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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
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)
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