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Evaluation of Methods
Short Term Programs Short term programs include diet aids, prepackaged foods, medical treatment, behavioral modification and exercise. For people with clinically severe obesity, none of these has been shown to lead to permanent success, nor is there proof of success of any of the short term programs in combination. Over 95 percent of non-surgical methods are unsuccessful. In most cases, short term benefits last less than five years. Even worse, failure of short term programs often results in "overshoot," which is a relapse, resulting in a worsening of the weight profile. Drop out rates in dietary programs range as high as 80 percent. A maximum expected weight loss is only 20 to 40 pounds; and almost all weight is regained within five years, often with overshoot. While some programs are better than others, these programs are considered by the NIH to be largely ineffective even in combination with psychotherapy, exercise and behavioral modification. Some even tend to endanger the dieter with loss of lean body mass. In some cases diet and exercise alone have resulted in significant weight loss. Exercise, particularly aerobic forms (such as walking, running or swimming) are a useful adjunct to other treatment methods. Behavior modification or psychotherapy may result in short term weight loss. Unfortunately, most of the lost weight tends to be regained within five years. This approach has been proven ineffective in the long run when used by itself. Like exercise, it is a worthwhile, even necessary, component in combination with other methods. Drug therapy for obesity has not found broad support in the medical profession. This approach suppresses the appetite but the effects last only as long as the drugs are taken and have not been proven effective for clinically severe obesity. Amphetamines and thyroid drugs are unsafe and have potential for misuse. Drug therapy may have similar effectiveness to diet therapy but carries several additional problems, including the fact that its results are very temporary. A cure is rarely seen after drug therapy. Rebound weight gain is almost inevitable. Weight loss resulting from drug therapy tends to be very slow, but the rebound weight gain is rapid. Long Term Programs Long term programs which differ from the one supported by MU Health Care's Missouri Bariatric Services include other types of surgery, long term drug therapy, diet and exercise and psychotherapy, all in various combinations. Dietary change methods include both caloric restriction and alterations in the ratio of fat proteins and carbohydrates ingested. The key to any successful treatment is a lifelong commitment. We emphasize very strongly the most important factor in success is each patient's personal dedication to lifelong change in eating and exercise habits and to postoperative medical follow-up. |
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The National Institutes of Health (NIH)
concluded in 1991 that further research into drug therapy and non-surgical
treatment should be done. We cannot speculate what further non-surgical
methods or measures may evolve, or whether some of these may be
helpful. Nevertheless, before considering surgery, it is important
to explore all other treatment options. To ensure success, contraindications
to surgery must be carefully considered and a multidisciplinary
evaluation conducted prior to making a decision. Before describing
the MU Health Care Missouri Bariatric Services, let's look at the
other options.
