How therapy for weight loss creates sustainable, long-term results.

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Millions of people worldwide struggle with being overweight and are looking for effective ways to achieve sustainable weight loss. Modern medicine today offers various therapeutic approaches, ranging from dietary changes and behavioral therapy to medication and surgical treatments.

The primary goal in treating obesity is long-term weight loss that not only achieves immediate results but also permanently reduces the risk of related health conditions. Successful therapies typically combine multiple treatment approaches and are individually tailored to the patient’s specific needs.

The choice of the right therapeutic method depends on several factors, including the degree of excess weight, existing co-morbidities, and personal circumstances. From conservative measures to surgical procedures, proven options are available today that can lead to lasting success when applied professionally.

Key Takeaways

• Successful weight reduction requires a holistic approach combining diet, exercise, and behavioral change.
• Medication can significantly enhance the effectiveness of lifestyle interventions.
• For cases of severe obesity, surgical procedures offer the most effective long-term solution.

Contents

1. Fundamentals of Weight Reduction

• Mechanisms of Weight Loss
• Indications for Therapy
• Risk Factors for Obesity

2. Therapeutic Approaches to Weight Reduction

• Dietary Changes and Types of Diets
• Exercise and Physical Activity
• Behavioral Therapy

3. Pharmacological Therapy Options

• Mechanisms of Action in Weight Loss Medications
• Currently Approved Medications
• Future and Innovative Approaches

4. Surgical Options for Obesity

• Bariatric Surgical Procedures
• Prerequisites and Risks
• Aftercare and Long-Term Management

Successful weight reduction is based on a controlled calorie deficit and requires an understanding of metabolic processes. Specific medical indications determine the need for therapy, while various risk factors contribute to the development of obesity.

The fundamental principle of weight reduction is based on an energy deficit. The body must expend more calories than it consumes through food.

The recommended energy reduction is approximately 500 kcal per day. This reduction leads to a weekly weight loss of about 0.5 kg.

The body reacts to weight reduction with several adaptive mechanisms:

• A decrease in the basal metabolic rate
• An increase in the sensation of hunger
• Changes in hormone production

These biological responses explain why the body counteracts weight reduction. Therefore, long-term success requires continuous effort.

Medical intervention for weight reduction is indicated for a BMI of 30 kg/m² or higher. This threshold defines obesity as a condition requiring treatment.

For a BMI of 27 kg/m² or higher, therapy is indicated if additional medical conditions are present, such as:

• Type 2 diabetes mellitus
• Arterial hypertension
• Lipid metabolism disorders (Dyslipidemia)
• Sleep apnea syndrome

For children and adolescents aged 12 and over, age-appropriate BMI percentiles are used. The decision to begin therapy considers the individual’s health risk.

Early intervention can prevent the development of secondary diseases. Treatment should be multidisciplinary.

Genetic factors significantly influence weight development. The familial clustering of obesity is scientifically documented.

Dietary habits are the most significant modifiable risk factor:

• High-calorie foods
• Large portion sizes
• Irregular meals
• Sugary drinks

A lack of physical activity markedly reduces energy expenditure. Sedentary jobs and insufficient physical activity promote weight gain.

Psychosocial factors such as stress, depression, or socioeconomic disadvantages increase the risk of obesity. Certain medications can also cause weight gain.

Metabolic diseases like hypothyroidism or Cushing’s syndrome can lead to pathological weight gain. A medical evaluation is necessary for any unexplained increase in weight.

The treatment of obesity is based on three fundamental pillars: a structured dietary change, regular physical activity, and psychological support. These approaches are typically combined to achieve sustainable weight reduction.

Professional nutritional counseling forms the foundation of any successful weight reduction plan. During this process, patients learn the principles of a calorie-reduced, balanced diet.

A calorie deficit is the key factor for weight loss. A reduction of 500-750 kcal per day leads to a weekly weight loss of approximately 0.5-0.75 kg (1.1-1.65 lbs).

Proven dietary approaches include:

• Mediterranean Diet: Rich in vegetables, whole grains, and healthy fats.
• Low-Carb Approaches: Reduced carbohydrate intake with an increased proportion of protein.
• Intermittent Fasting: Eating is restricted to specific time windows.

Portion control plays a central role. Patients learn to recognize their body’s signals of hunger and fullness and to choose appropriate portion sizes.

Regular physical activity supports weight reduction and improves cardiovascular health. The WHO recommends at least 150 minutes of moderate or 75 minutes of intensive activity per week.

Endurance training, such as walking, swimming, or cycling, burns calories and strengthens the cardiovascular system. Patients should begin with 10-15 minutes of activity daily.

Strength training helps preserve muscle mass during weight loss. Two to three sessions per week that target all major muscle groups are optimal.

Everyday activities like taking the stairs or gardening also increase daily energy expenditure. Pedometers or fitness trackers can motivate individuals to be more active in their daily lives.

Behavioral therapy helps patients identify and modify unhealthy eating habits. Psychological factors have a significant influence on eating behavior.

Self-monitoring through food diaries raises awareness of one’s eating habits. Patients document their food intake, emotions, and potential triggers for overeating.

Impulse control techniques are used to reduce emotional eating. Relaxation methods and stress management skills provide support for coping with difficult situations.

Relapse prevention prepares patients for future challenges. Patients develop strategies to handle holidays, social events, or periods of stress.

Cognitive restructuring aims to change negative thought patterns related to food and body weight. Setting realistic goals is crucial for promoting long-term motivation.

Pharmacological therapies for weight reduction utilize various mechanisms of action and are implemented as a supportive measure to complement lifestyle changes. Currently, there are three approved medications available, while innovative new approaches continue to open up further treatment possibilities.

Weight loss medications function through different biological pathways to promote weight reduction.

GLP-1 receptor agonists, such as liraglutide, work by slowing down the emptying of the stomach and increasing the feeling of fullness (satiety). These medications also regulate blood sugar levels and reduce appetite through their action on the central nervous system.

Lipase inhibitors function by blocking the absorption of dietary fats within the intestine. Orlistat, for example, inhibits pancreatic lipase, which reduces the body’s absorption of fat by approximately 30 percent.

The combination of naltrexone and bupropion acts on different neurotransmitter systems in the brain. Naltrexone blocks opioid receptors, while bupropion inhibits the reuptake of dopamine and norepinephrine. This dual action reduces food cravings and enhances the feeling of satiety.

In Austria, three pharmacological therapy options are available:

Medication	Active Ingredient	Primary Effect
Orlistat	Lipase inhibitor	Reduces fat absorption
Liraglutide	GLP-1 receptor agonist	Increases satiety
Naltrexone/Bupropion	Combination preparation	Reduces appetite

Orlistat is taken orally and works by blocking fat absorption in the intestine. Patients must follow a low-fat diet to minimize side effects.

Liraglutide is administered as a daily subcutaneous injection and is particularly suitable for patients with type 2 diabetes. The treatment typically leads to an average weight reduction of 8-10 percent.

The naltrexone-bupropion combination is administered orally twice a day. Patients require a gradual dose increase over a period of several weeks.

Semaglutide shows promising results, with a weight reduction of up to 15 percent. This GLP-1 receptor agonist is already approved for diabetes therapy and could soon become available for obesity treatment.

New dual-receptor agonists combine GLP-1 with other hormone receptors. These medications have the potential to achieve even greater weight loss effects.

Triple-receptor agonists are currently in development and have shown weight reductions of over 20 percent in studies. These drugs act simultaneously on GLP-1, GIP, and glucagon receptors.

Innovative approaches also include implantable devices and genetic therapies. These technologies aim for long-term regulation of body weight without the need for daily medication.

For individuals with severe obesity, surgical intervention often represents the last effective option for achieving permanent weight reduction. These procedures are utilized when conservative treatments have failed and encompass various techniques, each with specific prerequisites and aftercare requirements.

The two most common bariatric surgeries are the gastric bypass and the sleeve gastrectomy. Both procedures significantly reduce food intake.

In a sleeve gastrectomy, surgeons remove approximately four-fifths of the stomach. The remaining sleeve-shaped stomach can only hold small amounts of food.

The gastric bypass combines stomach reduction with a rerouting of the small intestine. This causes the patient to absorb fewer nutrients from food.

Both procedures also alter the hormones that regulate hunger and satiety. These hormonal adjustments provide additional support for weight loss.

The surgeries are typically performed using minimally invasive techniques. This approach reduces complications and significantly shortens the recovery time.

Surgical treatments are generally considered only for individuals with Class III obesity (BMI over 40) or Class II obesity accompanied by related health conditions. All conservative therapies must have been attempted without success beforehand.

Patients must be psychologically stable and prepared for a lifetime of follow-up care. The required age is typically between 18 and 65 years.

Potential risks include:

• Complications from anesthesia
• Bleeding and infections
• Leakage at suture lines
• Long-term nutritional deficiencies

The mortality rate is below 0.5 percent. Severe complications occur in approximately 2-5 percent of patients.

A thorough pre-operative examination clarifies individual risks. Experienced surgical centers demonstrate significantly better outcomes.

Aftercare begins immediately following the operation and is a lifelong commitment. Regular follow-up appointments are essential to monitor weight loss and watch for potential complications.

Key aftercare measures include:

• Quarterly check-ups during the first year
• Annual blood tests to monitor for nutritional deficiencies
• Supplementation with vitamins and minerals
• Nutritional counseling and behavioral therapy

Patients must permanently change their eating habits. Consuming small portions and chewing thoroughly are essential.

Weight loss typically occurs over a period of 12 to 18 months. On average, patients lose 60-80 percent of their excess body weight.

Psychological support assists in adjusting to the changes in lifestyle. Support groups can offer additional help with the challenges of daily life.