Obesity is a costly wide-spread epidemic that causes chronic disease and even death. However, for most individuals, obesity is treatable and the remedies are inexpensive. The purpose of this paper is to examine natural, conventional, and integrative treatment methods for obesity and determine which one, or combination, offers the more successful outcome for obese patients. Based on clinical data evaluated, the best type of therapy with which to treat obesity is integrative because medication and surgery associated with conventional medicine are rarely necessary.
Conventional medicine (CM) and Complementary and alternative health (CAH) definitions for obesity are the same, however, reasons for obesity and treatment options may differ. CM practitioners may prescribe medication, surgery, diet and exercise, while CAH practitioners my prescribe herbs and other supplements after determining the cause of a patient's obesity (Lovejoy 2013). “Causes of obesity are complex and multi-factorial, including factors such as lack of awareness, emotional triggers, hormone imbalance, stress, neurotransmitter imbalance, and toxicity” (Koithan & Sutherland 2009). A person is considered overweight when they have a Body Mass Index (BMI) of 25 and above, and considered obese when they have a BMI of 30 and above (WHO 2015a). In 2014, 600 million adults over the age of 18 were obese (WHO 2015a). Nearly 3 million people die each year due illness caused by overweight or obesity (WHO 2015b).
Obese individuals are at risk of many illnesses and chronic diseases, which is why it is essential that these individuals be educated on a healthier lifestyle and find the best treatment option to help them lose weight. Over weight and obesity can cause high blood pressure, high cholesterol, triglycerides, and insulin resistance. As body weight increases, the individual becomes at increased risk of coronary heart disease, ischemic stroke and type 2 diabetes. High body mass also increases the risk of cancer of the breast, colon, prostate, endometrium, kidney and gall bladder, as well as increases mortality rates (WHO 2015b).
Standard care for the treatment of obesity under the conventional medical care model is: dietary and behavior modification, exercise, medication and surgery. Low calorie diets are prescribed in order to reduce caloric intake. Consuming too many calories and unhealthy foods causes weight gain and chronic disease associated with obesity. A health professional can design a diet to meet the individual's specific needs and aid in weight loss (UCSF Medical Center 2015). The physician may also recommend an exercise plan and help the patient set goals for weight loss.
Behavior modification is also necessary as many obese or overweight individuals require physical activity and diet adjustments in order to lose weight. Setting realistic goals, maintaining a diary, avoiding high risk situations, a support network, and embracing more realistic weight and body image beliefs can aid in weight loss. However, these modifications do not result in long-term weight loss for many (UCSF Medical Center 2015). Diet, behavior modification, and setting goals are can aid in weight loss, however, regular physical activity can increase weight loss and improve overall health.
Exercise, along with proper diet and behavior modification, increases the chances of the individual being successful with long-term weight loss. Exercise not only helps to speed up metabolism, which is reduced when fewer calories are consumed, but can aid in weight loss and prevent or reduce risk factors associated with obesity-and inactivity-related chronic disease (UCSF Medical Center 2015). Lack of physical activity can also result in sedentary death syndrome, which is related to over 20 diseases and conditions. Obesity, heart and cardiovascular disease, high cholesterol, and poor physical endurance are only a few conditions related to sedentary death syndrome. In the next decade, sedentary death syndrome will cause an estimated 250,000 deaths (Anspaugh, Hamrick & Rosato 2011). “Physical inactivity is a modifiable risk factor for cardiovascular disease and a widening variety of other chronic diseases, including diabetes mellitus, cancer (colon and breast), obesity, hypertension, bone and joint diseases (osteoporosis and osteoarthritis), and depression,” (Warburton, Nicol & Bredin 2006). Physical activity and a nutritious diet can increase the patient’s chances of long term weight loss and prevent or reduce the risk factors of chronic disease.
When individuals have little success with the previously mentioned therapies they may resort to over-the-counter and prescription medications or surgery. Weight loss medications, such as Fastin, Xenical, Phentermine, and Meridia are stimulants and appetite suppressants that usually only offer temporary results and account for only 10% of weight loss, not to mention many have serious side-effects. Weight loss surgery is also dangerous and should only be used as a last resort. An individual is required to be at least 100 pounds overweight with a BMI of over 40 to even be considered a viable candidate for surgery. The candidate must then complete and pass a medical and psychological evaluation and prove commitment to weight loss before the surgery will be approved (UCSF Medical Center 2015). While surgery and medication may benefit obese patients, they should not be the first treatment option. There are many other treatment options that should be considered first.
Standard care for the treatment of obesity under naturopathy is “identifying and removing barriers to self-healing, such as poor diet or low self-esteem” (Koithan & Sutherland 2009). Naturopathy seeks to find the cause of obesity, such as hormonal imbalance, emotional triggers, and stress, but does not focus on weight loss. In naturopathic medicine, procedures and healing compounds pose few or no side effects. An example is serotonin, dopamine, and norepinephrine, which are used to regulate appetite and satiety (Koithan & Sutherland 2009). The standard care for the treatment of obesity under naturopathy can be combined with conventional care to provide healing for the whole body and increase weight loss.
Standard care for the treatment of obesity under the integrative model of care is nutrition, physical activity, and stress management, as well as dietary supplements and herbs, traditional Chinese medicine, fiber, pro- and prebiotics, prescription medication, and hypnosis and mindfulness approaches to weight loss. The integrative model considers the patient's health, environment, spirituality, and biology in order to arrive at a therapy that will work for that individual (Lovejoy 2013). Although most effective out of all the models, this model does not necessarily guarantee weight loss success because weight loss, inevitably, depends on the patient.
Each system of care begins treating obesity through dietary and lifestyle changes. However, conventional treatments also include medication and surgery, naturopathy treatments focus on dietary and lifestyle changes allowing the body to heal itself, and integrative treatments combine conventional and natural treatments, as well as herbs and supplements, and hypnosis. Each medical system begins obesity treatment through standard lifestyle changes, such as increased physical activity and decreased food or calorie intake. However, many times these changes do not result in weight loss, and other treatments should be examined.
Studies suggest that incorporating spices such as curcumin, cinnamon, turmeric, red peppers, ginger, and black pepper can prevent or reduce chronic illness associated with obesity and help the patient lose weight when obesity is caused by inflammation (Aggarwal 2010). Stress and infection can cause inflammation, which causes obesity. Obesity is a symptom of energy imbalance and a condition of chronic inflammation which encourages insulin resistance, resulting in Type 2 diabetes. Macrophages invade fat cells (adipose tissue) when weight gain begins and cause and contribute to sustained fat inflammation. There is a correlation between the proportion of macrophages and fat tissue present with the least being present in lean conditions and increasing with the amount of fat tissue (Johnson, Milner & Makowski 2012). Diet can also contribute to inflammation, however, spices, such as curcumin, and other foods have an anti-inflammatory effect, which can aid in weight loss and improve overall health (Aggarwal 2010). Therefore, dietary changes may be necessary when considering obesity treatment options.
Dietary, lifestyle, and changes in physical activity are proven treatments for weight loss, but what about medication, surgery, naturopathy, and acupuncture, and other alternative therapies? Have these treatments been scientifically tested, and if so, which are most effective in treating obesity?
“...over the past twenty years practitioners of conventional medicine have made a marked shift from a reliance on experience (directly observed or as recorded by others in medical journals) to a reliance on more rigorous research to evaluate the effectiveness of treatments,” (Institute of Medicine 2005).
For example, a clinical research study on the effectiveness of anti-obesity supplements in Japan resulted in only 11 out of 49 having any clinical or animal evidence supporting their claims. The eleven supplements reviewed for safety and effectiveness were: Ashitaba (a green and yellow vegetable rich in vitamins and nutrients), Bofu-Tsusho-san (a traditional Japanese herbal medicine), Capsinoid (from chili peppers), DHA/EPA(essential fatty acids), Forskohlii (a South Asian herb), Garcinia cambogia (hydroxycitric acid), Lactoferrin (an iron-binding glycoprotein), L-carnitine (a vitamin-like amino acid derivative), Lychee Polyphrnol (derived from the lychee fruit), Tea Catechin (Polyphenol bioactivities from green tea), and Yeast hydrolysate (used to make sake and bread). Each of these supplements were effective in decreasing body weight, waist circumference, adipose tissue, or BMI. Although these supplements have been tested and proven effective many have not, and millions of individuals all over the world continue to use supplements that have not been tested, and may not be effective at all in treating obesity (Yasueda, Ito & Maeda, 2013). Fortunately, many diet changes and spices have been tested and proven to be effective in treating obesity.
Spices, such as curcumin, red chili, cinnamon, cloves, black pepper, and ginger have been studied on animals and, to a lesser extent, humans to determine their efficacy on inflammation induced obesity. In animals and humans, these spices have been shown to treat obesity and insulin resistance. Curcumin alone was beneficial in treating obesity, insulin resistance, and obesity- and diabetes-related complications in the kidneys, heart, pancreas, liver, and adipocytes. Thus far, these spices have proven to be safe, effective, and inexpensive treatment options for obesity, inflammation and metabolic diseases. However, more studies are required to determine correct dosages (Aggarwal 2010).
Studies conducted on obesity treatments, such as lifestyle and dietary changes, medications, dietary supplements and herbs, traditional Chinese medicine, and hypnotherapy and mindful based approaches produced different results: some treatments were beneficial in treating obesity, while others had little to no effect. Lifestyle and dietary changes proved effective in aiding in weight loss and preventing weight regain (Lovejoy 2013). Physical activity and diet together yield better results than either alone, but in some circumstances dietary and herbal supplements may be used to further aid weight loss.
There are many dietary supplements and herbs on the market claiming to help a person lose weight. Unfortunately, most of them are not clinically proven to be safe and effective. Results of the few over-the-counter herbs and dietary supplements are mixed. Out of the ten supplements with published evidence (Chromium picolinate, Conjugated linoleic acid, Hydroxycitric acid, Fiber supplements, DHEA, Ephedra/caffeine mixtures, 5-hydroxytryptophan, Hoodia gordonii, Green tea catechins, and Probiotics/prebiotics) only four (Fiber supplements, Ephedra/caffeine mixtures, 5-hydroxytryptophan, and Green tea catechins) showed evidence for effect on weight, and of those only one (Ephedra/caffeine mixtures), posed safety concerns (Lovejoy 2013). While there are many dietary herbs and supplements on the market, consumers must be cautious to ensure the product is safe and effective. Pharmaceuticals should be used with caution, as well.
Most of the pharmaceuticals for weight loss have been taken off the market due to safety concerns. There are three on the market at this point that have been approved for long term treatment of obesity: orlistat, lorcaserin, and phentermine/topiramate. These drugs have proven effective for weight loss, however, lorcaserin and phentermine/topiramate are for use by individuals whose BMI is over 27, and phentermine is only approved for short-term use (Lovejoy 2013). Using pharmaceuticals for weight loss is only a short-term remedy, and should mainly be used when other methods such as diet, exercise, and mindful based approaches have proven ineffective.
Hypnotherapy and mindful based approaches may not be effective in treating obesity, however, they may improve the mental health of obese individuals, which can eventually aid in weight loss. Mindfulness can help reduce stress and help the patient be mindful of when, why, and how much they eat, which leads to weight loss. Evidence has also proven that traditional Chinese herbal medicine, acupuncture, and qigong are effective in reducing weight or lowering the risk of obesity, although more studies are required for this to be proven (Lovejoy 2013). However, obese patients have a lower prevalence of using CAM modalities than individuals who are not obese (Bertisch, Wee & McCarthy 2008). A patient whose conventional physician recommends CAM therapies for weight loss may be more likely to utilize other methods because of the level of trust between patient and physician.
There are conventional, CAM, and integrative treatments for obesity. The main course of treatment for each is dietary and lifestyle changes. Conventional medicine also incorporates pharmaceuticals and surgery, both of which are mainly for individuals with a BMI over 27. Surgery is only recommended in worst case circumstances (Lovejoy 2013). Therefore, other therapies should be used before considering surgery.
CAM and naturopathy treatments focus mainly on behavioral changes, determining the cause of obesity that is specific to the individual patient, dietary supplements, and herbal compounds (Koithan & Sutherland 2009). CAM modalities also used to treat obesity include: relaxation techniques, natural herbs, massage, chiropractic medicine, tai chi, and acupuncture (Bertisch, Wee & McCarthy 2008). These modalities are not used in conventional medicine to treat obesity, although, they may be used in an integrative environment.
Integrative medicine combines both conventional and CAM therapies. The physicians can work together to establish the most effective treatments for overweight and obese patients. The physicians will examine the cause of the patient's obesity and formulate a lifestyle, behavioral, and dietary plan that will best help the patient succeed. However, there can be issues when combining conventional and CAM medicines. Herbal medications used with pharmacological medications can cause adverse effects. Herbal medications used alone can cause allergic reactions, especially if they have not been scientifically tested, and acupuncture can cause injury or diseases, such as hepatitis or infection (Niggemann & Grüber 2003). Even considering the complications that can arise when using integrative therapies, integrated treatments are the best option for treating obesity.
An integrated approach of successful treatments for obesity will yield better results for health and weight loss. Changes in diet and an increase in physical activity are the most successful treatments in combating obesity, as well as educating patients on the dangers of inactivity and eating foods high in fat and sugar (Koithan & Sutherland 2009). Certain spices have also been successful in reducing the risk or effects of obesity related diseases and aided in weight loss for overweight and obese patients (Aggarwal 2010). A knowledgeable practitioner would, first, recommend patient education, dietary and lifestyle changes, and incorporating more spices such as curcumin, cinnamon, turmeric, red peppers, ginger, and black pepper into the diet in order for patients to have more success with improved health, weight loss, and reduced risk of regaining weight (Aggarwal 2010).
Taking an integrated approach to weight loss and obesity will yield better results than CAM or conventional methods alone. Many of the treatments for obesity and weight control are either ineffective, potentially harmful, or both. This is why it is important to examine treatments for all modalities; to eliminate the treatments that will have a negative effect, or no effect at all. CAM treatments focus on the mind, body, and spirit. These methods improve overall health and aid in weight loss, especially when used with diet, exercise, and herbs, supplements, pharmaceuticals, and surgery. The most effective treatment plan for obesity is to heal the mind and spirit, and then the body.
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