Losing weight is difficult for many people. Keeping it off can be even harder. There are many approaches to losing weight, and no one approach is effective for everyone who tries it.

Lifestyle changes — eating healthier and getting more exercise — are considered first-line therapy for obesity. Some people find commercial weight loss programs helpful. Several classes of medications can help promote weight loss. Bariatric (weight loss) surgery is effective at helping some people lose weight, while others try weight loss balloons.

Diet and Nutrition

Eating a lower-calorie, nutritious diet can help you lose weight or maintain a balanced weight, feel better, control blood glucose (sugar), and keep cholesterol at healthy levels. Even small changes in what, when, and how much you eat can affect your health. Replacing sugary soft drinks with fruit-flavored water or high-calorie snack foods with fresh fruit or veggie snacks could provide results.

There are many diets designed to help people lose weight. No one diet is effective or healthy for everyone trying to lose weight.

A nutritious diet for someone trying to lose weight is not very different from a healthy diet in general. Focus your diet on:

• Fresh vegetables and fruit
• Whole grains
• Legumes
• Fish and lean protein sources
• Low-fat dairy products
• Sources of healthy unsaturated fats, such as nuts and olive oil

Exercise

For people trying to lose weight, increasing physical activity is one of the most important things you can do. In addition to burning calories, exercise can improve your mood, help you keep cholesterol and blood pressure in check, and prevent serious complications such as diabetes and heart disease from developing or growing worse. Even if you only lose a small amount of weight, exercise is still highly beneficial for your health.

Regular exercise does not necessarily mean going to the gym or playing sports. Nearly any physical activity that gets you up and moving can provide significant benefits.

Commercial Weight Loss Programs

Commercial weight loss programs are a popular way to try to lose weight. Well-known brands include WeightWatchers, Jenny Craig, and Nutrisystem, but there are many other programs available. Some programs involve eating branded, prepackaged meals that must be purchased from the company, while others allow you to eat any food you like but ask you to track points or calories.

Many commercial programs include an aspect of community support, counseling, or behavior change as part of their system. Depending on what works best for you, you can find a program that provides regularly scheduled group meetings, individual counseling, or online community forums.

Depending on your health conditions, some weight loss programs might provide too much or too little of the nutrients you need. Always check with your doctor before making significant changes to your diet.

Medications

Several prescribed medications are approved by the U.S. Food and Drug Administration (FDA) to help people lose weight along with diet and exercise. Most medications are indicated for people with a body mass index (BMI) of 30 or higher or for people with a BMI of 27 who have weight-related conditions, such as type 2 diabetes, high blood pressure, or sleep apnea.

Appetite Suppressants

Phentermine is a stimulant and an appetite suppressant. It is believed that phentermine works by reducing the perception of hunger. Phentermine is usually prescribed for short-term use, and it’s important not to take it longer than your doctor recommends.

Methamphetamine and lorcaserin (Belviq) are other stimulants used to promote weight loss. Some drugs in these classes can be addictive, so it’s very important to take them only for a limited time and under a doctor’s supervision. All of them can have multiple side effects, including constipation, headache, dizziness, upset stomach, and dry mouth. Let your doctor know if you experience any side effects while taking these medications.

Lipase Inhibitors

Alli — a formulation of a drug called orlistat — is sold over the counter. Orlistat is a lipase inhibitor that works by preventing your body from absorbing calories from fat in foods. The drug can cause fecal incontinence, along with other side effects. Orlistat is also sold at prescription strength under the brand name Xenical.

GLP-1 Receptor Agonists

Liraglutide (Saxenda) is prescribed to treat both diabetes and obesity. It’s a glucagon-like peptide 1 (GLP-1) receptor agonist that signals the pancreas to make more insulin and prevents the liver from releasing glucose. Another medication in this class, semaglutide (Wegovy), is FDA-approved specifically for obesity. It works similarly by reducing appetite and increasing feelings of fullness.

Tirzepatide (Zepbound), a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist, is another FDA-approved treatment for obesity, combining the effects of both incretin hormones to promote weight loss by regulating appetite and blood sugar.

Other GLP-1 receptor agonists are sometimes prescribed off-label for weight management. While GLP-1 receptor agonists are the primary incretin mimetics used for obesity, other types, such as GIP receptor agonists and dual GIP/GLP-1 receptor agonists, are gaining approval and expanding treatment options.

Combination Medications

Contrave is a combination of two drugs, naltrexone and bupropion. Naltrexone is an opiate antagonist that decreases food cravings, and bupropion is an antidepressant that causes weight loss as a side effect. Common side effects of this drug combination include headache, dizziness, and digestive upset.

Qsymia (phentermine/topiramate) is another combination drug composed of a stimulant/appetite suppressant and an antiseizure drug that causes weight loss as a side effect.

Other Treatments for Obesity

If diet, exercise, and medications have not resulted in weight loss, and your BMI score is very high or you have serious obesity-related health conditions, your doctor may suggest trying a more invasive treatment. Bariatric surgery, a balloon system, or a vagal nerve blockade have helped some people lose weight when other treatments were ineffective.

Surgery

Some people undergo bariatric surgery such as gastric bypass (Roux-en-Y), adjustable gastric band (also known as the lap-band or LABG), or sleeve gastrectomy to lose weight. To be eligible for bariatric surgery, it is usually necessary to have a BMI score over 35 — or a lower BMI score as well as medical complications such as poorly controlled diabetes. Bariatric surgery has been proven effective for weight loss and can reverse diabetes in many people, enabling them to control blood glucose without insulin or diabetes medication.

Any surgery carries risks. These include:

• Blood clots
• Blood loss
• Infection
• Breathing problems
• Reactions to medication
• Heart attack or stroke during the surgery

Weight loss surgery can cause reflux, incisional hernias, leaks, and bowel obstructions. After bariatric surgery, you must drastically change when and how much you eat and increase your exercise levels to avoid side effects. Some people experience poor food absorption in the intestines after bariatric surgery that results in nutritional deficiencies and symptoms such as gas, constipation, and diarrhea.

Balloon Systems

Obalon, Orbera, and ReShape are temporary balloon systems approved by the FDA to aid weight loss for people with high BMI scores or obesity-related complications. Also called intragastric balloons, these systems work by taking up space in the stomach, making you feel full and causing you to eat less.

Each balloon system is a little different, but most are placed in the stomach by swallowing a capsule, which is then inflated. Most balloon systems are retrieved after a few months via endoscopy, which involves a flexible tube with a camera and tools on it being inserted down the throat.

Rare but serious side effects of balloon systems can happen if the balloon deflates, enters the intestines, and causes a blockage that requires surgery to correct.

Vagus Nerve Blockade

The vagus nerve carries messages of hunger from your digestive system to your brain. A vagus nerve blockade involves surgically implanting a small electrode onto the vagus nerve in the abdomen. The electrode is controlled externally and can be programmed by a doctor. A vagus nerve blockade is designed to be used for eight years. In addition to the risks of any surgery, vagus nerve blockade can cause pain, heartburn, and nausea among other symptoms.

Read more about specific medications and procedures in this list of treatments for obesity.

After Major Weight Loss

If you lose a lot of weight quickly, you may develop significant amounts of loose skin. Some people choose to have plastic surgery to remove it. You can discuss this procedure and any other follow-up care with your doctor.

Find Your Team

On MyObesityTeam, the social network and online support group for people with obesity and their loved ones, more than 53,000 members come together to share experiences, seek advice, and offer support.

Have you tried medical treatments for obesity? How was your experience? Join the conversation today to share your experiences and connect with others on MyObesityTeam.