It won’t work without perseverance

Multiple weight reductions followed by subsequent weight increases will cause the body weight to rise higher and higher. This is also known as »yo-yo dieting« or »weight cycling«. The guidelines you recommend will be realistic and considered successful if the patient can reduce the initial weight by more than five percent within six to twelve months. This may seem low but promises more success in the long run. In your consultation, the question as to when the customer had noticed the weight gain may help to find out the causes, such as increased food intake or alcohol consumption due to stress, certain medication intake or life situations resulting in physical inactivity. This will provide a first approach to change.

To lose weight slowly, a daily energy deficit of about 500 kilocalories is recommended. Overweight persons can reach this goal by reducing their food portions and choosing lower-energy food. The simplest way to be successful is to minimise fat intake. »Lowcarb«, according to the guidelines, also promises success. Thus everyone can suit their personal taste preferences. Food with 1500 to 2000 kcal per day will taste good and satisfy if it contains a lot of fruit, vegetables and wholemeal products. Once the patient has reached his/her target weight, this diet – slightly extended – can in principle be continued. Formula diets such as Optifast®, Modifast® or Almased® can encourage those willing to lose weight to use them as a first step in the direction of weight reduction. The formula diets replace as a rule one to two main meals. Step by step the formula meals are later replaced again by normal food. The latter should, however, contain less calories as compared to the former eating habits.

Overweight people can profit from scientifically evaluated programmes such as »Losing weight with culinary pleasures« or »I am slimming down« or »WeightWatchers«. They offer concrete recommendations and recipes. The change in diet must always be accompanied by more physical activity when trying to lose weight. Physical activity increases the energy consumption and additionally has a positive effect on well-being, the psyche and the metabolism. For the weight reduction to be effective there should be at least 150 minutes of physical activity per week. Excellent results are shown by endurance sports. Who has more muscles uses more calories and this way loses weight more easily. Behavioural therapies can support the intention to lose weight.

Medication hardly plays a role in the treatment of overweight, and if any then only a small complementary role if the combined nutritional, movement and behavioural therapies do not suffice.

Orlistatist is the only medicine recommended by the authors of the guidelines. With most of the other medicines and products, the experts arrive at an unfavourable risk-benefit balance or criticise the lack of evidence of any effectiveness. At the pharmacy the question frequently arises concerning dietary supplements and medicinal products which the customers know from advertising. Part of these are the so-called fat absorbers such as Chitosan and Litramin. They can bind fat molecules and cholesterol so that these cannot be absorbed. By having a certain swelling ability, they are said to enhance the feeling of fullness as well.

Chitosan is a swellable derivative of the chitin from the shell of marine creatures. Litramin comes from the leaves of the prickly pear (opuntia). There are, however, no studies in existence that would substantiate the weight reduction after having taken these preparations. Preparations containing bladder wrack are also being advertised for weight loss. Due to their high iodine content, seaweeds can stimulate the thyroid gland, thus helping to reduce weight. A corresponding preparation has now been registered as a traditional medicinal product by the Federal Institute for Drugs and Medicinal Products (BfArM). Additionally, swelling agents such as Guar, alginic acid, glucomannan and Carmellose are said to help weight loss. They fill the stomach for a long time thereby dampening the feeling of hunger.

A positive long-term effect can, however, only be expected if the diet too is permanently changed. To maintain the achieved weight is, however, much harder than losing weight. Already within the first year, the majority of those who had successfully reduced their weight, gain back between 30 and 50 percent of the weight lost. After five years more than half has reached their initial weight again or has even exceeded it. Therefore, weight reduction programmes can only make sense if they continue to support those affected once they have reached their target weight. The long-term replacement of a meal with a formula meal can also be helpful.