Weight Loss Treatments

There are many weight-loss methods available but many are unsuccessful and short-term, especially for those that are morbidly obese. Among the morbidly obese, less than 5 percent are successful in losing a considerable amount of weight and also maintaining the weight loss with non-surgical programs-- usually a combination of dieting, behavior modification therapy, and exercise.

Individuals do lose weight without surgery, however, particularly when they work with a certified health care professional to create an effective and safe weight-loss program. The majority of health insurance companies don't cover weight-loss surgery unless you first make a serious effort to lose weight using non-surgical methods.

Many individuals participate in a combination of the following therapies:

Dietary Modification

A lot of us have attempted a variety 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 regain the weight they've lost within two years. For individuals that have weight-loss surgery, dieting is an instrumental part of maintaining weight loss after surgery.

If you decide to go on a diet, we advise that you work with a health professional that can tailor a diet to meet your needs. A diet should considerably limit your caloric intake, but 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 only 400 to 800 calories a day and feature high-protein, low-fat liquids.

Behavior Modification

The objective 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.
• Recording your diet and exercise patterns in a diary.
• Recognizing high-risk situations and avoiding them.
• Rewarding specific actions, such as exercising for a longer time or consuming less of a certain type of food.
• Adopting rational beliefs regarding weight loss and body image.
• Establishing a support network, including family, friends, and co-workers, or joining a support group that can help you concentrate on your goal.

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

Surgery is a tool to get your body to start 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 key component for 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 slowing your metabolism to burn fewer calories, instead of promoting weight loss. Daily exercise can help accelerate your metabolism, effectively reducing the "set point"-- a kind 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 intimidating if you're morbidly obese. Your health condition may make any amount of physical exertion extremely hard. But you can learn strategies to help you begin a reasonable exercise routine. The following strategies can help you begin exercising and can be integrated into your daily routine:

• Park your vehicle at the far end 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

An assortment of over-the-counter and prescription weight loss drugs are available. Some people find these drugs help curb their appetites. 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 people stop taking the medication, weight gain generally occurs.

Weight loss medications, 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 drug works by blocking about 30 percent of dietary fat from being absorbed. Alli is a lower-dose, over-the-counter 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. Using 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 medications can have major side effects. We advise that you see a licensed healthcare professional that can prescribe appropriate medications. Before insurance companies will reimburse you for weight-loss surgery, you must adhere to a well-documented treatment plan that usually includes medications.

Surgery

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

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

To be considered for weight-loss surgery, you have to meet at least one of the following criteria:

• Be more than 100 pounds over your ideal, suggested 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 may be considered with a BMI as low as 35 if your doctor determines that there's a medical need for weight reduction and surgery seems the only way to achieve the targeted weight loss.

To get approved for surgery, you have to complete a medical and psychological pre-evaluation process, and demonstrate that you are committed to long-term, follow-up care after surgery. Most surgeons require that you show serious incentive and a clear understanding of the extensive dietary, exercise, and medical requirements that must be followed for the remainder of your life.

The UCSF Bariatric Surgery Center has conducted surgical weight loss procedures since 1996. Various procedures include different risks and benefits. During your initial consultation, your surgeon will discuss in detail the different choices 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 Carlsbad, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377