Options for Treatment
For anyone who has considered a weight loss program, there is certainly
no shortage of choices. In fact, to qualify for insurance coverage of
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 surgery is an option for
the majority of patients.
Weight Loss Surgery
Weight loss 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
Surgery 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.
Diet & Behavior Modification
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 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.
Exercise
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.
Over-the-Counter & Prescription Drugs
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 weight loss
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)
Am I Morbidly Obese?
Answering this question may give you the courage you need to take the
first step. Below are tools you can use to determine if you are morbidly
obese and potentially a candidate for weight loss surgery.
There are several medically accepted criteria for defining morbid
obesity. You are likely morbidly obese if you are:
- more than 100 lbs. over your ideal body weight, or
- have a Body Mass Index (BMI) of over 40, or
- have a BMI of over 35 and are experiencing severe negative
health effects, such as high blood pressure or diabetes, related to
being severely overweight
- unable to achieve a healthy body weight for a sustained
period of time, even through medically supervised dieting
Select your gender, and then move the red slider handles or select
your height and weight to calculate your BMI. The results of the BMI
calculations are displayed below. Note that these are approximate
values, and are intended to be used only as a rough guide.
Obesity-related health conditions are health conditions that, whether
alone or in combination, can significantly reduce your life expectancy.
A partial list of some of the more common conditions follows. Your
doctor can provide you with a more detailed and complete list:
Type 2 Diabetes. Obese individuals develop a
resistance to insulin, which regulates blood sugar levels. Over time,
the resulting high blood sugar can cause serious damage to the body.
High blood pressure/Heart disease. Excess body
weight strains the ability of the heart to function properly. The
resulting hypertension (high blood pressure) can result in strokes, as
well as inflict significant heart and kidney damage.
Osteoarthritis of weight-bearing joints. The
additional weight placed on joints, particularly knees and hips, results
in rapid wear and tear, along with pain caused by inflammation.
Similarly, bones and muscles of the back are constantly strained,
resulting in disk problems, pain and decreased mobility.
Sleep apnea/Respiratory problems. Fat deposits in
the tongue and neck can cause intermittent obstruction of the air
passage. Because the obstruction is increased when sleeping on your
back, you may find yourself waking frequently to reposition yourself.
The resulting loss of sleep often results in daytime drowsiness and
headaches.
Gastroesophageal reflux/Heartburn. Acid belongs
in the stomach and seldom causes any problem when it stays there. When
acid escapes into the esophagus through a weak or overloaded valve at
the top of the stomach, the result is called gastroesophageal reflux,
and "heartburn" and acid indigestion are common symptoms. Approximately
10-15% of patients with even mild sporadic symptoms of heartburn will
develop a condition called Barrett's esophagus, which is a pre-malignant
change in the lining membrane of the esophagus, a cause of esophageal
cancer. For more information on Heartburn, its causes and possible
cures, visit
www.heartburnhelp.com.
Depression. Seriously overweight persons face
constant challenges to their emotions: repeated failure with dieting,
disapproval from family and friends, sneers and remarks from strangers.
They often experience discrimination at work, cannot fit comfortably in
theatre seats, or ride in a bus or plane.
Infertility. The inability or diminished ability
to produce offspring.
Urinary stress incontinence. A large, heavy
abdomen and relaxation of the pelvic muscles, especially associated with
the effects of childbirth, may cause the valve on the urinary bladder to
be weakened, leading to leakage of urine with coughing, sneezing, or
laughing.
Menstrual irregularities. Morbidly obese
individuals often experience disruptions of the menstrual cycle,
including interruption of the menstrual cycle, abnormal menstrual flow
and increased pain associated with the menstrual cycle.U
For information to see if you qualify for the free surgery at
Buffalo General Hospital as part of the OHIP program - please call
1-866-878-7006 and be sure to mention VIP Docs for this special program.
Email
weightloss@vipdocs.com
