Weight Loss Treatments

There are countless weight-loss methods available but many are ineffective 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 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 safe weight-loss program. Most health insurance providers don’t cover weight-loss surgery unless you first make a serious effort to lose weight using non-surgical approaches.

Many individuals participate in a combination of the following therapies:

Dietary Modification

A lot of us have tried a variety of diets and have been stuck 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 choose to go on a diet, we advise that you work with a health professional who can customize a diet to meet your needs. A diet should greatly restrict your caloric intake, but maintain your nutrition. Calorie-restrictive diets fall into 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 include 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:

• Setting 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 certain 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 joining 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 plan on having weight-loss surgery, behavior modification and dieting will be critical in helping you 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 greatly increases your chance of long-term weight loss. It is a key component for any long-term weight management program, especially weight-loss surgery.

Research shows that when you reduce the amount of calories you consume, your body reacts by slowing your metabolism to burn fewer calories, instead of stimulating weight loss. Daily exercise can help accelerate 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 intimidating if you’re morbidly obese. Your health condition may make any level of physical exertion incredibly challenging. But you can learn strategies to help you start a realistic exercise regimen. The following strategies can help you begin exercising and can be incorporated 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.
• 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 non-prescription and prescription weight loss drugs are available. Some people find these medications help suppress their appetites. 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 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 boosts 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 medication.
• Phentermine– Phentermine, an appetite suppressant, has been available for many years. It is half of the “fen-phen” combination that continues to be available for use. Using 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 drugs can have serious side effects. We advise that you go to a licensed healthcare professional that can prescribe suitable medications. Before insurance companies will reimburse you for weight-loss surgery, you have to follow a well-documented treatment plan that generally includes medications.

Surgery

Many people, that are morbidly obese and who 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 people 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 considered with a BMI as low as 35 if your doctor determines that there’s a medical need for weight reduction and surgery appears to be 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. The majority of surgeons require that you show serious incentive and a clear understanding of the extensive dietary, exercise and medical guidelines that have to be followed for the remainder of your life.

The UCSF Bariatric Surgery Center has performed surgical weight loss procedures since 1996. Various procedures include different risks and advantages. During your initial consultation, your surgeon will discuss in detail the various 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 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.