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Obesity
Treatment

There are countless weight-loss strategies available but many are ineffective and short-term, particularly for those who are morbidly obese. Among the morbidly obese, less than 5 percent succeed in losing a significant amount of weight and maintaining the weight loss with non-surgical programs — usually a combination of dieting, behavior modification therapy and exercise.

People do lose weight without surgery, however, particularly when they work with a certified health care professional to develop an effective and safe weight-loss program. Most health insurance companies don't cover weight-loss surgery unless you first make a serious effort to lose weight using non-surgical approaches.

Many people participate in a combination of the following therapies.

Dietary Modification

Many of us have tried a variety of diets and have been caught in a cycle of weight gain and loss — "yo-yo" dieting — that can cause serious health risks by stressing the heart, kidneys and other organs.

Ninety percent of people participating in all diet programs regain the weight they've lost within two years. For people who have weight-loss surgery, dieting is an instrumental part of maintaining weight loss after surgery.

If you decide to go on a diet, we recommend that you work with a health professional who can customize a diet to meet your needs. A diet should greatly restrict your calorie intake, but maintain your nutrition. Calorie-restrictive diets fall into two basic categories.

  • Low calorie diets (LCDs) are individually planned to include 500 to 1,000 calories a day less than you burn.
  • Very low calorie diets (VLCDs) typically limit intake to only 400 to 800 calories a day and feature high-protein, low-fat liquids.

See information on the Weight Management Program at UCSF Medical Center.

Behavior Modification

The goal of behavior modification therapy is to change your eating and exercise habits to promote weight loss. Examples include:

  • Setting realistic weight loss goals — short term and long term.
  • Recording your diet and exercise patterns in a diary.
  • Identifying high-risk situations and avoiding them.
  • Rewarding specific actions, such as exercising for a longer time or eating less of a certain type of food.
  • Adopting realistic beliefs about weight loss and body image.
  • Developing a support network, including family, friends and co-workers, or joining a support group that can help you focus on your goal.

Although some people experience success with behavior modification, most patients achieve only short-term weight loss for the first year. If you plan on having weight-loss surgery, behavior therapy and dieting will be instrumental in helping you maintain your weight loss after surgery.

Surgery is a tool to get your body to start losing weight. Diet and behavior modification will determine your ultimate success.

Exercise

Exercise greatly increases your chance of long-term weight loss. It is a key component for any long-term weight management program, particularly weight-loss surgery.

Research shows that when you reduce the number of calories you consume, your body reacts by slowing your metabolism to burn fewer calories, rather than promote weight loss. Daily physical activity can help speed up your metabolism, effectively reducing the "set point" — a sort of thermostat in the brain that makes you resistant to either weight gain or loss — to a lower natural weight.

Starting an exercise program can be intimidating if you're morbidly obese. Your health condition may make any level of physical exertion extremely difficult. But you can learn strategies to help you start a realistic exercise routine. The following strategies can help you start exercising and can be incorporated into your daily routine.

  • Park your car at the far end of parking lots and walk through them. Walking is considered one of the most effective forms of exercise. You can start slowly and build up over time.
  • Reduce the time you spend watching television.
  • Ride an exercise bike.
  • Swim or participate in low-impact water aerobics.
  • Take the stairs instead of the elevator.
  • Walk briskly for five minutes in the morning and five minutes in the afternoon.

Medications

A variety of over-the-counter and prescription weight loss drugs are available. Some people find these drugs help curb their appetites. 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, approved by the U.S. Food and Drug Administration (FDA) for treating obesity, include:

  • Beta-methyl-phenylethylamine (Fastin) — This is a stimulant that increases fat metabolism.

  • Orlistat (Xenical) — This drug works by blocking about 30 percent of dietary fat from being absorbed. Alli is a lower-dose, over-the-counter formula of the same medication.

  • Phentermine — Phentermine, an appetite suppressant, has been available for many years. It is half of the "fen-phen" combination that remains available for use. The use of phentermine alone has not been associated with the adverse health effects of the fenfluramine-phentermine combination.

  • Sibutramine (Meridia) — This is an appetite suppressant approved for long-term use.

Medications are an important part of the morbid obesity treatment process but weight-loss drugs can have serious side effects. We recommend that you visit a certified health care professional who can prescribe appropriate medications. Before insurance companies will reimburse you for weight-loss surgery, you must follow a well-documented treatment plan that typically includes medications.

Surgery

Many people ,who are morbidly obese and who have been unsuccessful in losing and keeping off the weight, opt for bariatric or weight-loss surgery.

Bariatric surgery, which involves sealing off most of the stomach to reduce the quantity of food you can consume, can be an effective means for morbidly obese people to lose weight and maintain that weight loss.

To be considered for weight-loss surgery, you must meet at least one of the following qualifications:

  • Be more than 100 pounds over your ideal, recommended body weight.

  • Have a body mass index (BMI) of 40 or higher (20 to 25 is considered a normal). BMI is a number based on both your height and weight. Surgery may be considered with a BMI as low as 35 if your doctor determines that there's a medical need for weight reduction and surgery appears to be the only way to accomplish the targeted weight loss. (Calculate your BMI.)

To qualify for surgery, you must complete a medical and psychological pre-evaluation process, and show how that you are committed to long-term, follow-up care after surgery. Most surgeons require that you demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of your life.

The UCSF Bariatric Surgery Center has performed surgical weight loss procedures since 1996. Various procedures involve different risks and advantages. During your initial consultation, your surgeon will discuss in detail the different options available to you, along with their associated risks and advantages.

The most common bariatric surgeries are "restrictive" procedures that reduce the size of the stomach and limit the calories you can consume.

Learn more about bariatric surgery, and the advantages and disadvantages of each procedure.

Reviewed by health care specialists at UCSF Medical Center.

Related Information

UCSF Clinics & Centers

Gastroenterology

Bariatric Surgery Center
400 Parnassus Ave., Sixth Floor, Room A-655
San Francisco, CA 94143-0338
Phone: (415) 353-2804
Fax: (415) 353-2505
Appointment information

Obesity and Weight Management
1701 Divisadero St., Suite 500
San Francisco, CA 94143-0320
Phone: (415) 353-2105
Fax: (415) 353-7901
Appointment information