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Treatment Options
Introduction
The ability to maintain a healthy weight is one of the most powerful things someone can do to improver their long term health prospects. Unfortunately the body is very resistant to weight loss. Our body has a host of mechanisms designed to preserve our weight and maintain our hunger. This may have been helpful to us in ancient times when the ability to gain and maintain weight during times of starvation would have been very important. The ability to maintain an abnormally high weigh, however, does not serve us well in modern times. Food now is so readily available. There is also evidence that our more heavily food source may satisfy our hunger less well. It is also true that our patterns of energy expenditure have also changed over the years. Life is now more convenient, but this has the effect of decreasing the number of calories one burns when preforming daily activity.
Nonsurgical Treatment
For people who have a small amount of weight to lose, the combination of long term caloric restriction, increase energy burning by maintaining an active lifestyle, and behavioral modification to avoid mindless eating and augmenting activity is the preferred approach to weight loss. Various constituency diets or "fad" diets have been tried but they all suffer form the inability to maintain compliance with the program on a long term basis in order to maintain weight loss. Among the best studied approaches to weight loss are the "total meal replacement" programs, such as Medifast and Optifast. These programs involve eating ONLY a set number of provided meals or drinks. They work on three principals:
- Stimuli narrowing: By drastically limiting the types of foods and flavors associated with eating, there is a general de-emphasis of food and eating. This helps the patient think about food less and be less hungry.
- Clear food boundaries: We are all subject to a type of internal bargaining when we are trying to motivate ourselves to do something we really don't want to do. This usually goes something like this... "I was good at lunch so I can eat *** for dinner.... I went for a walk today so I can have desert." This type of internal bargaining is counter productive for losing weight and developing a healthier eating pattern. Meal replacement programs help with this by very clearly defining the boarder of what you can do and still be in compliance with the program.
- Low carbohydrate/Ketosis: Most meal replacement programs involve a marked reduction in carbohydrate intake. Often the carbohydrate intake is low enough to lead to some degree of ketosis. Ketosis is the situation where protein is converted to carbohydrate to be used by tissues that can not use fats as a fuel source. A by product of this conversion is ketones which when present in the blood act in the brain to decrease hunger. This phenomenon is the basis for the low carbohydrate approaches such as the "Atkins" and "South Beach" diets.
Increasingly people recognize the significant health benefits of weight reduction. Unfortunately, multiple studies have shown that for people with serious weight issues (BMI greater that 35) only 5 percent are able to maintain medically significant weight loss.
Surgical Treatment
There are a variety of commonly preformed weight loss surgeries. Among these are Adjustable Gastric Banding, Gastric Bypass, Sleeve Gastrectomy, Duodenal Switch, and Vertical Band Gastroplasty. At LifeShape, we are totally committed to Adjustable Gastric Banding. In designing our program to specifically cater to the needs of gastric banding patients, we are able to maximize weight loss success. Gastric banding has the advantages of being reversible, adjustable, minimally invasive, and carries the lowest operative risk.
Eligibility
Gastric band surgery is not right for everyone. Here are some of the things we will consider when evaluating your candidacy for obesity surgery. The BAND may be right for you if:
- Your BMI is 40 or higher or 30 or higher with medical conditions that are related to obesity. (BMI is calculated by dividing body weight (lbs.) by height in inches squared (in2) and multiplying that amount by 704.5). (Calculate your BMI)
- You have been overweight for more than 5 years.
- Your serious attempts to lose weight have had only short-term success.
- You do not have any other disease that may have caused your obesity.
- You are prepared to make substantial changes in your eating habits and lifestyle.
- You are willing to continue being monitored by LifeShape Advanced Bariatric Center of Florida.
- You do not drink alcohol in excess.
Contraindications - The LAP-BAND® System may not be right for you if:
- You have an inflammatory disease or condition of the gastrointestinal tract, such as severe esophagitis, or Crohn's disease.
- You have severe heart or lung disease that makes you a poor candidate for surgery.
- You have some other disease that makes you a poor candidate for surgery.
- You have a problem that could cause bleeding in the esophagus or stomach.
- This might include esophageal or gastric varices (a dilated vein).
- It might also be something such as congenital or acquired intestinal telangiectasia (dilation of a small blood vessel).
- You have portal hypertension.
- Your esophagus, stomach, or intestine is not normal (congenital or acquired). For instance you might have a narrowed opening.
- You have, or have experienced in the past, a stomach injury, such as a gastric perforation at or near the location of the intended band placement.
- You have cirrhosis.
- You have chronic pancreatitis.
- You are pregnant. (If you become pregnant after the LAP-BAND System has been placed, the band may need to be deflated. The same is true if you need more nutrition for any other reason, such as becoming seriously ill. In rare cases, removal may be needed.)
- You are addicted to alcohol or drugs.
- You have an infection anywhere in your body or one that could contaminate the surgical area.
- You are on chronic, long-term steroid treatment.
- You cannot or do not want to follow the dietary rules that come with this procedure.
- You have an autoimmune connective tissue disease such as systemic lupus erythematosus or scleroderma.
Please note: Since LifeShape is an outpatient adjustable gastric band program, we presently can not accommodate patients who have a weight higher than 450lbs or BMI greater than 70. Our patients must also be ambulatory and healthy enough to undergo outpatient surgery.
Not meant as a substitute for consultation with your doctor. Please read the disclaimer. Copyright 2002 to 2011 Mark Fusco All rights reserved
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