Managing obesity – by which I mean achieving a body mass index (BMI) of less than 30 – is a genuinely realistic goal for most obese patients. However, weight reduction strategies will vary according to whether you suffer from mild obesity, morbid obesity or super-obesity, as well as accompanying conditions (comorbidities). In all cases, be guided by your physician.
Obesity Reduction is a Top Health Priority
The surge in severe clinical obesity among adults and teenagers over recent years has also seen a significant increase in weight-related diseases, such as cardiovasular disease, type 2 diabetes and insulin resistance syndrome. As a result, obesity management has become a top health priority throughout the developed world and beyond.
Ways To Manage Obesity
There are three basic methods of obesity management.
- Bariatric surgery (eg. lap band, roux-en-Y gastric bypass)
- Diet, exercise, counseling, plus FDA-approved weight loss drugs
- Conventional dietary and exercise therapy with lifestyle counseling
Bariatric Surgery For Severe Obesity With Comorbid Conditions
This extreme solution for obesity is only available for certain candidates. As a rule, in order to qualify for gastric reduction surgery you must suffer from severe clinical obesity (BMI 40+), which typically means being 100+ pounds overweight (man) or 80+ pounds overweight (woman). Alternatively, a surgical operation may be indicated for obese individuals with BMI 35+ who also suffer from obesity-related health problems. Successful candidates must have tried and failed to lose weight by conventional means.
Post-Operative Lifestyle and Diet
It’s important to realise that bariatric surgery is only a beginning. Although both main types of bariatric operation (gastric banding, stomach bypass) greatly reduce calorie intake thus leading to significant initial weight loss, it is vital for patients to comply with post-operative dietary and exercise guidelines if they are to maintain this weight loss. For well-motivated patients, bariatric surgery can lead to significant and permanent weight reduction. Unhappily, the drastic diet regimen after surgery is beyond the capability of many bariatric patients, and weight regain after about 24 months is not uncommon.
Is Bariatric Surgery Suitable For You?
If you qualify for gastric surgery, then before commiting yourself pay close attention to the post-operative advice given to you by your bariatric surgeon or weight loss clinic. If you are satisfied that you can commit to the dietary changes required after surgery, this obesity management solution may be appropriate for you. Gastric bypass is a serious operation however, with the usual health risks, and should not be undertaken lightly. Some malabsorptive gastric bypass operations, like Biliipancreatic Diversion or Duodenal Switch cause lifelong nutritional deficiencies, which require constant nutritional supplementation.
If you are severely obese, then whether or not you qualify for bariatric surgery, your doctor may recommend drug treatment to reduce weight. The two most common FDA-approved drugs for long term treatment of obesity are orlistat (brand name Xenical) and sibutramine (brand name Meridia). Each works in a different way. Xenical is safer as it has no effect on the brain or nervous system. Instead, Xenical reduces intake of fat-calories by binding with food-fats in the gut, which are then excreted as normal. To minimize discomfort, a low-fat diet is mandatory. Meridia works on brain chemicals to reduce appetite. No specific diet plan (low-fat, low-carb) is required, however both types of medication require patients to control calorie intake by following calorie controlled eating plans, and take regular exercise.
Weight Loss Success Using Drugs
Typically, obesity drugs lead to greater weight reduction that diet and exercise alone. Exactly how much weight you can expect to lose is unclear, as clinical trials are not consistent on this point, but an extra weight loss of 2 pounds per month would not be unusual. Expect monthly prescription costs of about $200 or more.
Conventional Diet and Exercise With Support
This option includes medically-supervised weight loss programs administered by clinics or hospitals, as well as online diet programs and self-administered diets.
Medically Supervised Obesity Management Programs
Examples include Optifast and Health Management Resources. Both are available at numerous hospitals and health care clinics throughout America. Based on meal replacement diet plans, their obesity reduction programs also provide considerable support. This includes: counseling on behavior modification, physical exercise and problem-solving. Weight reduction typically averages 2-5 pounds a week, depending on patient motivation and compliance. Typical monthly costs are in the range $200-$300. Candidates may be screened before acceptance.
Online Weight Loss Programs
The key to obesity management is personal support. Without this, reducing weight from (say) 300 pounds to (say) 160 pounds is extremely difficult, and can be a long and lonely journey. Thus any online program which does not offer ongoing weight loss help is unlikely to work. e-diets are the market leaders in online diet solutions, although my own weight management program is extremely successful because of the encouragement and advice provided on my weight loss forum.