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
Diet & Behavior Modification
Exercise
Over-the-Counter & Prescription Drugs
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).
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.
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:
- Park at the far end of parking lots and walk
- Take the stairs instead of the elevator
- Cut down on television
- 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.
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)
