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."
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. Patients who have had weight loss surgery and are benefiting from its results report improvements in their quality of life, social interactions, psychological well-being, employment opportunities and economic condition.
Diet & Behavior Modification
There are literally hundreds of diets available. 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 VLCDs lose significant amounts of weight. However, after returning to a normal diet most regain the lost weight in under a year.
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 and you are now considering surgery as your next option then 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 with losing weight - complying with diet and behavior modifications required by most surgeons will determine your ultimate success.
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 will increase your chances of long-term 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. There are ways to get started and here are only a few examples:
- Park at the far end of parking lots and walk
- Take the stairs instead of the elevator
- Turn off the television
- Swim or participate in low-impact water aerobics
- Ride an exercise bike
The CNY Bariatric Surgery Center has the unique opportunity to offer our patients the option of enrolling in the Vitality! Fitness Programs at the Institute for Human Performance (IHP) in Syracuse NY, which has proven to be an effective alternative for those who are not able to do traditional exercise.
Water Excercise Class led by Carol Sames, Ph.D., in the IHP pool - one of many exercises offered through the Vitality! Fitness Programs
If you are unable to take advantage of the Vitality! Fitness Programs or would prefer to go to a more traditional gym environment especially one that is closer to where you live, then we recommend that you find one that offers a non-intimidating atmosphere. In the Syracuse area where our clinic is located there are several gyms to choose from. Some of our clinical staff have worked one-on-one with members of the fitness staff at Champions Fitness Center to help educate them about working with Bariatric patients in particular.
Over-the-Counter & Prescription Drugs
New over-the-counter and prescription weight loss medications have been introduced recently. Some people have found medication helpful 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 stops when the patient stops taking the medication and is subsequently followed by weight re-gain.
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)
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 a 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 (BMI) 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 follow 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).