Overweight / Weight Loss Treatment

There are numerous weight-loss strategies available but many are unsuccessful and short-term, especially for those that are morbidly obese. Amongst the morbidly obese, less than 5 percent succeed in losing a significant amount of weight and also maintaining the weight loss with non-surgical programs-- generally 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 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 serious effort to lose weight using non-surgical approaches.

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

Dietary Modification

Many of us have attempted a number of diets and have been stuck 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 people participating in all diet programs gain back 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 choose to go on a diet, we suggest that you work with a health professional who can tailor a diet to meet your needs. A diet needs to considerably 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 restrict 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 stimulate weight loss. Examples include:

• Establishing realistic weight loss goals-- short term and long term.
• Recording your diet and exercise patterns in a diary.
• Recognizing high-risk situations and avoiding them.
• Rewarding particular actions, such as exercising for a longer time or consuming less of a certain kind of food.
• Adopting rational beliefs about weight loss and body image.
• Developing a support network, including family, friends and colleagues, or participating in a support group that can help you focus on your goal.

Although some individuals experience success with behavior modification, most patients 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 helping you maintain your weight loss after surgery.

Surgery is a device 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 vital component for any long-term weight management program, especially weight-loss surgery.

Research shows that when you decrease the number of calories you consume, your body responds by reducing your metabolism to burn fewer calories, rather than promote weight loss. Daily exercise can help accelerate your metabolism, successfully minimizing 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 daunting if you're morbidly obese. Your health condition might make any amount of physical exertion extremely challenging. But you can learn techniques to help you begin a reasonable exercise regimen. 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 efficient forms of exercise. You can start slowly and build up over time.
• Minimize 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 afternoon.

Medications

An assortment of over-the-counter and prescription weight loss medications are available. Some people find these medications 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 individuals stop taking the medication, weight gain frequently 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 many years. It is half of the "fen-phen" combination that remains available for use. The use of phentermine alone has not been associated with the negative 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 serious side effects. We advise that you visit a certified health care professional that can prescribe proper medications. Before insurance providers will reimburse you for weight-loss surgery, you must follow a well-documented treatment plan that typically includes medications.

Surgery

Many individuals that are morbidly obese and who have been unsuccessful in losing and keeping off the weight, opt for 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 criteria:

• 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 a normal). BMI is a number based on both your height and weight. Surgery might be considered 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 means to achieve the targeted weight loss.

To get approved for surgery, you must complete a medical and psychological pre-evaluation process, and demonstrate that you are dedicated to long-term, follow-up care after surgery. Most surgeons require that you show serious motivation 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 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 Encinitas, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377.

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