For
anyone who has considered a weight loss program, there is certainly
no shortage of choices. In fact, to qualify for insurance coverage
of bariatric weight loss surgery, many insurers require patients to have
a history of medically supervised weight loss efforts.
Most non-surgical weight loss programs are based on some
combination of diet/behavior modification and regular exercise.
Unfortunately, even the most effective interventions have
proven to be effective for only a small percentage of patients.
It is estimated that less than 5% of individuals who participate
in non-surgical weight loss programs will lose a significant
amount of weight and maintain that loss for a long period
of time.
According to the National Institutes of Health, more than
90% of all people in these programs regain their weight within
one year. Sustained weight loss for patients who are morbidly
obese is even harder to achieve. Serious health risks have
been identified for people who move from diet to diet, subjecting
their bodies to a severe and continuing cycle of weight loss
and gain known as "yo-yo dieting."
The fact remains that morbid obesity is a complex, multifactorial
chronic disease.
For many patients, the risk of death from not having the
surgery is greater than the risks from the possible complications
of having the procedure.
That
is the key reason that in 2000, approximately 40,000 weight
loss surgical procedures were performed and why the American
Society for Bariatric Surgery estimates that 50,000 weight
loss surgical procedures will be performed in 2001. Patients
who have had the procedure and are benefiting from its results
report improvements in their quality of life, social interactions,
psychological well-being, employment opportunities and economic
condition.
In clinical studies, candidates for the procedure who had
multiple obesity-related health conditions questioned whether
they could safely have the surgery. These studies show that
selection of surgical candidates is based on very strict criteria
and bariatric surgery is an option for the majority of patients.
Bariatric Surgery
Diet & Behavior Modification
Exercise
Over-the-Counter &
Prescription Drugs
Bariatric surgery is major surgery. Its growing use to treat
morbid obesity is the result of three factors:
- Our current knowledge of the significant health risks
of morbid obesity
- The relatively low risk and complications of the procedures
versus not having the surgery
- The ineffectiveness of current non-surgical approaches
to produce sustained weight loss
Bariatric should be viewed first and foremost as a method for
alleviating debilitating, chronic disease. In most cases, the
minimum qualification for consideration as a candidate for the
procedure is 100 lbs. above ideal body weight or those with
a Body Mass Index of 40 or greater. Occasionally a procedure
will be considered for someone with a BMI of 35 or higher if
the patient's physician determines that obesity-related health
conditions have resulted in a medical need for weight reduction
and, in the doctor's opinion, surgery appears to be the only
way to accomplish the targeted weight loss. In many cases, patients
are required to show proof that their attempts at dietary weight
loss have been ineffective before surgery will be approved.
More important, however, is the commitment on the part of the
patient to required, long-term follow-up care. Most surgeons
require patients to demonstrate serious motivation and a clear
understanding of the extensive dietary, exercise and medical
guidelines that must be followed for the remainder of their
lives after having weight loss surgery (see
Life
After Surgery).
There are literally hundreds of diets available. Moving from
diet to diet in a cycle of weight gain and loss - yo-yo dieting
- that stresses the heart, kidneys and other organs can also
be a health risk.
Doctors who prescribe and supervise diets for their patients
usually create a customized program with the goal of greatly
restricting calorie intake while maintaining nutrition.
These diets fall into two basic categories:
- Low Calorie Diets (LCDs) are individually planned so that
the patient takes in 500 to 1,000 fewer calories a day than
he or she burns.
- Very Low Calorie Diets (VLCDs) typically limit caloric
intake to 400 to 800 a day and feature high-protein, low-fat
liquids.
Many patients on Very Low Calorie Diets lose significant
amounts of weight. However, after returning to a normal diet,
most regain the lost weight in under a year. Ninety percent
of people participating in all diet programs will regain the
weight they've lost within two years.
Behavior
modification uses therapy to help patients change their eating
and exercise habits. Like low-calorie diets, behavior modification,
in most patients, results in short-term success that tends
to diminish after the first year.
If diet and behavior modifications have failed you and bariatric surgery
is your next option, it is important to understand that diet
and behavior modification will be instrumental to sustained
weight loss after your surgery. The surgery itself is only
a tool to get your body started losing weight - complying
with diet and behavior modifications required by most surgeons
would determine your ultimate success.
Starting
an exercise program can be especially intimidating for someone
suffering from morbid obesity. Your health condition may make
any level of physical exertion next to impossible. The benefits
of exercise are clear, however. And there are ways to get
started.
A National Institutes of Health survey of 13 studies concludes
that physical activity:
- results in modest weight loss in overweight and obese
individuals
- increases cardiovascular fitness, even when there is no
weight loss
- can help maintain weight loss
New theories focusing on the body's set point (the weight
range in which your body is programmed to weigh and will fight
to maintain that weight) highlight the importance of exercise.
When you reduce the number of calories you take in, the body
simply reacts by slowing metabolism to burn fewer calories.
Daily physical activity can help speed up your metabolism,
effectively bringing your set point down to a lower natural
weight. So when following a diet to attempt to lose weight,
exercise increases your chances of long-term success.
Examples to get you started:
- Park at the far end of parking lots and walk
- Take the stairs instead of the elevator
- Cut down on television
- Swim or participate in low-impact water aerobics
- Ride an exercise bike
Overall, walking is one of the best forms of exercise. Start
out slowly and build up. Your doctor, or people in a support
group, can offer encouragement and advice. Incorporating exercise
into your daily activities will improve your overall health
and is important for any long-term weight management program,
including weight loss surgery. Diet and exercise play a key
role in successful weight loss after surgery.
New over-the-counter and prescription weight loss medications
have been introduced. Some people have found them effective
in helping to curb their appetite. The results of most 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 patients stop taking the medication,
weight gain usually occurs.
Weight loss drugs can have serious side effects. Still, medications
are an important step in the morbid obesity treatment process.
Before insurance companies will reimburse/pay for bariatric
surgery, you must follow a well-documented treatment path.
"Since many people cannot lose much weight no matter how
hard they try, and promptly regain whatever they do lose,
the vast amount of money spent on diet clubs, special foods
and over-the-counter remedies, estimated to be on the order
of $30 billion to $50 billion yearly, is wasted." (New England
Journal of Medicine)
Midsouth Bariatrics routinely performs bariatric surgery on patients in and around the Memphis area, including Missouri, Mississippi, Kentucky, and eastern Tennessee. Please contact us to learn more about your weight loss surgery options. We look forward to hearing from you.
