(1200–1500 calories a day), they may recommend that
certain individuals follow a very-low-calorie liquid
protein diet (400–700 calories) for as long as three
months. This therapy, however, should not be con-
fused with commercial liquid protein diets or commer-
cial weight-loss shakes and drinks. Doctors tailor
these diets to specific patients, monitor patients care-
fully, and use them for only a short period of time. In
addition to reducing the amount and type of calories
consumed by the patient, doctors will recommend
professional therapists or psychiatrists who can help
the individual effectively change his or her behavior in
regard to eating.
For individuals who are severely obese, dietary
changes and behavior modification may be accompa-
nied by surgery to reduce or bypass portions of the
stomach or small intestine. Although obesity surgery
is less risky as of 2003 because of recent innovations in
equipment and surgical technique, it is still performed
only on patients for whom other strategies have failed
and whose obesity seriously threatens their health.
Other surgical procedures are not recommended,
including liposuction, a purely cosmetic procedure in
which a suction device is used to remove fat from
beneath the skin, and jaw wiring, which can damage
gums and teeth and cause painful muscle spasms.
Appetite-suppressant drugs are sometimes pre-
scribed to aid in weight loss. These drugs work by
increasing levels of serotonin or catecholamine,
which are brain chemicals that control feelings of full-
ness. Appetite suppressants, though, are not consid-
ered truly effective, since most of the weight lost while
taking them is usually regained after stopping them.
Also, suppressants containing amphetamines can be
potentially abused by patients. While most of the
immediate side-effects of these drugs are harmless,
the long-term effects of these drugs, in many cases,
are unknown. Two drugs, dexfenfluramine hydro-
chloride (Redux) and fenfluramine (Pondimin) as
well as a combination fenfluramine-phentermine
(Fen/Phen) drug, were taken off the market when
they were shown to cause potentially fatal heart
defects. In November 1997, the United States Food
and Drug Administration (FDA) approved a new
weight-loss drug, sibutramine (Meridia). Available
only with a doctor’s prescription, Meridia can signifi-
cantly elevate blood pressure and cause dry mouth,
headache,constipation, and insomnia. This medica-
tion should not be used by patients with a history of
congestive heart failure, heart disease, stroke, or
uncontrolled high blood pressure.
Other weight-loss medications available with a
doctor’s prescription include:diethylpropion (Tenuate, Tenuate dospan)
mazindol (Mazanor, Sanorex)
phendimetrazine (Bontril, Plegine, Prelu-2, X-Trozine)
phentermine (Adipex-P, Fastin, Ionamin, Oby-trim)
Phenylpropanolamine (Acutrim, Dextarim) is the
only nonprescription weight-loss drug approved by
the FDA These over-the-counter diet aids can boost
weight loss by 5%. Combined with diet and exercise
and used only with a doctor’s approval, prescription
anti-obesity medications enable some patients to lose
10% more weight than they otherwise would. Most
patients regain lost weight after discontinuing use of
either prescription medications or nonprescription
weight-loss products.
Prescription medications or over-the-counter weight-
loss products can cause:
constipation
dry mouth
headache
irritability
nausea
nervousness
sweating
None of them should be used by patients taking
monoamine oxidase inhibitors (MAO inhibitors).
Doctors sometimes prescribe fluoxetine (Pro-
zac), an antidepressant that can increase weight loss
by about 10%. Weight loss may be temporary and
side effects of this medication include diarrhea,
fatigue, insomnia, nausea, and thirst. Weight-loss
drugs currently being developed or tested include
ones that can prevent fat absorption or digestion;
reduce the desire for food and prompt the body to
burn calories more quickly; and regulate the activity
of substances that control eating habits and stimulate
overeating.Alternative treatment
Diuretic herbs, which increase urine production,
can cause short-term weight loss but cannot help
patients achieve lasting weight control. The body
responds to heightened urine output by increasing thirst
to replace lost fluids, and patients who usediureticsfor
an extended period of time eventually start retaining
water again anyway. In moderate doses, psyllium, a
mucilaginous herb available in bulk-forming laxatives
like Metamucil, absorbs fluid and makes patients feel
as if they have eaten enough. Red peppers and mustard
help patients lose weight more quickly by accelerating
the metabolic rate. They also make people more thirsty,Obesity