What are my Weight Loss Options?
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.
Weight Loss Surgery Options
The American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:
- Restrictive procedures that decrease food intake.
- Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.
Which Procedure is Right for You?
The most important step in weight loss surgery is getting all of the information you need about the various surgical options. Ultimately your surgeon and other physicians are your best resource for information about the procedure they will recommend to you. When you ask a question, make sure you understand the answer. Do not hesitate to ask for a clearer explanation given in simpler language. The decision to have a weight loss surgical procedure may take several visits to their office and consultation with more than one doctor. Ask your doctor for names of other patients who have had similar procedures and who are willing to discuss their experiences, good and bad, with you.
You may choose to research weight loss surgery on your own via the Internet or through your local library. As with any search for medical information, be sure that your sources are responsible recognized experts in the field you are investigating. An excellent resource for weight loss surgery is the American Society for Bariatric Surgery.
Although the results of weight loss surgery can be drastic, there are potential risks and complications. Before making your decision, you should be well informed. These steps are necessary if you are to give what is called "informed consent" for the procedure. Informed consent is a legal term meaning that a patient agrees that they have received and understood enough information about a procedure's benefits and risks to allow them to make a decision that is right for them. Your surgeon will require you to sign a consent form before performing your procedure. Before you sign a consent form, you should have a solid understanding of what is about to take place. You should know what you would need to do to live well after the operation. And you should be aware of the signs or symptoms of complications to look for which may occur after your surgery.
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.
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.
This procedure involves surgery on the stomach only (it is only a restrictive procedure) and does not involve the intestine (which would make it malabsorptive). It basically consists of making a stomach that looks like a pouch into a long tube, or “sleeve”. The sleeve gastrectomy procedure removes approximately 2/3 of the stomach, which provides for quicker sense of fullness and decreased the appetite. The smaller stomach sleeve restricts food intake by allowing only a small amount of food to be consumed in a single sitting. A small sleeve (or narrow tube) is created with a surgical stapler along the inside curve of the stomach, from the pylorus of the stomach up to the esophagus.
After the creation of the sleeve is completed, the remainder of the stomach is removed. The valve at the outlet of the stomach remains, which provides for the normal process of stomach-emptying to continue, which allows for the feeling of fullness. Internal incisions are typically closed with absorbable sutures (stitches that do need to be manually removed) while external incisions are closed with sutures or steri-strips; based on surgeon preference. The hospital stay averages 24-48 hours. Most patients return to normal activity in one to two weeks and full surgical recovery usually occurs in two to three weeks. As with all surgical procedures there are risks. Potential complications are perforation of the stomach/intestine or leakage, causing peritonitis or abscess, bleeding, infection, gastric or bowel obstruction, ulcers, vomiting and/or nausea are a common occurrence, often certain foods or improper foods are the cause. Food choices and vitamin supplements are lifelong changes.
Diet and 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.
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 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)
Laparoscopic or Minimally Invasive Surgery
For the last decade, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still "experimental." In fact, laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for several years. Although few bariatric surgeons perform laparoscopic weight loss surgeries, more are offering patients this less invasive surgical option whenever possible.
When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures.
The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. Other realized benefits with laparoscopy have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.
Laparoscopic procedures for weight loss surgery employ the same principles as their "open" counterparts and produce similar excess weight loss. Not all patients are candidates for this approach, just as all bariatric surgeons are not trained in the advanced techniques required to perform this less invasive method. The American Society for Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.