WLS Treatment for morbid obesity

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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, wasted. " (New England Journal of Medicine)