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Diet treatment
An expert panel was convened in 1998 and concluded that a reduction of 10% in body weight as an initial goal through reduced calorie dieting and exercises. There are broadly divided into `low-calorie diets’, `low-carbohydrate diets’, `very-low calorie diets’ and `very low fat diets’.

Low-Calorie Diets
The majority of diet plans (eg weight watchers, DASH, lighterlife) falls within this group. In general the diets are high in carbohydrates and low in fats containing between 500 to 1400 cal/day. The different diets varies in the way the food is consumed. Most diets (eg weight watchers, lightlife) work in conjunction with behavioural therapy.

Low-Carbohydrate Diets
Included in this category is the Atkins diet and protein power diet. These diets are high in fat and protein. The principle of this diet is based on carbohydrates being absorbed rapidly resulting rise in glycaemia and insulin levels. This in turn lowers the blood sugar levels that lead to food cravings. Atkins argued that this diet depletes the body’s glycogen store and is forced to utilise energy from fat and muscle.

Very-Low Calorie Diets
As the name suggest the caloric value of this diet is extremely low, less than 800cal/day. The diet is specially formulated, nutritionally balanced consisting of protein high in essential amino acids, fatty acids, vitamin and mineral supplements. This diet requires close medical supervision and should not be taken longer than 16 weeks. While this diet can achieve rapid weight loss it is nonetheless tempered by sudden deaths that can occur with this diet.

Very-Low-Fat diets
These diets contain about 10-15% of fat (Rosemary Conley’s realistic Hip and Thigh Diet, Pritikin Diet, F-plan). They are high on carbohydrate and fibre content. These diets are vegetarian-style with limited meat products. Flatulence and constipation are common with this diet. The American Heeart Association has cautioned against these types of diets because of increase triglyceride levels.

Weight reduction is achieved regardless of which diet you choose to follow. With the exception of very-low calorie diet, the amount of weight loss ranges from only 9 to 30lbs (4 to 13kg) after 6 months of dieting. Unfortunately half of this weight is regained by 1year following dieting. The largest report reviewing diet treatments with long-term results reported one third to two thirds of dieters regain more weight than they lost on their diets and cast doubt on any health improvements*. They concluded that for the majority of dieters dieting can lead to weight cycling that may be more harmful to health.

Drug treatment

Until recently there have been three drugs approved for treatment of obesity. These are Orlistat (Xenical), Sibutramine (Meridia; Reductil) and the recently withdrawn Rimonabant (Accomplia). Other drugs that have been used for treating obesity include phentermine, exenatide and metformin.

Orlistat works by stopping you from absorbing about a third of the fat from your food. The effectiveness of this drug is dose dependent and the maximal weight loss was achieved at 6 to 9 months. Side-effects may include oily bowel motion and stomach upset.

Sibutramine works by interfering with the appetite resulting in reduction of food intake by a quarter. In animals this drug also increases the metabolic rate (amount of energy burnt) but this is uncertain in humans.

Combining orlistat and sibutramine do not increase the amount of weight loss.

Rimonabant is another drug that acts by reducing the appetite. This drug has recently been withdrawn because of concerns over increase suicide risk in people who have been taking this drug.

Phentermine was first introduced in1959 as an appetite suppressing drug. Phentermine is may be addictive and can only be prescribed for 3 months.

Exenatide and metformin are drugs for treating type 2 diabetes. Exenatide reduces stomach emptying and reduces food intake by a fifth.

Drug treatment for obesity can produce weight loss but the effect is only modest and weight regain occurs in the majority when the drug is stopped. The effectiveness of drug treatment is increased when combined with lifestyle modification. As yet there are no long term data on the efficacy and safety on these drugs and they are only prescribed for a maximum of 2 years.

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