Weight Loss Treatments

There are countless weight-loss methods available but many are unsuccessful and temporary, especially for those that are morbidly obese. Amongst 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.

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

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

Dietary Modification

A lot of us have attempted a variety of diets and have been stuck in a cycle of weight gain and loss-- "yo-yo" dieting-- that can lead to serious 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 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 suggest 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:

• Establishing realistic weight loss goals-- short term and also long term.
• Tracking your diet and exercise patterns in a diary.
• Identifying high-risk situations and avoiding them.
• Rewarding specific actions, such as exercising for a longer time or consuming less of a certain kind 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 concentrate on your goal.

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

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

Exercise

Exercise greatly 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 amount of calories you consume, your body reacts by reducing your metabolism to burn fewer calories, rather than promote weight loss. Daily physical activity can help speed up your metabolism, successfully 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 amount of physical exertion extremely difficult. But you can learn strategies to help you start a reasonable exercise regimen. The following strategies can help you start exercising and can be integrated into your everyday 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 number of over-the-counter and prescription weight loss medications are available. Some people find these drugs 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 normally 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 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 remains available for use. The use of phentermine alone has not been linked to 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 serious side effects. We suggest that you see a certified health care professional that can prescribe suitable medications. Before insurance providers will reimburse you for weight-loss surgery, you have to adhere to 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 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, 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 taken into consideration 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 accomplish the targeted weight loss.

To get approved for surgery, you have to complete a medical and psychological pre-evaluation process, and show 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 need to be followed for the remainder of your life.

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

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

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