The prevalence of obesity has increased steadily in Western cultures over the past century, particularly during the last several decades. In fact, most health professionals agree that we are in the midst of an obesity epidemic in the United States.

Being overweight is closely linked to many very serious health conditions, most particularly risk factors for heart disease and stroke including high blood pressure, high cholesterol, high triglycerides, low levels of HDL (high-density lipoprotein—the "good" cholesterol), and type 2 diabetes. Fortunately, even modest reductions in weight can help improve these conditions. Plus, practicing the behavioral changes of a healthier diet and regular exercise can actually reduce these risk factors whether weight loss occurs or not.

Energy Balance: The Simple Principle of Weight Loss

Scientists often explain weight loss quite simply in terms of the energy balance equation: energy in versus energy out. To lose weight, you must consume fewer calories than you burn or, in reverse, you must burn more calories than you consume.

This is, of course, easier said than done. But no matter what weight loss methods you may employ—diet, exercise, medicine, supplements, surgery, therapy, group support—the principle of energy balance is unavoidable. In fact, experts from both traditional and nontraditional disciplines agree that to achieve and maintain weight loss you must make changes in your diet and activity level to favorably affect the balance of the energy equation.

Getting Started

Getting started is often the most difficult part of losing weight. Any changes you make in your eating and exercising behaviors must become habitual, which takes time. In addition, carrying extra weight, no matter how much, can affect how you feel about yourself psychologically, sometimes making it more difficult to take the necessary steps to begin to change.

The following five strategies are crucial to successful weight loss and can help to overcome some of these barriers:

• Set realistic goals and monitor your progress toward achieving these goals.
• Modify your eating and exercise behaviors, as well as habits influencing both.
• Examine and restructure unrealistic, negative thoughts, or expectations.
• Reduce stress.
• Develop a network of social support.

These strategies bridge the gap between traditional and alternative medicine and have been used successfully by people engaged in many different approaches to weight loss.

Medications and Supplements

There is a great deal of interest in whether prescription medicines or supplements can facilitate weight loss. Some prescription medicines suppress appetite by interfering with brain chemicals that affect mood and appetite. Others reduce fat absorption from the gut. Here are examples of medicines that may be prescribed for weight loss:

Some studies have shown that some medicines, such as orlistat, facilitate weight loss and maintenance of that loss for up to two years when they are used as adjuncts to diet and exercise. These types of medicines are usually prescribed only for people who are severely obese when other methods of weight loss have not worked. Accordingly, these medicines are not without side effects or potential adverse events and should only be used with careful monitoring by a doctor and a registered dietitian. The same goes for dietary supplements, which should be treated as medicines and taken only under the supervision of a doctor. It is also important to point out that medicines and supplements should not be used indefinitely since the long-term risks are not known.

Supplements do not undergo the same rigorous approval process as drugs. That being said, certain supplements may provide weight loss benefits, since they may contain similar mechanisms of action as drugs. Along the same line, some of the same risks and side effects may be present, as well, which is why you should talk to your doctor before taking any over-the-counter weight loss products.

The question is: At what point should you consider taking medicines or supplements? Some health experts say that after three or more months of behavioral changes that fail to produce a 5%-10% reduction in total body weight. However, most advocate a more conservative approach that focuses on behavioral change for at least 6-12 months before introducing a drug or supplement—unless there are other factors, such as high blood sugars or high blood pressure, that are not responding to diet and exercise alone.

An additional note of caution for both diet medicines and supplements: There are certain substances that are potentially dangerous and carry risks that clearly outweigh the possible benefits. For example, the prescription drugs dexfenfluramine (Redux) and fenfluramine (Pondimin) were taken off the market because of their connection to valvular heart abnormalities and a lung disorder known as pulmonary hypertension. The Food and Drug Administration (FDA) also banned the sale of dietary supplements containing the herbal substance ephedra (also known as ma huang) due to concerns over their cardiovascular effects, including increased blood pressure and irregular heart rhythm. Whenever you are considering taking a diet supplement, know exactly what is in the product and share this information with your doctor.

Realistic Goals

It is clear that while the energy balance principle behind weight loss may be simple, actually losing weight is not. Lifestyle changes in diet and exercise are imperative to successful weight loss, but trying a prescription medicine or dietary supplement might also be an option to consider, depending on your weight and your health status.

Both medicines and supplements can be useful adjuncts to diet and exercise when used under the supervision of a doctor or qualified practitioner. Consider the following suggestions:

• Medicines and supplements:
  • Are not substitutes for behavioral changes, which are crucial to maintaining weight loss over the long term—Indeed, research suggests that people are more likely to successfully lose weight with a combination of strategies (eg, diet, exercise, counseling, and medicine).
  • Should be used only by people who are significantly overweight and when more standard methods have been unsuccessful
  • Should be used for a limited period of time to be decided in conjunction with your healthcare professional.
• Try to have realistic ideas about what the medicines or supplements will help you accomplish.
• With guidance from a therapist, explore the deeper individual and cultural issues you may have about food, eating, and body image. In doing so, use this information not for self-judgement but for greater self-understanding, acceptance, and compassion.
• Remember that even modest changes can make a big difference.