Non Operative Obesity Management

 

The goal of obesity treatment is to reach and stay at a healthy weight. This improves your overall health and lowers your risk of developing complications related to obesity. You may need to work with a team of health professionals — including a dietitian, bariatric counselor or a bariatric surgeon — to help you understand and make changes in your eating and activity habits.

The initial treatment goal is usually a modest weight loss — 5% to 10% of your total weight. That means that if you weigh 91 kgand have obesity by BMI standards, you would need to lose only about 4.5 to 9 kg for your health to begin to improve. However, the more weight you lose, the greater the benefits. All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your obesity severity, your overall health and your willingness to participate in your weight-loss plan.

 

Dietary changes

Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term.

 

Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight-loss success. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:

  • Cutting calories. The key to weight loss is reducing how many calories you take in. The first step is to review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
  • Feeling full on less. Some foods — such as desserts, candies, fats and processed foods — contain a large amount of calories for a small portion. In contrast, fruits and vegetables provide a larger portion size with fewer calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
  • Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils.
  • Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories.
  • Meal replacements. These plans suggest that you replace one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off.

Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets.

Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight — and keep it off — you have to adopt healthy-eating habits that you can maintain over time.

 

Exercise and activity

Increased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking.

To boost your activity level:

  • Exercise. People with obesity need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve.
  • Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day. A nice recommended goal is to try to reach 10,000 steps every day. Gradually increase the amount of steps to reach that goal.

 

Behavior changes

A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns.

Behavior modification, sometimes called behavior therapy, can include:

  • Counseling. Talking with a mental health professional can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Counseling can be one-on-one or in a group. More-intensive programs — those that include 12 to 26 sessions a year — may be more helpful in achieving your weight-loss goals.
  • Support groups. You can find mutual friends and understanding in support groups where others share similar challenges with obesity. Check with your doctor about the support group meetings.

 

Prescription weight-loss medication

Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. 

 

The main purpose of weight-loss medications, also known as anti-obesity medications, is to help you to stick to a low-calorie diet by stopping the hunger and lack of fullness signals that appear when trying to lose weight. Your doctor may recommend weight-loss medication if other diet and exercise programs haven't worked and you meet one of these criteria:

  • Your body mass index (BMI) is 30 or greater
  • Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea

Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects. Some weight-loss medications can't be used by women who are pregnant or by people who take certain medications or have chronic health conditions. You can discuss with the doctor regarding the available medications and the dosage appropriate for you. 

 

You'll need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.

 

Endoscopic procedures for weight loss

These types of procedures don't require any incisions in your skin. After you receive anesthesia, flexible tubes(Endoscopes) and tools are inserted through your mouth and down your throat into your stomach.

There are several different types of endoscopic procedures used for weight loss.

 

 One procedure involves placing stitches in your stomach to reduce its size and the amount of food you can comfortably consume. In another endoscopic procedure, doctors insert a small balloon into your stomach. The balloon is filled with water to reduce the amount of space available in your stomach. This helps you feel fuller faster.Another Procedure is where an injection is instilled all over the stomach which makes you feel less hungry and thereby cause weight loss. These procedures are usually approved for people with BMIs of 30 or above when diet and exercise alone have not been successful. The expected weight loss varies among procedures from 5% to 10% of total body weight loss.

 

Non-Surgical Treatment

The three major phases of any successful weight-loss program are:

Like all chronic medical conditions, effective management of obesity must be based on a partnership between a highly motivated patient and a committed team of health professionals, including the physician, psychologists, physical and exercise therapists, dieticians, and other sub specialists, depending on the co morbidities of the individual patient. However, they show short-term success, and for the morbidly obese, the results rarely last. For many, this can translate into what's called the "syndrome" in which the patients continually gain and lose weight with the possibility of serious psychological and health consequences.

 

When it comes to permanent weight loss, recent research reveals that conventional methods of weight loss generally fail. Patients on diet, exercise programs or medication lose about 10% of their body weight but tend to gain two-thirds of it in one year and almost all of it within five years. Another study found that patients in weight loss programs who were able to maintain their reduced weight after five years are less than 5%. People generally regain two thirds of the weight lost within a year, and they regain almost all of it within 5 years. If you are tired of trying all treatments without much success, you might explore the surgical option. It is the only proven method of achieving long-term weight control and also regress co-morbid conditions effectively.

  • A pre-inclusion screening phase involving identification of BMI, evaluation of co-morbidities like hormone deficiencies, metabolic syndromes and other diseases.
  • A definitive weight-loss program includes diet, exercise, life style changes and;
  • A maintenance phase, which can conceivably last for the rest of the subject's life but which must last for at least 2 years after the weight-loss program is completed.

 

Nutrition

Non-surgical treatment majorly involves nutritional counseling with or without usage of supplements to enhance the weight loss program. Management by nutrition and supplements being the pillars of weight loss and is highly individualistic. A reasonable goal for weight-loss in the setting of a nutrition based treatment program is approximately 1.0 -1.5 kg/wk. 

 

The concept that the weight-loss goal for each subject must be individualized and cannot be unilaterally based on standard weight-for-height diet norms is becoming increasingly apparent. One must consider the family's weight, as well as the patient's weight and cultural, ethnic, and racial background in setting individualized nutritional goals of weight loss. Consider these suggestions, and think about what other small changes might work for you.

  • Cut out the liquid calories, especially soda. This is important. Most calorie laden drinks are high in sugar. Your fruit juice might have a lot of vitamin C but it probably lacks fiber. Slowly eliminate sodas, juices, energy drinks, and other calorie filled liquids. They aren't very satisfying and will only keep you heavier. Replace liquid calories with water, water flavored with ginger/lemon, or herbal tea.
  • Eat only whole foods. Throw out the white bread, white rice, white sugar, and refined sugary cereals. Get rid of canned soups and concentrate on wholesome ingredients.
  • Don't think about counting calories.

 

Lifestyle Changes

The best way to start your weight loss program is to understand where you are going wrong in your lifestyle activity and alter it so that you start working towards weight loss the right way. Mere starving in the name of diet and gym will not help in long run. They might give you an initial satisfactory weight loss, but after few months you tend to lose energy and become weak rather than losing weight. You really need to be smart to work on your lifestyle and lose weight without much hard work.

 

The first and foremost change is to become more mobile. If you move around enough, you can reduce the risk of all lifestyle diseases and burn up to 500 calories per day without even dieting or hitting the gym. It requires you to rethink all your habits and find new, more active ways to get through the day. Other major issue is the timing of meals. Our body will have the least calorie-spending rate between 8 pm and 6 am. Also there will not be much of activity after you meal late in the night, which will not allow you to spend the calories taken in. 

 

If you can regularize your meals to the time when your body is at its peak metabolism potential, ie 7 am, 12 pm, 7 pm, you will burn up to 500 calories more than before without even moving a muscle. You will be surprised to hear even sleeping early can help you stay slim. The above lifestyle changes can add up to burning of 1500 calories along with an insensible loss of 500 calories, which accounts for the expenditure of almost all the calorie intake in a healthy Indian diet. This is simply how you go from being couch potatoes to muffin-top blasting fitness freaks.

 

Exercise

When it comes to successful and lasting weight loss, eating well is only part of the battle. Physical activity will help you inch closer to your goal by burning calories and building muscle. However, that's not the only reason to make exercise part of your daily life. 

 

Exercise also helps prevent many health conditions, decreases stress, and makes you feel better. The Centers for Disease Control and Prevention (CDC) encourages healthy adults to complete at least two hours and 30 minutes of moderate aerobic activity per week. Moderate aerobic activity includes many forms of exercise, such as brisk walking, using an elliptical machine, or swimming laps. Alternately, you can complete one hour and 15 minutes of vigorous aerobic activity per week, such as running or cycling.

 

It's best to spread your exercise out throughout the week. Aim to get 30 to 60 minutes of aerobic activity on most days. The CDC also recommends doing strength training, such as weightlifting or yoga, at least twice per week.

One excellent, widely available option is walking. You also have other options besides walking. Just make sure to start slowly and gradually build up your fitness level. 

 

Beginning an exercise program too quickly is a recipe for injury and could set you up for failure. The more you exercise, the less you need to reduce your food intake. By increasing your muscle mass, you increase your metabolism. When you replace fat with muscle, your body burns more calories at rest. In general, people who exercise regularly are healthier and get sick less often. Regular workouts can help you prevent and manage many health problems, including:

  • high blood pressure
  • high cholesterol
  • cancer, including colon and breast cancer
  • type 2 diabetes
  • rheumatoid arthritis

The use of laparoscopy for performing these procedures is the biggest advancement in bariatric surgery. The laparoscopic procedure is a minimally invasive procedure where the surgery is performed through small incisions. Patients experience minimal discomfort and rapid recovery with the process.

 

Indications

Weight-loss surgery has proven to be a successful method for the treatment of morbid obesity. Due to the continuous evolution of surgical principles, today there are multiple options that enable both patients and surgeons to choose the procedure of choice according to their convenience. Some of the surgical procedures performed to treat obesity include:

  • Intragastric balloon
  • Gastric banding
  • Sleeve gastrectomy
  • Roux en Y gastric bypass
  • Mini Gastric Bypass
  • Other novel procedu
  • Cosmetic procedures such as liposuction, and tummy tuck

Surgical Treatment

According to international accepted criteria, the indications for obesity surgery are

  • BMI > 40 kg/m2
  • BMI>35 with pronounced co-morbidities.
  • Failed non-surgical attempts at weight reduction over a period of one year
  • Absence of surgical contraindication or concomitant disease.
  • Age between 18 and 65 years

With the change in the geographic nature of obesity based on food, lifestyle and genetic make-up of patients, modification to international accepted criteria were made by IFSO-APC, IDF & OSSI by way of reducing the BMI by 2.5 points. Nevertheless, limits to the indication for surgery continue to be changing. For example, diabetes specialist suggests a BMI of 32 kg/m2 in patients with type 2 diabetes as an indication for surgery. The general exclusion criteria involve organ-related cause of obesity (endocrine disease), severe mental disorder (schizophrenia, florid drug addiction or severe depression), severe concomitant disease (cancers), patients under 18 or over 65 years of age, and a high surgical risk (relative contraindication). With introduction of a recent criteria, adolescent population with high risk for normal life due to obesity can be taken as an criteria for surgical indication.

 

Contraindications

Bariatric surgery is not recommended in patients with:

  • Inflammatory diseases such as Crohn's disease
  • Severe heart, lung or liver diseases
  • History of auto immune diseases such as scleroderma or systemic lupus erythematous
  • Alcohol or drug addiction
  • Pregnancy
  • Chronic pancreatitis (inflammation of the pancreas)
  • Presence of Infection.

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