Overweight/Weight Loss Treatments

There are numerous weight-loss strategies available but many are ineffective and short-term, particularly for those that are morbidly obese. Amongst the morbidly obese, less than 5 percent succeed in losing a significant amount of weight and maintaining the weight loss with non-surgical programs-- usually a combination of dieting, behavior modification therapy, and exercise.

People do lose weight without surgery, however, especially when they work with a certified health care professional to develop an effective and risk-free weight-loss program. The majority of health insurance providers do not cover weight-loss surgery unless you first make a major effort to lose weight using non-surgical methods.

A lot of people participate in a combination of the following therapies:

Dietary Modification

Many of us have tried a number of diets and have been caught in a cycle of weight gain and loss-- "yo-yo" dieting-- that can cause major health risks by stressing the heart, kidneys, and other organs.

Ninety percent of individuals participating in all diet programs gain back the weight they've lost within two years. For people that have weight-loss surgery, dieting is an instrumental part of maintaining weight loss after surgery.

If you choose to go on a diet, we recommend that you work with a health professional who can customize a diet to meet your needs. A diet needs to greatly restrict your caloric intake, yet maintain your nutrition. Calorie-restrictive diets fall under two basic categories:

• Low-calorie diets (LCDs) are individually planned to include 500 to 1,000 calories a day less than you burn.
• Very low-calorie diets (VLCDs) usually limit intake to just 400 to 800 calories a day and feature high-protein, low-fat liquids.

Behavior Modification

The goal of behavior modification therapy is to change your eating and exercise habits to promote weight loss. Examples include:

• Setting reasonable weight loss goals-- short-term and also long-term.
• Tracking your diet and exercise patterns in a journal.
• Identifying high-risk situations and avoiding them.
• Rewarding particular actions, such as exercising for a longer time or eating less of a certain type of food.
• Adopting rational beliefs about weight loss and body image.
• Establishing a support network, including family, friends, and co-workers, or participating in a support group that can help you concentrate on your goal.

Although some individuals experience success with behavior modification, most people achieve only short-term weight loss for the first year. If you intend on having weight-loss surgery, behavior modification and dieting will be critical in aiding you to maintain your weight loss after surgery.

Surgery is a tool to get your body to begin losing weight. Diet and behavior modification will determine your ultimate success.

Exercise

Exercise significantly increases your chance of long-term weight loss. It is a vital component of any long-term weight management program, particularly weight-loss surgery.

Research shows that when you reduce the number of calories you consume, your body reacts by reducing your metabolism to burn fewer calories, rather than stimulate weight loss. Daily physical activity can help accelerate your metabolism, effectively minimizing the "set point"-- a sort of thermostat in the brain that makes you resistant to either weight gain or loss-- to a lower natural weight.

Starting an exercise program can be daunting if you're morbidly obese. Your health condition might make any level of physical exertion extremely difficult. But you can learn techniques to help you begin a reasonable exercise routine. The following strategies can help you begin exercising and can be incorporated into your daily routine:

• Park your car at the back of parking lots and walk through them. Walking is considered one of the most effective forms of exercise. You can start slowly and build up over time.
• Reduce the time you spend watching television.
• Ride an exercise bike.
• Swim or participate in low-impact water aerobics.
• Take the stairs rather than the elevator.
• Walk briskly for five minutes in the morning and five minutes in the evening.

Medications

A variety of non-prescription and prescription weight loss drugs are available. Some people find these medications help curb their cravings. Studies show that individuals on drug therapy lose around 10 percent of their excess weight and that the weight loss plateaus after six to eight months. As people stop taking the medication, weight gain usually occurs.

Weight loss drugs, approved by the U.S. Food and Drug Administration (FDA) for treating obesity, include:

• Beta-methyl-phenylethylamine (Fastin)-- This is a stimulant that increases fat metabolism.
• Orlistat (Xenical)-- This medication works by blocking about 30 percent of dietary fat from being absorbed. Alli is a lower-dose, non-prescription formula of the same drug.
• Phentermine-- Phentermine, an appetite suppressant, has been available for years. It is half of the "fen-phen" combination that continues to be available for use. The use of phentermine alone has not been associated with the adverse health effects of the fenfluramine-phentermine combination.
• Sibutramine (Meridia)-- This is an appetite suppressant approved for long-term use.

Medications are an important part of the morbid obesity treatment process but weight-loss drugs can have serious side effects. We advise that you see a licensed healthcare professional who can prescribe proper medications. Before insurance providers will reimburse you for weight-loss surgery, you must adhere to a well-documented treatment plan that generally includes medications.

Surgery

Many people, who are morbidly obese and that have been unsuccessful in losing and keeping off weight, choose bariatric or weight-loss surgery.

Bariatric surgery, which involves sealing off most of the stomach to reduce the amount of food you can consume, can be an effective way for morbidly obese individuals to lose weight and maintain that weight loss.

To be considered for weight-loss surgery, you must meet at least one of the following qualifications:

• Be more than 100 pounds over your ideal, recommended body weight.
• Have a body mass index (BMI) of 40 or higher (20 to 25 is considered normal). BMI is a number based on both your height and weight. Surgery might be taken into consideration with a BMI as low as 35 if your physician determines that there's a medical need for weight reduction and surgery seems the only way to achieve the targeted weight loss.

To qualify for surgery, you must complete a medical and psychological pre-evaluation process, and demonstrate that you are committed to long-term, follow-up care after surgery. The majority of surgeons require that you show serious incentive and a clear understanding of the extensive dietary, exercise, and medical guidelines that must be followed for the rest of your life.

The UCSF Bariatric Surgery Center has performed surgical weight loss procedures since 1996. Various procedures involve different risks and benefits. During your initial consultation, your surgeon will go over in detail the various options available to you, together with their associated risks and benefits.

The most common bariatric surgeries are "restrictive" procedures that reduce the size of the stomach and restrict the calories you can consume.

For further information about Dr. Stengler’s practice and his clinic in Rancho Santa Fe, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377