Weight Loss Treatments

There are countless weight-loss strategies available but many are unsuccessful and temporary, particularly for those who 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-- generally a combination of dieting, behavior modification therapy, and exercise.

Individuals do lose weight without surgery, however, especially when they work with a certified healthcare professional to develop an effective and risk-free weight-loss program. Most health insurance companies do not 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 treatments:

Dietary Modification

Many 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 lead to major 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 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 recommend that you work with a health professional that can tailor a diet to meet your needs. A diet needs to significantly limit 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 include 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:

• Establishing realistic weight loss goals-- short term and also long term.
• Documenting your diet and exercise patterns in a diary.
• Recognizing high-risk situations and avoiding them.
• Rewarding certain actions, such as exercising for a longer time or eating less of a certain kind of food.
• Adopting realistic beliefs about weight loss and body image.
• Establishing 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 intend on having weight-loss surgery, behavior therapy and dieting will be crucial 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 vital component for any long-term weight management program, particularly weight-loss surgery.

Research shows that when you reduce the amount of calories you consume, your body reacts by reducing your metabolism to burn less calories, instead of promoting weight loss. Daily exercise can help accelerate your metabolism, successfully reducing 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 might make any amount of physical exertion incredibly difficult. But you can learn techniques to help you start a reasonable exercise routine. The following strategies can help you begin exercising and can be incorporated into your everyday 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 number 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 normally 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 continues to be 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 drugs can have serious side effects. We recommend that you go to a licensed healthcare professional who can prescribe proper medications. Before insurance providers will reimburse you for weight-loss surgery, you must adhere to a well-documented treatment plan that usually includes medications.

Surgery

Many individuals, who 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 means for morbidly obese people to lose weight and maintain that weight loss.

To be considered for weight-loss surgery, you must meet at least one of the following qualifications:

• 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 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 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 demonstrate serious motivation and a clear understanding of the extensive dietary, exercise, and medical requirements that have to be followed for the rest 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 first consultation, your surgeon will go over in detail the different options 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 Jolla, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377