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
For many patients, the risk of death from not having the surgery is
greater than the risks from the possible complications of having the
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
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.
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.
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
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.
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)