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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,
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!
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
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
Cardiac Function
Stress Incontinence
Sleep Apnea
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
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
 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
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.