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 nonsurgical 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 most 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 2002, approximately 80,000 weight loss surgical procedures were performed and why the American Society for Bariatric Surgery estimates that 150,000 weight loss surgical procedures will be performed in 2003.
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 Exercise Over-the-Counter & Prescription DrugsWeight 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 (see Life After Surgery).
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 surgen, or people in your 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)