Every family has someone who is overweight and all of us know someone who is obese. So in this article I am going to briefly touch upon what is overweight, what is obesity and what can be done to reduce weight. The BMI is a frequently used value to quantify obsity. The BMI is calculated by dividing the weight in kilograms by the height in metres, squared. Although not the most accurate or the best way, it has been used for many decades as measuring tool to determine ideal body weight and its relatrion to their height and build. So for a person who is 6 feet in height and and 85 kg in weight, the BMI would be calculated as follows:
BMI= Weight in Kg/(Height in Meters)2
= 85/ (1.85 X 1.85) = 24.8 kg/m2
Below is the BMI range for classifying people as normal, overweight and obese.
Normal – 20-25
Overweight – 25-30
Medical Obesity – 30-40
Surgical Obesity – >40
The above values that are mentioned are a little different for females and for people of Southeast Asian ancestry viz people from India, Sri Lanka, Pakistan and Bangladesh.
Before we go into talking about medications to help you lose weight, let’s talk about what I think is primary and mandatory for significant and consistent weight loss. Weight loss requires predominantly three things.
1. a diet of reduced calories
2. Regular daily “large volume” exercise. (1-3 hrs a day)
3. Regular daily measurements of body in the mornings after evacuating your bladder.
4. To document everything – daily weight, all foods eaten and duration and type of exercise done through the day because whatever is measured, improves!
The primary goal in any weight loss program is to develop a daily calorie deficit i.e. to consume fewer calories and to spend more calories by exercise. Put simply, if you can eat 300Kcal of less food every day and ensure a 400Kcal burn by exercising, you ensure a daily calorie deficit of 700Kcals/day = 3500Kcals a week (in the very least, over 5 days) and this will ensure a half Kg weight loss week and therefore a 2 Kg weight loss every month. In 10 months it should be possible to lose 20 Kg of weight.
Dietary interventions that I have seen work with people are:
1. Daily calorie, restricted diet – a low or ultra low calorie diet.
2. Meal replacement with low calorie, prepared meals. Avoidance of high calorie and calorie dense foods (fast foods, bakery foods, fried foods etc)
3. To replace Carbohydrates with proteins.
4. To take a completely different diet from what you have taken before such as a Paleo diet or Atkins diet.
5. Time restricted feeding and Intermittent fasting.
Do you have a daily exercise program for seven days a week!
To develop a daily habit of exercising, irrespective of the amount of time that you have free to do the exercise. And the person who wishes to lose weight must realise that every minute counts and that it is impossible to be unable to do atleast some exercise every single day e.g., if you cant do an entire session of exercise during your usual time, decide to do atleast some exercise, even if it is only for 5 min so as to build a definite routine and habit that will help your cause. These little habits of daily exercise can eventually be built upon to help you do more and more exercise over time.
Measurements measurements measurements! Why do you need to test yourself?
It is important to maintain a separate logbook where you can enter every thing that you have eaten in the day and also the exercise that you have done even if it’s only for five minutes, and at whatever time you done it , if you keep track of this every day every week, it will give you a clear picture of how well you doing and and will help you find ways of improving whatever you do.
Many doctors would prescribe weight loss medication only after the patient has been established on a reasonable low calorie diet and on a program of regular exercise. Without these two very important habits, the best of the medicines are doomed to fail.
So who should take weight loss drugs?
Generally people with a BMI of more than 30 or have a BMI greater than 27 AND a serious medical problem like diabetes or high blood pressure will be offered medication to help them lose weight. The target for treatment would be 12 to 15% weight reduction. Even 5 to 10% of body weight loss would make a tremendous difference and help improve the blood pressure or sugar control.
Six medicines are currently FDA approved for long-term use and weight loss.
1. Orlistat
2. Liraglutide
3. Semaglutide
4. Bupropion-Naltrexone
5. Setmelanotide
6. Phentermine-topiramate
These medicines are not for everyone as they do have some side-effects. The doctor should be able to take you through the pros, cons and cautions of the medicines and recommend the best medicine for you. Some of these medicines are only for adults, while some others can be used for children six years,12 years and older. Long-term treatment refers to treatment for more than three months and these medicines are usually given till at least 5% of your weight loss is noted over 3 to 6 months and if there is no weight loss, these medicines could be changed or even stopped. Surgery might also be an option and could be recommeded.
My advice for those wanting to go on a weight loss programme
1. Get a weight loss coach/mentor and do everything he/she tells you.
2. Dont ever negotiate the price that you will have to pay to reduce weight.
3. Be 100% honest. Say what you have done and do what you have said (that you would do)
4. Document what you have eaten and the exercise that you have done every day.
5. Show where and how you will fit in your new activities (diet/exercise etc) into your day. How will you reprioritize your daily schedule to accomodate the new activities?
Dr Subash Rau - General Physician’s blog 
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