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
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)
To schedule a consulation, call Dr. Jesse Lopez in the
Surgical Specialties office.
The phone number is (913) 469-6447.
