Weight Loss Treatments

There are numerous weight-loss strategies available but many are unsuccessful and short-term, particularly for those who are morbidly obese. Among 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.

People do lose weight without surgery, however, particularly when they work with a certified health care professional to develop an effective and safe 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.

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

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 cause significant health risks by stressing the heart, kidneys and other organs.

Ninety percent of people participating in all diet programs regain 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 should considerably restrict your caloric 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) usually limit 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 promote weight loss. Examples include:

• Establishing realistic weight loss goals-- short term and long term.
• Documenting your diet and exercise patterns in a journal.
• Recognizing high-risk situations and avoiding them.
• Rewarding specific actions, such as exercising for a longer time or eating less of a certain kind of food.
• Adopting rational beliefs regarding 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 people achieve only short-term weight loss for the first year. If you plan on having weight-loss surgery, behavior therapy and dieting will be crucial in assisting 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 an essential component for any long-term weight management program, especially 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, instead of stimulating weight loss. Daily exercise can help accelerate your metabolism, effectively reducing 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 may make any amount of physical exertion incredibly challenging. But you can learn strategies to help you begin a reasonable exercise routine. The following techniques can help you start exercising and can be incorporated 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.
• 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 individuals find these drugs help curb their cravings. 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 generally 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 increases 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 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. 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 major side effects. We recommend 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 generally includes medications.

Surgery

Many individuals, 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 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 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 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 show that you are committed 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 guidelines that need 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 advantages. During your first consultation, your surgeon will discuss in detail the different choices available to you, together with their associated risks and advantages.

The most common 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 San Diego, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377