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Treatment Options of Obesity 1. Lifestyle 2. Medical 3. Surgical Lifestyle Treatments for Weight Loss Successful weight loss and maintenance requires a three-pronged approach: 1. Changing behavior patterns 2. Making dietary adjustments 3. Increasing physical activity Changing Behavior Patterns Behavior Modification – an ability to alter lifelong attitudes toward diet and exercise may one of the greatest, but most important, challenges Important to set : 1. Realistic goals 2. Seek support 3. Make changes gradually 4. Become aware of “unhelpful” behaviors 5. Evaluate “triggers” and relationship with food 6. Practice, practice, practice Making Dietary Adjustments Diet - derived from the Greek word “diaita”, which means “way of living”. 1. Realistic energy level – at least 10 kcals/lb./day 2. Choose foods with low energy density 3. Cut down on sugar added to foods - sugar is the #1 food additive in the U.S. accounting for 16% of all calories. 4. Practice portion control – “super-sizing”. 5. Consider the calories in beverages Energy Density • By selecting the low-fat version, a person can enjoy the same amount of tuna for fewer calories. Copyright 2005 Wadsworth Group, a division of Thomson Learning Increasing Physical Activity Physical activity – crucial to success! Why? 1. Burns energy 2. Speeds metabolism 3. Helps control appetite 4. Reduces stress; improves self-esteem What & How Much? 1. Essential activity is enjoyed & suits lifestyle 2. Aerobic exercise encouraged but strengthening & flexibility important too Think FIT – F=frequency, I=intensity, T=time Physical Activity – Activity and energy expenditure – Activity and metabolism – Activity and body composition – Activity and appetite control – Activity and psychological benefits – Choosing activities – Spot reducing Copyright 2005 Wadsworth Group, a division of Thomson Learning Medical Treatments for Obesity More aggressive strategies for those with high medical risks &/or severe obesity 1. Very-Low-Calorie (<800 kcals/day) and Low-Calorie diets – must include protein & vitamin/mineral supplements to preserve muscle mass and prevent nutritional deficiencies; require close medical supervision, behavioral counseling, and instruction for changing eating pattern once food is reintroduced 2. Medications – drug therapy helps suppress appetite, increase satiety, block the digestion and absorption of dietary fat, or alter the body’s energy balance; anorectics do not magically “melt away” pounds but do make it easier to adhere to lifestyle changes and provide the opportunity to alter behaviors; not without risk & may be needed long-term 3. Herbal supplements – popular but surprisingly little reliable information about their safety and effectiveness Surgical Treatments for Obesity Bariatric surgery has been recognized by the NIH as an accepted and effective approach that provides consistent, permanent weight loss for clinically severe obese people or for obese people with significant complications of obesity. Traditional nonsurgical treatment options, lifestyle and medical, are often not effective long term for obese people Improves and – in some cases - resolves comorbidities Weigh benefits of surgery vs. the risks of staying morbidly obese % Medical Co-Morbidities Resolved after Bariatric Surgery Type 2 Diabetes 95% Hypercholesterolemia 97% Hypertension 92% GERD 98% Cardiac Function 95% improvement Stress Incontinence 87% Osteoarthritis 82% Sleep Apnea 75% Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass roux-n-y-500 patients. Obes Surg 2000. And others. Surgical Procedures Purely restrictive procedures – normal digestion & absorption but create the feeling of fullness Vertical Banded Gastroplasty – the upper stomach is stapled vertically creating a small pouch separated from the rest of the stomach by a band or ring restricting the flow of food Laparoscopic Adjustable Gastric Banding – an adjustable silicone band divides the stomach into one small & one large portion Combination restrictive & malabsorptive procedure Gastric Bypass Roux-en-Y– considered the “gold standard” - a small upper gastric pouch is completed separated from the rest of the stomach and a segment of the small intestine is rerouted to connect directly to the gastric pouch Surgical Procedures Copyright 2005 Wadsworth Group, a division of Thomson Learning How Does the Surgeries Work? Surgery factors: restriction of meal size “dumping syndrome” some malabsorption decreased appetite There are side effects and risks with all three procedures life-long medical care is required. Patient Selection Criteria for Bariatric Surgery Surgery indicated in patients with: BMI of 40 or over BMI of 35 or higher with significant comorbidity Long-standing history of obesity Multiple unsuccessful attempts to lose weight using nonsurgical methods Ability to comply with dietary and behavioral changes as recommended by the weight management team Who Is a Surgical Candidate? Meets NIH criteria No endocrine cause of obesity Acceptable operative risk Understands surgery and risks Absence of drug or alcohol problem No uncontrolled psychological conditions Consensus after multidisciplinary team evaluation: Primary care clinician, bariatrician, surgeon, psychologist, dietitian, exercise physiologist Well-informed, motivated, and dedicated to lifestyle change and long-term follow-up All three treatment options require a three-pronged approach for successful weight loss and maintenance : 1. Changing behavior patterns 2. Making dietary adjustments 3. Increasing physical activity Conclusion In theory, weight control is a simple matter of balancing energy intake (the calories supplied by food) with energy output (the calories expended by physical activity and metabolism). In practice, the task is clearly not that simple!! While the basic principle of energy balance remains true, genetics, metabolism, and environment are important mechanisms controlling how much a person eats and how their body uses and stores energy.