Efficacy of Non-Surgical Weight Loss Options
Published scientific reports document that non-operative methods alone have not been effective in achieving a medically significant long term weight loss in severely obese adults. It has been shown that the majority of patients regain all the weight lost over the next five years. The average medical weight reduction trial is a 10-12 week study with average weight loss of 2.5 kg. The use of anorectic medications has recently been advocated as a long term therapeutic modality in the management of what is clearly a chronic disease. In a nearly four year study, utilizing a two drug regimen of Phentermine and Fenfluramine, behavior modification, diet and exercise, the initial optimistic results have not been sustained, with a one third drop out rate and a final average weight loss of only three pounds in those who were followed for the four years of the study. This drug combination appears to have an unacceptably high association with cardiac valvular disease and has been withdrawn from therapeutic use because of these potentially life threatening sequelae.
Dietary weight loss attempts often cause depression, anxiety, irritability, weakness and preoccupation with food. The treatment goal for morbid obesity should be an improvement in health achieved by a durable weight loss that reduces life threatening risk factors and improves the performance of activities of daily living. Temporary fluctuations in body weight from calorie restricted diets should be avoided.
Exercise and Weight Loss
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 weight loss, 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 for weight loss. 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.
Diet and Behavioral 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): 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. It is for this reason that so many are turning to weight loss surgery as a permanent solution for extended weight loss.
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 weight loss surgery is your next option, it is important to understand that diet and behavior modification will be instrumental to sustained weight loss after your weight loss 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.
Over the Counter and 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).