Home > Options for treatment
Options for treatment
 For
anyone who has considered a weight loss program, there is certainly no shortage
of choices. In fact, to qualify for insurance coverage of weight loss surgery,
many insurers require patients to have a history of medically supervised weight
loss efforts.
Most non-surgical weight loss programs are based on some combination of diet/behavior
modification and regular exercise. Unfortunately, even the most effective
interventions have proven to be effective for only a small percentage of
patients. It is estimated that less than 5% of individuals who participate in
non-surgical weight loss programs will lose a significant amount of weight and
maintain that loss for a long period of time.
According to the National Institutes of Health, more than 90% of all people in
these programs regain their weight within one year. Sustained weight loss for
patients who are morbidly obese is even harder to achieve. Serious health risks
have been identified for people who move from diet to diet, subjecting their
bodies to a severe and continuing cycle of weight loss and gain known as "yo-yo
dieting."
The fact remains that morbid obesity is a complex, multifactorial chronic
disease.
For many patients, the risk of death from not having the surgery is greater than
the risks from the possible complications of having the procedure.
 That
is the key reason that in 2000, approximately 40,000 weight loss surgical
procedures were performed and why the American Society for Bariatric Surgery
estimates that 50,000 weight loss surgical procedures will be performed in 2001.
Patients who have had the procedure and are benefiting from its results report
improvements in their quality of life, social interactions, psychological
well-being, employment opportunities and economic condition.
In clinical studies, candidates for the procedure who had multiple
obesity-related health conditions questioned whether they could safely have the
surgery. These studies show that selection of surgical candidates is based on
very strict criteria and surgery is an option for the majority of patients.
Weight Loss Surgery
Weight loss surgery is major surgery. Its growing use to treat morbid obesity is
the result of three factors:
-
Our current knowledge of the significant health risks of
morbid obesity
-
The relatively low risk and complications of the procedures
versus not having the surgery
-
The ineffectiveness of current non-surgical approaches to
produce sustained weight loss
 Surgery
should be viewed first and foremost as a method for alleviating debilitating,
chronic disease. In most cases, the minimum qualification for consideration as a
candidate for the procedure is 100 lbs. above ideal body weight or those with a
Body Mass Index of 40 or greater. Occasionally a procedure will be considered
for someone with a BMI of 35 or higher if the patient's physician determines
that obesity-related health conditions have resulted in a medical need for
weight reduction and, in the doctor's opinion, surgery appears to be the only
way to accomplish the targeted weight loss. In many cases, patients are required
to show proof that their attempts at dietary weight loss have been ineffective
before surgery will be approved. More important, however, is the commitment on
the part of the patient to required, long-term follow-up care. Most surgeons
require patients to demonstrate serious motivation and a clear understanding of
the extensive dietary, exercise and medical guidelines that must be followed for
the remainder of their lives after having weight loss surgery (see Life After
Surgery).
Diet & Behavior
Modification
There are literally hundreds of diets available. Moving from diet to diet in a
cycle of weight gain and loss - yo-yo dieting - that stresses the heart, kidneys
and other organs can also be a health risk.
Doctors who prescribe and supervise diets for their patients usually create a
customized program with the goal of greatly restricting calorie intake while
maintaining nutrition.
These diets fall into two basic categories:
-
Low Calorie Diets (LCDs) are individually planned so that
the patient takes in 500 to 1,000 fewer calories a day than he or she burns.
-
Very Low Calorie Diets (VLCDs) typically limit caloric
intake to 400 to 800 a day and feature high-protein, low-fat liquids.
Many patients on Very Low Calorie Diets lose significant
amounts of weight. However, after returning to a normal diet, most regain the
lost weight in under a year. Ninety percent of people participating in all diet
programs will regain the weight they've lost within two years.
 Behavior
modification uses therapy to help patients change their eating and exercise
habits. Like low-calorie diets, behavior modification, in most patients, results
in short-term success that tends to diminish after the first year.
If diet and behavior modifications have failed you and surgery is your next
option, it is important to understand that diet and behavior modification will
be instrumental to sustained weight loss after your surgery. The surgery itself
is only a tool to get your body started losing weight - complying with diet and
behavior modifications required by most surgeons would determine your ultimate
success.
Exercise
 Starting
an exercise program can be especially intimidating for someone suffering from
morbid obesity. Your health condition may make any level of physical exertion
next to impossible. The benefits of exercise are clear, however. And there are
ways to get started.
A National Institutes of Health survey of 13 studies concludes that physical
activity:
-
results in modest weight loss in overweight and obese
individuals
-
increases cardiovascular fitness, even when there is no
weight loss
-
can help maintain weight loss
New theories focusing on the body's set point (the weight
range in which your body is programmed to weigh and will fight to maintain that
weight) highlight the importance of exercise. When you reduce the number of
calories you take in, the body simply reacts by slowing metabolism to burn fewer
calories. Daily physical activity can help speed up your metabolism, effectively
bringing your set point down to a lower natural weight. So when following a diet
to attempt to lose weight, exercise increases your chances of long-term success.
Examples to get you started:
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Park at the far end of parking lots and walk
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Take the stairs instead of the elevator
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Cut down on television
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Swim or participate in low-impact water aerobics
-
Ride an exercise bike
Overall, walking is one of the best forms of exercise. Start
out slowly and build up. Your doctor, or people in a support group, can offer
encouragement and advice. Incorporating exercise into your daily activities will
improve your overall health and is important for any long-term weight management
program, including weight loss surgery. Diet and exercise play a key role in
successful weight loss after surgery.
Over-the-Counter & Prescription Drugs
New over-the-counter and prescription weight loss medications have been
introduced. Some people have found them effective in helping to curb their
appetite. The results of most studies show that patients on drug therapy lose
around 10 percent of their excess weight and that the weight loss plateaus after
six to eight months. As patients stop taking the medication, weight gain usually
occurs.
Weight loss drugs can have serious side effects. Still, medications are an
important step in the morbid obesity treatment process. Before insurance
companies will reimburse/pay for weight loss surgery, you must follow a
well-documented treatment path.
"Since many people cannot lose much weight no matter how hard they try, and
promptly regain whatever they do lose, the vast amount of money spent on diet
clubs, special foods and over-the-counter remedies, estimated to be on the order
of $30 billion to $50 billion yearly, is wasted." (New England Journal of
Medicine)  |
