Weight Management

Weight Matters:
When Willpower Isn't Enough

When you're significantly overweight, nobody has to tell you that you'd probably be happier and healthier without the extra pounds. But what if the weight won't come off, no matter how hard you try?

"Willpower alone might not be enough for people who are significantly overweight," says Arthur Frank, M.D., medical director of the weight-management program at George Washington University in Washington, D.C. "If you've honestly tried to lose weight and failed, medications or surgery could be helpful under certain conditions."

Most medical weight-loss programs first try to help you make the long-term behavioral changes necessary to achieve and maintain a healthful weight. This includes exercising regularly and eating healthful food.

If you still remain seriously overweight, you and your doctor might discuss these other options.

Medications
"Prescription medications can be helpful, but they're not for everyone," warns Dr. Frank. Generally, drugs are recommended only if you have a Body Mass Index of 30 or higher, or have obesity-related health problems.

"All weight-loss drugs can have side effects, which usually can be managed," says Dr. Frank. "If your weight has become a risk factor, the benefits of the drug would probably be greater than the problems."

Surgery
Gastric surgery for weight control is a major procedure. It is appropriate for selected patients if their BMI is 40 or above, or if their BMI is 35 or above and they have serious medical conditions. Surgical options include:

Gastric banding and vertical banded gastroplasty (VBG), which are the most common operations for weight loss. These are known as restriction operations because they reduce food intake by limiting the amount of food the stomach can hold. In gastric banding, for example, a band is placed around the upper end of the stomach, creating a small pouch that catches the food, allowing it to drain slowly into the rest of the stomach. VBG is a variation that uses staples as well as bands to create the pouch.
Gastric bypass operations, which also create stomach pouches, reroute food directly into a lower portion of the intestine so less nutrients are absorbed. These procedures produce more weight loss, but they also involve higher risks of complications, including nutritional deficiencies such as anemia and osteoporosis as well as unpleasant effects after eating. Although drugs and surgery can promote weight loss, "they're not magic," reminds Dr. Frank. "They all require your active participation. If you continue with the same old habits, you can easily out-eat anything that a doctor can do with you or do for you. But, if you're willing to approach weight loss in a deliberate and thoughtful way, these approaches can make it easier."

About This Article
Publication: Vitality magazine; ; Publication Date: October 2001; Author: Jacob, Bonnie; Online Editor: Sinovic, Dianna; Online Medical Reviewer: Ratini, Melinda DO, MS; Date Last Modified: 9/29/2004