaster Max, Rapid Burn.

Chitosan

Derived from the powdered shells of crustaceans.

Binds to dietary fat to stop absorption.

Studies show varying results, with only minor weight loss shown.

If it does work, there could be malabsorption of nutrients and loose, oily stools.

Products its been found in: Rapid Burn.

Chromium picolinate

Chromium is an essential trace element commonly used in the form of chromium picolinate.

Enhances insulin sensitivity and fat burning. May increase lean body mass.

Experts agree there’s insufficient evidence to recommend it as a weight-loss aid.

Side effects and interactions

No studies have reported side effects. However, it may cause DNA damage in high doses.

Products its been found in: Hydroxycut Advanced, Optislim Max, FatBlaster, FatBlaster Max, Xenadrine Ultra, Rapid Burn, Supprexxa Metabolism Formula.

Recalled slimming products

Australia has seen product recalls in the past that bring into question the regulation around listed weight-loss aids. A few years ago weight-loss chocolate bars were pulled from sale as they contained an unlisted ingredient – the prescription drug, sibutramine. Previously a leading prescription weight-loss medicine, sibutramine was withdrawn from the Australian market after being associated with cardiac events such as non-fatal heart attack and stroke.

In another worrying event, the heavily advertised Latin Seed was withdrawn for containing poisonous yellow oleander, instead of candle nut as claimed on the label. It can cause a variety of symptoms from diarrhoea to heart damage.

While these events are unusual, the fact that they do happen makes it difficult to see how the Therapeutic Goods Administration (TGA) can consider these products “low risk”.

Government approved?

If you think weight-loss pills are evaluated for safety and efficacy like prescription medicines, think again.

The TGA is the body that’s been charged with regulating complementary medicines. In Australia, all complementary and alternative medicines – such as weight-loss pills – need to be entered on the Australian Register of Therapeutic Goods. On this register there are two types of products – “registered goods” and “listed goods” – and it’s important to know the difference between the two.

  • Registered goods are medicines that are considered high risk – such as prescription medicines. They’re evaluated by the TGA for quality, safety and efficacy before being released onto the market.
  • Listed goods (identified by an AUST L number) are considered lower risk. They must only contain ingredients that have had their safety and quality approved for use in listed products, but they aren’t evaluated for efficacy.

Manufacturers can apply for a listing by just filling in an online form and paying a fee. Around 20% of products are randomly audited to make sure they meet standards. Manufacturers also have to hold a file of evidence to prove that their products work. Based on the literature we looked at, we suspect their “proof” is pretty underwhelming. In 2008, there were about 100 times more listed weight-loss products than registered products – today there are probably more.

Do they work?

So, if the products aren’t evaluated for efficacy, how do you know whether they’re worth the money? The short answer is you don’t – unless you do some legwork. We looked at the literature around the most common “active” ingredients. Several systematic reviews have concluded that, at best, more research is needed before any conclusions can be drawn.

Looking to get into shape? We test the most popular fitness bands in our fitness tracker reviews.

Australians struggling with obesity have a new drug available to them to treat the condition, following its approval for use.

The listing of the weight loss medication on the Australian Register of Therapeutic Goods is a “rare” step that will help more people access treatment that works for them, according to a leading obesity researcher.

Contrave, which is intended to be used alongside a reduced calorie diet and increased exercise, combines two drugs already used in Australia, often to help people shake dependence on smoking and alcohol.

The pill affects the central nervous system, by both suppressing appetite and reducing food cravings.

It has been shown in clinical trials to help people lose on average five per cent of their body weight.

That may not sound like a lot, but it is enough to improve people’s metabolic health and reduce rates of cardiovascular disease, diabetes and lipid disorders, according to the drug’s Australian inventor.

Researcher Michael Cowley – now Head of the Monash Biomedicine Discovery Institute’s Department of Physiology – discovered the drug while he was working in the United States.

Professor Cowley says he hopes the extra medication on the market, which has been approved for use in the US since 2014, will help people realise there are effective medical treatments available.

That will also help break down inappropriate social stigma, he believes.

“There is a sector of the medical community and a sector of the Australian political community who regard obesity as a moral failing,” he told AAP.

“Most of the rest of the world has acknowledged it as a disease and applies normally clinical judgement to treating diseases.”

Head of Clinical Obesity Research at Melbourne’s Baker Heart and Diabetes Institute, John Dixon, says Contrave’s listing lifts the number of obesity drugs available in Australia from three to four.

That comes as almost a third (28 per cent) of Australian adults are obese, with Professor Dixon saying “hardly any of them” are receiving effective weight loss therapy.

Some medications work for some people and not others, so increasing the available choices is important, Prof Dixon said, particularly given changing lifestyle factors is only effective for one-in-20 people.

“For those who really need it, and that’s a lot of them out there, we need to see doctors actually treating obesity actively, with medical treatments,” Prof Dixon told AAP.

“We wouldn’t treat heart disease or diabetes or cancer just with lifestyle interventions, and yet that’s the prescription for managing weight.”

Contrave is not listed on Pharmaceutical Benefits Scheme – meaning the federal government is not subsidising it – and will cost those who use it about $230 to $250 per month.

Prof Dixon said no medications to treat obesity are listed on the PBS, despite plenty being listed to treat complications for the condition such as diabetes, hypertension, some cancers and sleep apnea.

“It’s abysmal. This is called obesity stigma blame,” he said.

The drug’s side effects – established in clinical trials – include headache, constipation, dizziness, vomiting and dry mouth.

Are weight-loss drugs worth trying?


Image: Bigstock

Updated: May 22, 2018Published: November, 2015

Newer medications, which may be safer than earlier drugs, have expanded the options for treating obesity.

Obesity is now considered more than a risk factor for other conditions; it’s a disease itself. It has been the subject of intense scientific and medical research to develop effective treatments. But the quest has been elusive.

Four medications approved by the FDA since 2012—Qsymia (phentermine and topiramate), Belviq (lorcaserin), Contrave (naltrexone and bupropion ) and Saxenda (liraglutide)—have added to the options for treating obesity, says Dr. Lee Kaplan, who directs the Obesity, Metabolism, and Nutrition Institute at Harvard-affiliated Massachusetts General Hospital. “We now have six FDA-approved drugs, but that is a tiny percentage of the number available to treat hypertension and other chronic diseases, so we need even more options to treat obesity most effectively.”

Will the newer drugs help you?

Like older medications, the new drugs are best used as part of a comprehensive weight-loss program that includes close monitoring by an experienced physician. The approved drugs are usually prescribed for people with a BMI higher than 30, especially if they have other conditions such as type 2 diabetes, high blood pressure, joint problems, or sleep apnea, which can often be alleviated by losing weight.

Not everyone responds the same way to any given drug. A few people may lose a great deal of weight on a particular drug, while others may lose little or none. “At present we have no way to predict this response in advance,” Dr. Kaplan says. Fortunately, however, if you don’t respond to one drug, you may do well with another. It often requires trying multiple medications to find the right one for each person.

The weight-loss drugs won’t melt off the pounds overnight. When they are successful, they result in an average weight loss of about 5% over a period of six to 12 months. However, even that modest weight loss can improve your health and reduce your risk of heart disease, stroke, and diabetes.

Are weight-loss drugs safe?

You may remember some disturbing reports about previous weight-loss medications. Dexfenfluramine and fenfluramine were taken off the market after they were linked to heart valve damage. Sibutramine (Meridia) was removed after it was linked to heart attack and stroke in people at highest risk for them.

The options on the market today come with their own cautions. The ingredient phentermine—a component of Adipex-P, Ionamin, and Qsymia—isn’t usually recommended for people who have high blood pressure or other heart conditions. Topiramate, another component of Qsymia, has been linked to an increased risk of birth defects, so women who take it should take special precautions not to get pregnant.

If a drug helps you lose 5% of your weight within a few months without side effects, you will likely want to continue it. But medications are not a substitute for lifestyle changes. They work best when used as part of a broader medical weight-loss program. They should be just one part of a lifelong plan that includes a healthy diet, regular exercise, adequate sleep, and stress reduction.

Which medication to choose?

Some weight-loss medications contain drugs used to treat other conditions. You may want to consider a “dual-purpose” medication if you have the following:

  • Type 2 diabetes. You might want to try liraglutide (Saxenda), which may lower your blood sugar.

  • Migraines. If you’re a migraine sufferer and don’t intend to get pregnant, you might consider Qsymia. One of its components, topiramate, is approved for treating migraines and seizures.

  • Depression. Contrave contains bupropion, an antidepressant. It may elevate your mood, which can aid weight loss.

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Key Points
  • Older obesity pharmacotherapies are limited by tolerability and dependence issues and are approved only for short-term use (≤12 weeks).
  • Newer weight loss agents are typically better tolerated, have better safety profiles, and are approved for chronic weight management including weight maintenance.
  • Pharmacotherapy for overweight and obesity should be used only as an adjunct to lifestyle therapy and not alone.

AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity Recommendation1

Short-term Therapy
  • R79. Pharmacotherapy should be offered to patients with obesity, when potential benefits outweigh the risks, for the chronic treatment of the disease. Short-term treatment (3 to 6 months) using weight-loss medications has not been demonstrated to produce longer-term health benefits and cannot be generally recommended based on scientific evidence.

Choice of Weight-Loss Agent
  • R80. In selecting the optimal weight-loss medication for each patient, clinicians should consider differences in efficacy, side effects, cautions, and warnings that characterize medications approved for chronic management of obesity, and the presence of weight-related complications and medical history; these factors are the basis for individualized weight-loss pharmacotherapy; a generalizable hierarchical algorithm for medication preferences that would be applicable to all patients cannot currently be scientifically justified.
  • R81. Clinicians and their patients with obesity should have access to all approved medications to allow for the safe and effective individualization of appropriate pharmacotherapy.

Combinations of Weight-Loss Medications
  • R82. Combinations of FDA-approved weight-loss medications should only be used in a manner approved by the FDA or when sufficient safety and efficacy data are available to assure informed judgment regarding a favorable benefit-to-risk ratio.

Agent Selection for Specific Clinical Conditions

Chronic Kidney Disease
  • R83. Weight-loss medications should not be used in the setting of end-stage renal failure, with the exception that orlistat and liraglutide 3 mg can be considered in selected patients with a high level of caution.
  • R84. The use of naltrexone extended release (ER)/bupropion ER, lorcaserin, or phentermine/topiramate ER is not recommended in patients with severe renal impairment (<30 mL/min).
  • R85. All weight-loss medications can be used with appropriate cautions in patients with mild (50 to 79 mL/min) and moderate (30 to 49 mL/min) renal impairment, except that in moderate renal impairment the dose of naltrexone ER/bupropion ER should not exceed 8 mg/90 mg twice per day, and the daily dose of phentermine/topiramate ER should not exceed 7.5 mg/46 mg.
  • R86. Orlistat should not be used in patients with, or at risk of, oxalate nephropathy. Liraglutide 3 mg should be discontinued if patients develop volume depletion, for example, due to nausea, vomiting, or diarrhea.

Nephrolithiasis
  • R87. Naltrexone ER/bupropion ER, lorcaserin, and liraglutide 3 mg are preferred weight-loss medications in patients with a history, or at risk, of nephrolithiasis. Caution should be exercised in treating patients with phentermine/topiramate ER and orlistat who have a history of nephrolithiasis.

Hepatic Impairment
  • R88. All weight-loss medications should be used with caution in patients with hepatic impairment and should be avoided in severe hepatic impairment (i.e., Child-Pugh score >9).
  • R89. Dose adjustments for some medications are warranted in patients with moderate hepatic impairment specifically, the maximum recommended dose of naltrexone ER/bupropion ER is 1 tablet (8 mg/90 mg) in the morning; the maximum recommended dose of phentermine/ topiramate ER is 7.5 mg/46 mg daily.
  • R90. Clinicians should maintain a high index of suspicion for cholelithiasis in patients undergoing weight-loss therapy, regardless of the treatment modality; in high-risk patients, liraglutide 3 mg should be used with caution; effective preventive measures include a slower rate of weight loss, an increase in dietary fat, or administration of ursodeoxycholic acid.

Hypertension
  • R91. In patients with existing hypertension, orlistat, lorcaserin, phentermine/topiramate ER, and liraglutide 3 mg are preferred weight-loss medications. Heart rate should be carefully monitored in patients receiving liraglutide 3 mg and phentermine/topiramate ER. Naltrexone ER/bupropion ER should be avoided if other weight-loss medications can be used because weight loss assisted by naltrexone ER/bupropion ER cannot be expected to reduce blood pressure, and the drug is contraindicated in uncontrolled hypertension.

Cardiovascular Disease and Cardiac Arrhythmia
  • R94. In patients with established atherosclerotic cardiovascular disease, orlistat and lorcaserin are preferred weight-loss medications. Liraglutide 3 mg, phentermine/topiramate ER, and naltrexone ER/bupropion ER are reasonable to use with caution, and to continue if weight-loss goals are met, with careful monitoring of heart rate and blood pressure. Cardiovascular outcome trials are planned or ongoing for all weight-loss medications except orlistat.
  • R95. Orlistat and lorcaserin are preferred weight-loss medications in patients with a history or risk of cardiac arrhythmia. Naltrexone ER/bupropion ER, liraglutide 3 mg, and phentermine/topiramate ER are not contraindicated but should be used cautiously with careful monitoring of heart rate and rhythm.

Depression With or Without Selective Serotonin Reuptake Inhibitor Therapy
  • R96. All patients undergoing weight-loss therapy should be monitored for mood disorders, depression, and suicidal ideation.
  • R97. Orlistat, liraglutide 3 mg, and phentermine/topiramate ER at initiation (3.75 mg/23 mg) and low treatment (7.5 mg/46 mg) doses may be considered in patients with obesity and depression.
  • R98. Lorcaserin and naltrexone ER/bupropion ER should be used with caution in patients with obesity and depression or avoided if patients are taking medications for depression.

Anxiety
  • R99. Maximal dose (15 mg/92 mg) phentermine/topiramate ER should be used with caution in patients with obesity and anxiety disorders.

Psychotic Disorders With or Without Medications
  • R100. Patients with psychotic disorders being treated with antipsychotic medications (lithium, atypical antipsychotics, monoamine oxidase inhibitors) should be treated with a structured lifestyle intervention to promote weight loss or prevent weight gain.

  • R101. Treatment with metformin may be beneficial in promoting modest weight loss and metabolic improvement in individuals with psychotic disorders who are taking antipsychotic medications.
  • R102. Caution must be exercised in using any weight-loss medication in patients with obesity and a psychotic disorder due to insufficient current evidence assessing safety and efficacy.

Eating Disorders Including Binge Eating Disorder
  • R104. Patients with overweight or obesity who have binge eating disorder should be treated with a structured behavioral/lifestyle program in conjunction with cognitive behavioral therapy or other psychological interventions.
  • R105. In patients with overweight or obesity and binge eating disorder, treatment with orlistat or approved medications containing topiramate or bupropion may be considered in conjunction with structured lifestyle therapy, cognitive behavioral therapy, and/or other psychological interventions.
  • R106. Structured lifestyle therapy and/or selective serotonin reuptake inhibitor therapy may be considered in patients with obesity and night eating syndrome.

Glaucoma
  • R107. Liraglutide 3 mg, orlistat, and lorcaserin are preferred weight-loss medications in patients with a history, or at risk of, glaucoma. Phentermine/topiramate ER should be avoided and naltrexone ER/bupropion ER used with caution in patients with glaucoma.

Seizure Disorder
  • R108. Phentermine/topiramate, lorcaserin, liraglutide, and orlistat are preferred weight-loss medications in patients with a history, or at risk, of seizure/epilepsy. The use of naltrexone ER/bupropion ER should be avoided in these patients.
  • R109. All patients with obesity should be monitored for typical symptoms of pancreatitis (e.g., abdominal pain or gastrointestinal distress) due to a proven association between these diseases.
  • R110. Patients receiving glyburide, orlistat, or incretin-based therapies (glucagon-like peptide-1 receptor agonists or dipeptidyl peptidase 4 inhibitors) should be monitored for the development of pancreatitis. Glyburide, orlistat, and incretin-based therapies should be withheld in cases of prior or current pancreatitis; otherwise there are insufficient data to recommend withholding glyburide for glycemic control, orlistat for weight loss, or incretin-based therapies for glycemic control or weight loss due to concerns regarding pancreatitis.

Opioid Use
  • R111. In patients requiring chronic administration of opioid or opiate medications, phentermine/topiramate ER, lorcaserin, liraglutide 3 mg, and orlistat are preferred weight-loss medications, while naltrexone ER/bupropion ER should not be used.

Women of Reproductive Potential
  • R112. Weight-loss medications must not be used in pregnancy.
  • R113. All weight-loss medications should be used in conjunction with appropriate forms of contraception in women of reproductive potential.
  • R114. Weight-loss medications should not be used in women who are lactating and breast-feeding.

The Elderly, ≥65 years
  • R115. Elderly patients (≥65 years) should be selected for weight-loss therapy involving structured lifestyle interventions that include reduced-calorie meal plans and exercise, with clear health-related goals in mind that include prevention of type 2 diabetes (T2D) in high-risk patients with prediabetes, blood pressure lowering, and improvements in osteoarthritis, mobility, and physical function.
  • R116. Elderly patients with overweight or obesity being considered for weight-loss therapy should be evaluated for osteopenia and sarcopenia.
  • R117. Weight-loss medications should be used with extra caution in elderly patients with overweight or obesity; additional studies are needed to assess efficacy and safety of weight-loss medications in the elderly.

Addiction/Alcoholism
  • R118. In patients with obesity and alcohol or other addictions, consider using orlistat or liraglutide 3 mg. Lorcaserin (abuse potential due to euphoria at suprapharmacologic doses) and naltrexone ER/bupropion ER (lowers seizure threshold) should be avoided in patients with alcohol abuse, and naltrexone ER/bupropion ER is contraindicated during alcohol withdrawal.

Post-Bariatric Surgery
  • R119. Patients that have undergone bariatric surgery should continue to be treated with an intensive lifestyle intervention. Patients that have regained excess weight (≥25% of the lost weight), have not responded to intensive lifestyle intervention, and are not candidates for reoperation may be considered for treatment with liraglutide (1.8 to 3.0 mg) or phentermine/topiramate ER; the safety and efficacy of other weight-loss medications have not been assessed in these patients.

Reference
  1. Garvey WT, Mechanick JL, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients With Obesity. Endocr Pract. 2016;22(suppl 3);1-205.

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Morbidly Obese: Tips for Losing 100 Pounds or More

10 Tips for Losing 100 Pounds or More

Experts offer advice for those with lots to lose

By Colette Bouchez
WebMD Weight Loss Clinic – Feature

When Lisa Goetze tipped the scales at 550 pounds, she wanted to put her fingers in her ears and scream “Stop!” every time a well-meaning friend advised her to start exercising.

“It wasn’t that I didn’t want to exercise,'” says Goetze, now a svelte size 14 and an American Council on Exercise-certified personal trainer and weight management consultant.

“No one understood that when you are very large, even holding up your body for a three-minute shower is a painful, and sometimes nearly impossible, feat. Walking around the block, it’s just impossible.”

For the group of people doctors call “morbidly obese” — those struggling to lose 100 pounds or more — losing weight is fraught with challenges others may never imagine.

“When you’re large, the same weight loss and exercise rules don’t apply. They can’t apply, but nobody really gets that, not even many doctors,” says Goetze, whose company aims to address the needs of what she says is this forgotten group.

From bathroom scales that can’t measure your weight, to exercise equipment built for someone half your size, to the health problems associated with being extremely overweight, frustrations abound.

What’s more, experts say, the nuts and bolts of dieting — including caloric intake — is different for those who need to lose a lot.

“You can’t just toss a very overweight person the latest diet book or piece of exercise equipment and expect it to work. There is a whole different mindset to large-scale weight loss, and a whole different approach becomes necessary,” says Warren Huberman, PhD, a behavioral consultant for the surgical weight loss program at New York University Medical Center.

That can make finding the right diet plan a challenge. But fortunately for WebMD Weight Loss Clinic members, the WLC eating plan takes current weight and calorie intake into consideration, rather than setting a “one-size-fits-all” calorie limit.

So where do you begin, and how do you stay motivated, when your goal is to lose 100 pounds or more? Three weight loss experts — including one who shed nearly 400 pounds herself — offer these 10 strategies to set you on the right path.

1. Seek Supervision.

“The more overweight you are, the more likely you need to be monitored — and the more you need some type of medical supervision, at least at the start,” says Janet Finestein, MS, RD, a nutritionist and dietitian at the Comprehensive Weight Loss Center of NewYork-Presbyterian Hospital.

Because obesity contributes to other health problems, including high blood pressure, high cholesterol, and insulin resistance, Finestein says medical care is a must.

“Sometimes uncovering these health risks and getting treatment can also help you lose weight,” says Finestein. “For example, learning how to control your insulin levels may also help you control your hunger, and that can make your weight loss much easier.”

2. Join a Support Group.

While it may seem as if no one understands your needs, you are not alone. Experts say one of the best places to find those kindred spirits is in a support group — like those found on the Weight Loss Clinic message boards.

“If you feel self-conscious about meeting with strangers, the Internet has opened up a whole new world of peer support, with groups and chats and online gatherings of those who share similar goals and similar problems, and I do encourage patients to get involved,” Huberman tells WebMD.

By sharing your experiences, or just listening to others share theirs, you may also discover ways to better cope with the challenges you face, Huberman says.

3. Incorporate Movement Into Your Life.

While joining a gym, or even going for an evening walk, may be out of the question at first, Goetze says that getting used to moving your body in small ways is something you can — and should — do.

“When you are very large, moving your body is not only physically challenging, it’s also emotionally challenging, because with every difficult move comes a reminder of your size,” says Goetze.

To counter the problem, she says, make a commitment to doing small movements every chance you get. Walk across the room to change the TV channel instead of using the remote, for example, or bend down to pick up that pencil you dropped.

“Small moves do burn calories, plus they subtly change your mindset about the role of movement in your life,” Goetze says.

4. Discover Weight Training.

Experts say one of the most important exercises for very overweight folks is weight training. It builds muscle that can help burn more calories. The best part: Many weight-training exercises can be done sitting down, making them ideal for those with a lot to lose.

“Even small actions can make a big difference.”

“Sitting in a chair and lifting some soup cans, putting on ankle weights and just moving your feet back and forth, lifting your arms over your head and reaching towards the ceiling, all can help build and strengthen muscles, and again, get your body moving,” says Goetze.

Finestein agrees: “The more weight you have to move with each movement, the less you have to do to see a reaction, so even small actions can make a big difference.”

5. Don’t Cut Calories Too Far.

That 1,200-calorie-a-day diet may be just what the doctor ordered for those who need to lose 20 or 30 pounds. But if you’re trying to lose 100 pounds or more, you need more calories just to survive.

“The more you weigh, the higher your caloric needs,” Finestein says, “so you can eat more than a person who weighs less, and still lose an equal amount of weight.”

If you cut just 500 calories out of your diet every day, you could see a one-pound weight loss each week, she says.

6. Focus on How Far You’ve Come.

To stay motivated for the long haul, experts say, pay attention to how much you accomplish each day.

“Forget where you want to get to,” says Finestein. “Realize how far you’ve come. Remember when you couldn’t bend over to tie your shoes, or couldn’t walk up a flight of stairs without puffing?” And, she says, never forget that for every pound you lose, your health improves.

“You might still be overweight, but you’re definitely healthier,” says Finestein.

7. Keep Your Goals Realistic.

Experts say it’s also vital not to set the bar too high for your weight loss goals.

“You have to cut yourself a little bit of slack by taking into consideration how long you have been overweight,” says Goetze.

When you have lots to lose, it takes longer to reach your goals — but it’s also extra rewarding when you do get there.

“It’s a lot easier if you concentrate on your health, rather than each and every pound.,” says Goetze.

8. Ditch the “Dieting Mindset.”

“The very idea that we go ‘on’ a diet suggests that at some point we will come ‘off’ the diet — and that’s where those who are morbidly obese make a wrong turn,” says Huberman.

To lose a significant amount of weight and keep it off, a permanent lifestyle change is needed.

“When you are obese, weight control must become a lifetime commitment, and it must involve a decision to completely change the role of food in your life,” Huberman says. “And you must make exercise a regular part of your daily living.

“When you can accept that you’re not on a diet, but that this is how you are going to live your life for the rest of your life, you will stay motivated and succeed.”

9. Consider Medication.

If diet and exercise alone don’t seem to do the trick, consider asking your doctor whether medication could be an option for you.

“Don’t be afraid, or ashamed, to admit you need some extra help, and talk to your doctor about all your weight loss options, including medication,” says Finestein.

Remember that weight loss medication is not a magic bullet. These medications can result in small amounts of weight loss — as long you eat healthfully and engage in physical activity.

10. Don’t Rule Out Weight Loss Surgery.

“For me, weight loss surgery turned out to be the right option — but I did try every other option first,” says Goetze.

She suggests you give yourself room to experiment, but keep in the back of your mind that surgery to reduce the size of the stomach is an option for many people.

“It is dramatic, and not easy, but it can be comforting to remember that there is always hope, no matter what,” says Goetze, who lost nearly 400 pounds after she opted for stomach-reducing surgery.

Keep in mind that weight loss surgery requires lifestyle changes — otherwise, you’ll regain the weight over time.

Researchers find cancer-fighting drugs help morbidly obese mice lose weight

“We were surprised to observe that when morbidly obese mice were treated with certain cancer-fighting drugs, the drugs not only targeted their cancers, but also tended to spontaneously resolve their obesity — even with undiminished gorging on a high-fat diet,” says Mayo Clinic cancer immunotherapist Peter Cohen, M.D., who co-led the study with postdoctoral fellow Cheryl Myers, Ph.D. and Mayo Clinic immunologist Sandra Gendler, Ph.D.

“Importantly, two chemotherapy agents — methotrexate and cyclophosphamide — could be dosed to completely reverse obesity without detectable toxicity, even in mice without cancer,” explains Dr. Myers. “Interestingly, these drugs are already used to treat some noncancerous conditions, such as rheumatoid arthritis.”

More research needs to be done to see if the same outcome can be achieved in morbidly obese patients.

“The ease with which this weight loss was achieved in mice — even with continued caloric binging — is in stark contrast to the Herculean difficulties morbidly obese patients experience trying to preserve weight loss through dietary restraint,” adds Dr. Gendler.

The weight reduction observed in the obese mice was not attributable to trivial explanations, such as a decrease in dietary intake, increased energy expenditure or malabsorption. Instead, the investigators identified multiple effects of methotrexate or cyclophosphamide that worked together to expedite loss of excessive weight in mice. Much like chemotherapy’s well-known ability to decrease red and white blood cell precursors transiently, methotrexate or cyclophosphamide depleted fat cell precursors, leading to much decreased fat storage. “This meant that excessive dietary calories had to go somewhere else in the body instead, such as to the liver,” explains Dr. Cohen.

“Surprisingly, the liver maintained a robust level of metabolic activity during methotrexate or cyclophosphamide treatment, but was nearly shut down in regards to fat production and fat storage,” adds Dr. Myers.

“Based on our composite data,” explains Dr. Gendler, “it appears that methotrexate or cyclophosphamide can induce the livers of obese mice to burn off rather than accumulate excessive dietary fat. This results in desirable weight reduction instead of increased obesity, even with continued caloric binging.”

The study sets the stage for further research, exploring how these metabolic mechanisms could reduce the need for severe dietary constraints in morbidly obese individuals.

How much exercise do you need?

You’ve worked on the calorie intake part of the equation. Now what about the “calories out?” Studies show that people who exercise while dieting lose more weight, and are better able to keep it off, than people who diet and do not exercise, said Wayne Miller, programs director at West Virginia School of Osteopathic Medicine’s Center for Rural and Community Health.

Miller and his colleagues reviewed 25 years’ worth of weight loss research and found that, during a typical 15-week weight loss program, people lost, on average, 23 lbs. (10.4 kg) by only dieting and 24 lbs. (10.9 kg) by dieting and exercising, they reported in 1997. That difference may seem small, but after one year, the people who only dieted kept off 14 lbs. (6.4 kg), on average, whereas those who dieted and exercised kept off 19 lbs. (8.6 kg).

As for how strenuous the exercise has to be, experts recommend that people who want to lose weight meet the government’s guidelines of at least 150 minutes of moderate physical activity (such as brisk walking) every week, or about 30 minutes a day for five days a week.

But those who want to maintain weight loss over the long term may need to do more exercise. A 2008 study of the National Weight Control Registry involving 3,600 people who lost at least 30 lbs. (13.6 kg) and kept it off for a year or longer found that they reported at least 60 minutes of moderate physical activity per day.

The National Institutes of Health also recommends resistance training to strengthen muscles at least twice a week. These activities include lifting weights and doing push-ups and crunches, which can help build muscle. Resistance training exercises are important for weight loss maintenance because muscle tissue requires more calories to maintain itself, meaning you will burn more calories just by having more muscle.

Do diet pills and supplements work?

If weight loss sounds like a lot of physical and mental work, that’s because it is. And there’s no magic pill: Dietary supplements that claim to help people lose weight have not been proven to work, and they have the potential to be dangerous, Cohen said. Many nutritionists and researchers agree that such supplements can do more harm than good. Supplements can contain drugs that are not listed on the label, and may have harmful side effects. In 2014, the Food and Drug Administration identified more than 30 weight loss supplements that contained hidden drugs, but only seven of these were recalled by their manufacturers.

Weight loss supplements send more than 4,600 people to the emergency room every year, often due to heart symptoms, such as chest pain and a rapid heart rate, according to an estimate by a study published in October 2015.

The bottom line, many experts told Live Science, is that there is often no scientific evidence supporting a supplement’s claims. The makers of diet supplements do not need to prove that their supplements actually help people lose weight in order to sell them in stores.

In contrast, makers of prescription and over-the-counter weight loss drugs, such as orlistat (brand names: Alli and Xenical) and lorcaserin (brand name: Belviq), must conduct studies showing that the drugs can lead to weight loss before the pills are approved by the FDA for use in obese individuals and those considered overweight (BMI of 27 or greater) who also have obesity-related risk factors.

Generally, people who take weight loss drugs — which often work by decreasing appetite and increasing feelings of satiety — can lose an average of 5 to 10 percent of their body weight in a year, according to the Mayo Clinic. However, these drugs still need to be used along with diet and exercise for people to achieve this level of weight loss. (Studies of these drugs involve people who have also made changes to their diet and activity level.)

According to the 2013 guidelines, the drugs might be helpful for people who aren’t able to lose weight with diet and exercise alone, but people should consider discontinuing the drugs if they don’t lose at least 5 percent of their body weight within 12 weeks of starting them.

However, Cohen cautioned that the long-term safety of weight loss drugs hasn’t been studied. Most of the studies look at these drugs’ safety after just one year, he said, and some earlier drugs that were approved by the FDA were later taken off the market because of their side effects. For example, in 2010, the weight loss drug sibutramine (sold under the brand name Meridia) was removed from the market — even though it had originally been approved — because it was later linked with an increased risk of heart attack and stroke.

In any case, weight loss drugs may not be a long-term method for keeping weight off, because people may regain the weight when they stop taking the drugs, Cohen said.

Lack of sleep increases the odds you’ll gain weight. Find out below how much shuteye you need. (Image credit: /Sabphoto)

Can a lack of sleep cause weight gain?

Here’s a bit of advice that may make a dieter smile, or yawn: Get more sleep. A growing body of evidence suggests that getting insufficient sleep increases the risk of obesity. However, most of these studies have been conducted at a single point in time, which makes it hard to determine whether a small amount of sleep was a cause or an effect of weight gain.

The longest-running study on the link between short sleep and weight gain followed about 68,000 women for 16 years. It found that women who slept 5 hours or less per night gained about 2.5 lbs. (1.1 kg) more, on average, than those who slept at least 7 hours per night, over 16 years. In addition, those who got 5 hours or less were 15 percent more likely to become obese during the study period than those who got at least 7 hours of sleep.

Getting too little sleep, which most experts define as less than 7 hours of shut-eye per night, may increase levels of an appetite-stimulating hormone called ghrelin, and decrease levels of the hormone leptin, which makes you feel full, according to the NIH. This may lead to an increase in hunger. In addition, people who sleep less could have more time to eat. In a small study of 11 people who stayed in a sleep lab, participants ate more snacks when they slept for just 5.5 hours than when they slept for 8.5 hours. This increase in snacking occurred mostly during the late-night hours.

Still, it’s not clear if getting more sleep actually helps people lose weight. However, studies are now being conducted to answer that question. In one study, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases will look at whether obese people who usually sleep less than 6.5 hours a night see changes in their weight if they increase their sleep by an hour per night.

Should you consider bariatric surgery?

Bariatric surgery, an operation on the stomach and intestine used to treat obesity, may be an option for people who are still severely obese after attempting to lose weight through other methods, such as diet and exercise. People with a BMI of 40 or greater, or those with a BMI of 35 or greater who also have obesity-related health conditions (such as type 2 diabetes), are candidates for this invasive surgery, according to the NIH.

People who have bariatric surgery will still need to make lifestyle changes, including following a healthy diet and engaging in regular exercise, to lose weight and keep it off.

A 2009 study that reviewed outcomes for more than 11,000 bariatric surgery patients found that patients typically lost about 56 percent of their excess body weight, or nearly 85 lbs. (38.5 kg), and maintained it for at least two years. Scientists who reviewed 89 studies on weight loss after bariatric surgery found that patients with a BMI of 40 or higher benefited most from the surgery, losing 44 to 66 lbs. (20 to 30 kg), on average, and maintained that weight loss for up to 10 years, they reported in 2005 in the Annals of Internal Medicine.

The operation has the following side effects:

  • The surgery alters the gut’s ability to absorb nutrients, so you may need to take vitamins and minerals, to prevent malnutrition.
  • You will not be able to eat large meals.
  • You will need to eat liquid or pureed foods for several weeks following the surgery, according to the Mayo Clinic.

How can you keep weight off?

It’s typically harder to keep weight off than it is to lose it, the experts agreed. Many studies show that people usually experience their maximum weight loss after about six months of a diet-and-exercise program. After that, the pounds come creeping back, although most people don’t regain all of the weight. For example, a 2007 review of 80 diet studies involving more than 26,000 people found that dieters lost about 11 to 19 lbs. (5 to 8.5 kg) after six months, but then their weight loss plateaued, and after four years, they maintained about 6.5 to 13 lbs. (3 to 6 kg) of weight loss.

Chart of the habits of those who successfully keep weight off. (Image credit: by Karl Tate, Infographics artist)

Participating in a program that focuses on maintaining weight loss — one that meets at least once per month for a year or more — can increase the chances that you’ll keep the weight off. A 2008 study of more than 1,000 people who lost about 19 lbs. found that people who participated in a weight loss maintenance program that met in-person once a month kept off about 3 lbs. (1.4 kg) more over a 2.5-year period than people who didn’t participate in the program.

To assist any weight loss effort, weigh yourself twice a week, continue the lower-calorie approach indefinitely and exercise at least 200 minutes per week, according to the 2013 guidelines. The Centers for Disease Control and Prevention recommends that you make a plan for how to keep up your healthy eating pattern, even on weekends, vacations and special occasions.

Eating breakfast may also stave off hunger later in the day. In a 2002 National Weight Control Registry study of nearly 3,000 people who kept off 30 lbs. (13.6 kg) for at least a year, researchers concluded that one habit that stood out was eating a morning meal: 78 percent of the participants ate breakfast every day.

Once you’ve lost weight, keeping it off can seem like a never-ending battle. But it’s a battle worth fighting, even if you slip sometimes. Trying, even if you don’t always succeed, is better than not doing so, scientists say. There’s no clear evidence that “yo-yo dieting” — or weight cycling, as researchers call it — is linked with an increased risk of early death or disease, compared with remaining obese, McManus noted. And very few studies report harmful effects of yo-yo dieting.

“Weight loss intervention should not be discouraged because of a person’s tendency to be a weight cycler,” McManus said.

In a nutshell, the bulk of the evidence says that maintaining your weight loss is achievable if you do the following: keep up your healthy diet, continue to exercise and monitor your weight so you notice when your regimen needs adjusting.

This article is part of a Live Science Special Report on the Science of Weight Loss. It will be updated whenever significant new research warrants. Note that any significant change in diet should be undertaken only after consultation with a physician.

Follow Rachael Rettner @RachaelRettner. Follow Live Science @livescience, Facebook & Google+. Original article on Live Science.

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