Sizing Things Up – Questions and Answers About Various Weight-loss Options
Q. I have tried unsuccessfully in the past to lose weight on my own. Why is it so hard?
A. Because food tastes good. Calories in minus calories out equals weight gained or lost. So, to lose weight, you have to burn more calories than you take in to lose weight. Unfortunately, that is harder to accomplish than you think.
Q. Could there be a medical reason why I am not losing the weight I want to?
A. Certainly. If your weight-loss efforts have been unsuccessful, you should ask your primary-care provider to order a medical workup to exclude any diseases that can cause weight gain.
Q. What is more important, portion control or eating healthy food selections?
A. Both are important in reducing calories taken in during a meal, and both can contribute to weight loss in conjunction with regular exercise to help burn calories.
Q. I know that they say losing weight involves a combination of healthy eating and exercise, but I just can’t see myself working out at a gym. What are my options?
A. You do not have to visit a gym to do calorie-burning exercise. Home exercise equipment can be very helpful, and although expensive, it is a one-time investment in making home exercise possible. If there are medical reasons why exercise to burn calories is not possible, then a consultation with an exercise physiologist (most gyms have one on staff or can refer you) should be considered.
Q. What is my best approach to losing weight? Should I consult with my primary-care physician? Some of my friends have had success seeing a dietitian, others by participating in programs like Weight Watchers. Some even see a weight-loss physician. How helpful are these?
A. All can be helpful, but the most important first step is a recognition that weight loss is necessary along with a commitment to making meaningful changes in diet and exercise to arrive at that goal. Yes, a consultation with a primary-care physician is very important. Dietitians play critical roles in teaching us how to eat better, and they can teach strategies to change the way that you eat to maximize weight loss.
Q. I’m reluctant to have surgery, but my wife’s friend recently had gastric bypass surgery with considerable success. Is this surgery available to anyone, and how does it work?
A. No, gastric bypass surgery is not available to everyone. There is a set of criteria developed by the National Institutes of Health that defines who can qualify for weight-loss surgery. In brief, patients who are about 100 pounds over their ideal body weight qualify for weight-loss surgery (sometimes less than that if there are certain diseases caused by obesity that are present). Gastric bypass works by limiting the size of the stomach to about that of a golf ball, and then sending food further downstream in the intestines, making you digest less efficiently. So, the benefits are that you will be eating smaller portions and digesting fewer calories.
Q. My wife’s friend had to wait a while before the surgery. Is that because there are so many people having it?
A. Think of weight-loss surgery as similar to a marathon: very few people can just go out and run 26 miles without first training for the event. The same holds true for weight-loss surgery. You have to train for it by making dietary modifications, exercising, making behavioral changes, attending support groups, and more.
Q. Are there other types of surgery available other than gastric bypass, and what do they involve?
A. There are two other types of weight-loss surgery: gastric banding and sleeve gastrectomy. Both are different than gastric bypass in that they do not involve the intestines. In banding — which is fading in popularity due to mediocre results and a relatively high rate of revisional surgeries — an adjustable band is placed around the top of the stomach to slow down the transit of food into the remainder of the stomach. This is designed to make you feel full faster, resulting in eating reduced portions. In sleeve gastrectomy, which has become the most popular option in the United States, the stomach is cut down to a much narrower size — think of a watermelon being reduced to a banana. That causes you to get full faster and to eat smaller portions. It also seems to reduce hunger.
Q. What are the risks and success rates?
A. There is risk in any surgery. Overall, deaths have dropped to about 1 in 1,000 patients nationwide. Complication rates are lowest for sleeve gastrectomy and highest for gastric bypass and higher in gastric banding patients. Weight-loss rates range from 30-40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of excess body weight in gastric banding to 50-55{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in sleeve gastrectomy and 55-60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in gastric bypass. v
Dr. John Romanelli is medical director of Robotic and Bariatric Surgery Programs at Baystate Medical Center.
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