There is only one drug in this class approved by the U.S. Food and Drug Administration: orlistat (Xenical). It is approved for teens ages 12 and older. (All other weight-loss drugs are approved for teens older than 16 and adults). Orlistat works by decreasing the body’s ability to absorb some fat from food, the NIDDK says. If less fat is absorbed, there are fewer calories for the body to use or store. Side effects of orlistat are usually mild and temporary. They include cramping, intestinal discomfort, gas, diarrhea and leakage of oily stool. Eating foods that are high in fat can make the side effects worse. Orlistat reduces the absorption of fat-soluble vitamins, so your doctor may advise taking a multivitamin at least two hours before or after taking orlistat.
Obesity surgery may be appropriate for people who have tried other methods to lose weight but remain severely obese, or for people who have a serious disease caused or made worse by obesity. Gastric surgery, also called bariatric surgery, is a major procedure. It changes the way your body digests food. It may be appropriate for people with a BMI of 40 or greater, or about 100 pounds overweight for men and 80 pounds for women, or for people with a BMI of 35 or greater if they have serious medical conditions.
These are the surgical options:
- Adjustable gastric banding and vertical banded gastroplasty (VBG). These are known as restriction operations because they reduce food intake by limiting the amount of food the stomach can hold. In adjustable gastric banding, for example, a hollow silicone band that can be inflated with saltwater is placed around the upper end of the stomach, creating a small pouch that catches the food, allowing it to drain slowly into the rest of the stomach. The flow of food from the pouch can be adjusted by increasing or decreasing the inflation of the band. VBG is a variation that uses staples and bands to create the pouch, but this variation is not often used. These surgeries can usually be done through one or more small incisions. Permanent weight loss after these surgeries requires changes in diet and exercise. The NIDDK says that after 10 years, only 20 percent of people who had these surgeries kept the weight off.
- Gastric bypass operation. This also creates a stomach pouch, rerouting food directly into a lower portion of the intestine so fewer nutrients are absorbed. This procedure produces more weight loss, but it also involves higher risks for complications, including nutritional deficiencies such as anemia and osteoporosis, as well as unpleasant effects after eating.
- A combination of procedures. Combining the two types of surgeries seems to result in more permanent weight loss. The combination restricts both food intake and the amount of calories and nutrients the body absorbs.
Because of the potential for nutritional deficiencies, the need to take vitamin and mineral supplements for life and other side effects, these surgeries are not usually recommended for teens. They may be considered for a teen who has a BMI of 40 or more, has reached his or her adult height (usually age 13 or older for girls and 15 or older for boys), and has a serious weight-related health problem such as type 2 diabetes or heart disease. Both the teen and his or her parents must be prepared to make the lifestyle and emotional changes required to make the surgery successful.
Although drugs and surgery can promote weight loss, they are not magic. They all require your active participation. If you continue with the same old habits, you can easily override anything a doctor can do for you.