Weight Loss Treatments

There are many weight-loss methods available but many are ineffective and short-term, especially for those who are morbidly obese. Among the morbidly obese, less than 5 percent succeed 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.

People 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 strategies.

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

Dietary Modification

A lot of us have tried a variety of diets and have been caught in a cycle of weight gain and loss-- "yo-yo" dieting-- that can cause significant 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 individuals who have weight-loss surgery, dieting is an instrumental part of maintaining weight loss after surgery.

If you decide to go on a diet, we suggest that you work with a health professional that can tailor a diet to meet your needs. A diet needs to significantly restrict your calorie 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) typically restrict intake to just 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 reasonable weight loss goals-- short term and also long term.
• Tracking 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 eating less of a certain type of food.
• Adopting realistic beliefs about weight loss and body image.
• Developing a support network, including family, friends and colleagues, or joining a support group that can help you focus 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 modification and dieting will be crucial in aiding you 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 key component for any long-term weight management program, particularly weight-loss surgery.

Research shows that when you decrease the number of calories you consume, your body reacts by slowing your metabolism to burn fewer calories, rather than promote weight loss. Daily exercise can help accelerate your metabolism, effectively 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 intimidating if you're morbidly obese. Your health condition may make any amount of physical exertion extremely difficult. But you can learn strategies to help you begin a realistic exercise routine. The following techniques can help you begin exercising and can be integrated into your daily routine:

• Park your vehicle 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.
• 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 evening.

Medications

A variety of non-prescription and prescription weight loss medications 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 individuals 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 boosts fat metabolism.
• Orlistat (Xenical)-- This medication 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. Using phentermine alone has not been linked to 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 major side effects. We advise that you see a licensed healthcare professional who can prescribe appropriate medications. Before insurance providers will reimburse you for weight-loss surgery, you have to follow a well-documented treatment plan that typically includes medications.

Surgery

Many people that are morbidly obese and that have been unsuccessful in losing and keeping off the 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 way 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, 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 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 means to achieve the targeted weight loss.

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

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

The most prevalent 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 La Mesa, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377.

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