Treatment Options for Losing Weight

Your Weight Loss Choices

If you are morbidly obese and need to lose weight, you have many choices and it is important to try several of them before you seriously consider bariatric surgery.  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 utilize a combination of diet/behavior modification and regular exercise. The unfortunate truth is that even the most effective of these only proves effective for 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 those who participate in such programs regain their weight within one year. This is of particular concern because there are serious health risks 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 sad truth is that morbid obesity is a complex, chronic disease with many different causes and effects. If you are considering bariatric surgery, you will need to weigh the risk of medical problems including early death if you don’t have weight loss surgery against the likelihood of possible complications of having the procedure.  Patients who have chosen to have bariatric surgery report, on the other hand, that their quality of life improves along with their social interactions, psychological well-being, employment opportunities and economic condition.

Doctors have carefully studied whether bariatric surgical procedures are safe for patients who have multiple obesity-related health conditions.  Clinical studies show that  the surgery is a safe option for the majority of patients who meet our strict criteria.

Weight Loss Surgery

Weight loss surgery is major surgery. Its growing use to treat morbid obesity is the result of three factors:

  • We’ve become aware of the many significant health risks associated with morbid obesity 
  • Non-surgical approaches to produce sustained weight loss don’t work very well
  • Relatively speaking, the surgery is safe and carries low risk of complications compared with the dangers of not having the surgery

The most important reason to have bariatric surgery is to get healthy – to alleviate debilitating, chronic disease. In most cases, the minimum qualification for patients to have bariatric surgery is to be 100 pounds above the ideal body weight or to have a Body Mass Index of 40 or greater.

Occasionally a bariatric procedure will be considered for a person with a BMI as low as 35 if the patient's doctor determines that his or her obesity has created medical problems that would be improved by weight loss and, in the doctor's opinion, surgery appears to be the only way to lose the weight. You may be required to show proof that your attempts at dietary weight loss have been unsuccessful before you will be approved as a candidate for bariatric surgery.

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 and Behavior Modification

There are literally hundreds of diets available. Moving from diet to diet in a cycle of weight gain and loss (called "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.  As with low-calorie diets, most patients who use behavior modification to lose weight achieve only temporary success.  Most regain their weight after the first year.

If diet and behavior modifications have failed you and surgery is your next option, it is important to understand that you will be using those same tools -- diet and behavior modification – to achieve sustained weight loss after your surgery. It is important to view the surgery itself as just a tool that gets your body started losing weight and you will need to make changes to your lifestyle in order to succeed over the long-term.

Exercise

If you feel overwhelmed and intimidated at the idea of starting an exercise program, it’s only natural.  People with morbid obesity find physical exertion nearly impossible.  This will change.  The benefits of exercise are clear and our program will help you to get started.

The benefits you will achieve by exercising are dramatic.  For example, 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

The prevailing theory is that the body establishes a “set point” (the weight range in which your body is programmed to weigh and will fight to maintain that weight) and exercise is a way to change that. If all you do is reduce the number of calories you take in, the body simply reacts by slowing metabolism to burn fewer calories. Adding daily physical activity to your schedule can help speed up your metabolism and bring your set point down to a lower natural weight. This is just one of the important ways that exercise increases your chances of long-term success with weight loss.

Simple Exercise Examples

There are many easy changes you can make to incorporate more exercise into your lifestyle. Here are some examples:

  • 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

One of the easiest and most effective forms of exercise is something you do every day anyway – walking.  Start out slowly and build up. Your doctor, your family and friends and the people you will meet in our support groups 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 and Prescription Drugs

New over-the-counter and prescription weight loss medications have been introduced with mixed success. 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 surgery, you must follow a well-documented treatment path.

Getting Started

If you think you may be a candidate for weight loss surgery, talk to your primary care physician about Danbury Hospital, call 1-800-516-3657 for more information, or attend a free event and learn more about losing weight through bariatric surgery and if it's right for you.




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