Weight Management Health Article

Surgical

As of 2003, bariatric surgery is the most successful approach to weight management for people who are morbidly obese (BMI of 40 or greater), or severely obese with additional health complications. Surgical treatment of obesity usually results in a large weight loss that is successfully maintained for longer than five years. The most common surgical procedures for weight management are vertical banded gastroplasty (VBG), sometimes referred to as "stomach stapling," and gastric bypass. Vertical banded gastroplasty works by limiting the amount of food the stomach can hold, while gastric bypass works by preventing normal absorption of the nutrients in the food.

Complementary and alternative medicine (CAM) approaches

Some forms of complementary and alternative medicine are beneficial additions to weight management programs.

MOVEMENT THERAPIES. Movement therapies include a number of forms of exercise, such as tai chi, yoga, dance therapy, Trager work, and the Feldenkrais method. Many of these approaches help people improve their posture and move their bodies more easily as well as keeping active. Tai chi and yoga, for example, are good for people who must avoid high-impact physical workouts. Yoga can also be adapted to a person's individual needs or limitations with the help of a qualified teacher following a doctor's recommendations. Books and videos on yoga and weight management are available through most bookstores or the American Yoga Association.

SPIRITUAL AND RELIGIOUS PRACTICE. Prayer, meditation, and regular religious worship have been linked to reduced emotional stress in people struggling with weight issues. In addition, many people find that spiritual practice helps them to keep a healthy perspective on weight management, so that it does not crowd out other important interests and concerns in their lives.

HERBAL PREPARATIONS. The one type of alternative treatment that people should be extremely cautious about making part of a weight management program is over-the-counter herbal preparations advertised as "fat burners," muscle builders, or appetite suppressants. Within a two-week period in early 2003, the national media carried accounts of death or serious illness from taking these substances. One is ephedra, a herb used in traditional Chinese medicine that can cause strokes, heart attacks, seizures, and psychotic episodes. The other is usnic acid, a compound derived from lichens that can cause liver damage.

Normal results

As of 2003, much more research needs to be done to improve the success of weight management programs. A position paper published by the American Dietetic Association in the summer of 2002 summarizes the present situation: "Although our knowledge base has greatly expanded regarding the complex causation of increased body fat, little progress has been made in long-term maintenance interventions, with the exception of surgery." Most adults in weight maintenance programs find it difficult to change eating patterns learned over a lifetime. Furthermore, their efforts are all too often undermined by friends or relatives, as well as by media messages that encourage overeating or the use of food as a mood-enhancing drug. More effective weight maintenance programs may well depend on broad-based changes in society.

BOOKS

American Psychiatric Association. "Eating Disorders." In Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.

Brownell, Kelly, Ph.D., and Judith Rodin, Ph.D. The Weight Maintenance Survival Guide. Dallas, TX: Brownell & Hager Publishing Co., 1990.

Flancbaum, Louis, M.D., with Erica Manfred and Deborah Biskin. The Doctor's Guide to Weight Loss Surgery. West Hurley, NY: Fredonia Communications, 2001.

Hornbacher, Marya. Wasted: A Memoir of Anorexia and Bulimia. New York: Harper Perennial Editions, 1999.

" Nutritional Disorders: Obesity." Section 1, Chapter 5 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, M.D., and Robert Berkow, M.D. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Pelletier, Kenneth R., M.D. "CAM Therapies for Specific Conditions: Obesity." In The Best Alternative Medicine, Part II. New York: Simon & Schuster, 2002.