http://www.medicinenet.com/obesity_weight_loss/page8.htm#what_is_the_role_of_physical _activity_and_exercise_in_obesity Physical activity and exercise help burn calories.

The amount of calories burned depends on the type, duration, and intensity of the activity. It also depends on the weight of the person. A 200-pound person will burn more calories running 1 mile than a 120-pound person, because the work of carrying those extra 80 pounds must be factored in. But exercise as a treatment for obesity is most effective when combined with a diet and weight-loss program. Exercise alone without dietary changes will have a limited effect on weight because one has to exercise a lot to simply lose 1 pound. However regular exercise is an important part of a healthy lifestyle to maintain a healthy weight for the long term. Another advantage of regular exercise as part of a weight-loss program is a greater loss of body fat versus lean muscle compared to those who diet alone. Other benefits of exercise include

improved blood sugar control and increased insulin sensitivity (decreased insulin resistance), reduced triglyceride levels and increased "good" HDL cholesterol levels, lowered blood pressure, a reduction in abdominal fat, reduced risk of heart disease.

The first goal of dieting is to stop further weight gain. The next goal is to establish realistic weight-loss goals. While the ideal weight corresponds to a BMI of 20-25, this is difficult to achieve for many people. Thus, success is higher when a goal is set to lose 10%-15% of baseline weight as opposed to 20%-30% or greater. It is also important to remember that any weight reduction in an obese person would result in health benefits. One effective way to lose weight is to eat fewer calories. One pound is equal to 3,500 calories. In other words, you have to burn 3,500 more calories than you consume to lose 1 pound. Most adults need between 1,200-2,800 calories per day, depending on body size and activity level to meet the body's energy needs. If you skip that bowl of ice cream, then you will be one-seventh of the way to losing that pound! Losing 1 pound per week is a safe and reasonable way to take off extra pounds. The higher the initial weight of a person, the more quickly he/she will achieve weight loss. This is because for every 1 kilogram (2.2 pounds) of body weight, approximately 22 calories are required to maintain that weight. So for a woman weighing 100 kilograms (220 pounds), he or she would require about 2,200 calories a day to maintain his or her weight, while a person weighing 60 kilograms (132 pounds) would require only about 1,320 calories. If both ate a calorie-restricted diet of 1,200 calories per day, the heavier person would lose weight faster. Age also is a factor in calorie expenditure. Metabolic rate tends to slow as we age, so the older a person is, the harder it is to lose weight.

There is controversy in regard to carbohydrates and weight loss. When carbohydrates are restricted, people often experience rapid initial weight loss within the first two weeks. This weight loss is due mainly to fluid loss. When carbohydrates are added back to the diet, weight gain often occurs, simply due to a regain of the fluid. General diet guidelines for achieving and (just as importantly) maintaining a healthy weight.

A safe and effective long-term weight reduction and maintenance diet has to contain balanced, nutritious foods to avoid vitamin deficiencies and other diseases of malnutrition. Eat more nutritious foods that have "low energy density." Low energy dense foods contain relatively few calories per unit weight (fewer calories in a large amount of food). Examples of low energy dense foods include vegetables, fruits, lean meat, fish, grains, and beans. For example, you can eat a large volume of celery or carrots without taking in many calories. Eat less "energy dense foods." Energy dense foods are high in fats and simple sugars. They generally have a high calorie value in a small amount of food. The United States government currently recommends that a healthy diet should have less than 30% fat. Fat contains twice as many calories per unit weight than protein or carbohydrates. Examples of high-energy dense foods include red meat, egg yolks, fried foods, high fat/sugar fast foods, sweets, pastries, butter, and high-fat salad dressings. Also cut down on foods that provide calories but very little nutrition, such as alcohol, non-diet soft drinks, and many packaged high-calorie snack foods. About 55% of calories in the diet should be from complex carbohydrates. Eat more complex carbohydrates such as brown rice, whole-grain bread, fruits, and vegetables. Avoid simple carbohydrates such as table sugars, sweets, doughnuts, cakes, and muffins. Cut down on non-diet soft drinks, these sugary soft drinks are loaded with simple carbohydrates and calories. Simple carbohydrates cause excessive insulin release by the pancreas, and insulin promotes growth of fat tissue. Educate yourself in reading food labels and estimating calories and serving sizes. Consult your doctor before starting any dietary changes. You doctor should prescribe the amount of daily calories in your diet.

http://www.medicinenet.com/obesity_weight_loss/page10.htm#what_is_the_role_of_medication_i n_the_treatment_of_obesity

What is the role of medication in the treatment of obesity?

Medication treatment of obesity should be used only in patients who have health risks related to obesity. Medications should be used in patients with a BMI greater than 30 or in those with a BMI of greater than 27 who have other medical conditions (such as high blood pressure, diabetes, high blood cholesterol) that put them at risk for developing heart disease. Medications should not be used for cosmetic reasons. Medications should only be used as an adjunct to diet modifications and an exercise program. Like diet and exercise, the goal of medication treatment has to be realistic. With successful medication treatment, one can expect an initial weight loss of at least 5 pounds during the first month of treatment, and a total weight loss of 10%-15% of the initial body weight. It is also important to remember that these medications only work when they are taken. When they are discontinued, weight gain can occur. The first class (category) of medication used for weight control cause symptoms that mimic the sympathetic nervous system. They cause the body to feel "under stress" or " nervous." As a result, the major side effect of this class of medication is high blood pressure. This class of medication includes sibutramine (Meridia, which was taken off the market in the U.S. in October 2010 due to safety concerns) and phentermine (Adipex P). These medications also decrease appetite and create a sensation of fullness. Hunger and fullness (satiety) are regulated by brain chemicals called neurotransmitters. Examples of neurotransmitters include serotonin, norepinephrine, and dopamine. Anti-obesity medications that suppress appetite do so by increasing the level of these neurotransmitters at the junction (called synapse) between nerve endings in the brain. Phentermine Phentermine (Fastin, Adipex P) -- the other half of fen/phen -- suppresses appetite by causing a release of norepinephrine in the body. Phentermine alone is still available for treatment of obesity but only on a short-term basis (a few weeks). The common side effects of phentermine include headache, insomnia, irritability, and nervousness. Fenfluramine (the fen of fen/phen) and dexfenfluramine (Redux) suppress appetite mainly by increasing release of serotonin by the cells. Both fenfluramine and dexfenfluramine were withdrawn from the market in September 1997 because of association of these two medications with pulmonary hypertension (a rare but serious disease of the arteries in the lungs) and association of fen/phen with damage to the heart valves. Since the withdrawal of fenfluramine, some have suggested combining phentermine with fluoxetine (Prozac), a combination that has been referred to as phen/pro. However, no clinical trials have been conducted to confirm the safety and effectiveness of this combination. Therefore, this combination is not an accepted treatment for obesity. Sibutramine (Meridia)

In December 1997, the United States Food and Drug Administration (FDA) approved sibutramine (Meridia), a drug which increases the levels of serotonin and norepinephrine in the brain, to treat obesity (both in attaining and in maintaining weight loss). However, the drug was withdrawn from the market in October 2010 because clinical trial data indicated that it is associated with an increased risk of heart attack and stroke. Orlistat (Xenical, alli) The next class (category) of drugs changes the metabolism of fat. Orlistat (Xenical, alli) is the only drug of this category that is U.S. FDA approved. This is a class of anti-obesity drugs called lipase inhibitors, or fat blockers. Fat from food can only be absorbed into the body after being broken up (a process called digestion) by digestive enzymes called lipases in the intestines. By inhibiting the action of lipase enzymes, orlistat prevents the intestinal absorption of fat by 30%. Drugs in this class do not affect brain chemistry. Theoretically, orlistat also should have minimal or no systemic side effects (side effects in other parts of the body) because the major locale of action is inside the gut lumen and very little of the drug is absorbed. The U.S. Food and Drug Administration approved orlistat capsules, branded as alli, as an over-the-counter (OTC) treatment for overweight adults in February 2007. The drug had previously been approved in 1999 as a prescription weight loss aid, whose brand name is Xenical. The OTC preparation has a lower dosage than prescription Xenical. Orlistat is recommended only for people 18 years of age and over in combination with a diet and exercise regimen. People who have difficulties with the absorption of food or who are not overweight should not take orlistat. Overweight is defined by the U.S. National Institutes of Health as having a body mass index (BMI) of 27 or greater. Orlistat can be taken up to three times a day, with each fat-containing meal. The drug may be taken during the meal or up to one hour after the meal. If the meal is missed or is very low in fat content, the medications should not be taken. The most common side effects of orlistat are changes in bowel habits. These include gas, the urgent need to have a bowel movement, oily bowel movements, oily discharge or spotting with bowel movements, an increased frequency of bowel movements, and the inability to control bowel movements. Women may also notice irregularities in the menstrual cycle while taking orlistat. Side effects are most common in the first few weeks after beginning to take orlistat. In some people, the side effects persist for as long as they are taking the drug. People with diabetes, thyroid conditions, who have received an organ transplant, or who are taking prescription medications that affect blood clotting should check with their physician before using OTC orlistat (alli), since drug interactions with certain medications are possible. A long-term decrease in fat absorption can cause deficiency of fat-soluble vitamins (such as vitamins A, D, E, K). Therefore, patients on orlistat should receive adequate vitamin supplementation. Belviq

In June 2012, the FDA approved Belviq (lorcaserin hydrochloride) as a weight loss medication. The medication works by controlling appetite (via serotonin activation). According to the FDA data, nearly half the patients using the medication lost at least 5% of their starting weight, which is more than double that lost by patients in the control group. This was only true for patients without type 2 diabetes. The medication is approved for patients who are obese (BMI >30 ) or overweight (BMQ >27) with one weight-related health issue. The predominant side effects were headache and dizziness, as well as fatigue. In patients with diabetes, low blood sugar was also a concern when taking Belviq. Qsymia Qsymia is the newest medication approved for weight loss. It is a combination of phentermine and topiramate extended release. As with the other medications, it is only approved for patients who are obese (BMI >30) or overweight (BMQ >27) with one weightrelated health issue. According to the FDA data, a statistically significant greater proportion of the patients taking Qsymia achieved 5% and 10% weight loss. All patients in the study were also encouraged to eat a well-balanced, reduced-calorie diet. It is important to note that Qsymia can lead to birth defects, and it is important for women to know that they are not pregnant before starting the medication. Other possible serious side effects include increased heart rate, eye problems (glaucoma), and suicidal thoughts. In patients with diabetes, low blood sugar was also a concern when taking Qsymia.