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Obesity and Weight Management

Need to lose 125 lbs, what about surgery?

03/02/2007

Question:

I am a 36 year old, white, female. Over the past 7 years my weight has been steadily increasing. I have tried different diets, working out, getting more rest, etc. My TSH is normal, so I should theoretically be able to lose. Nothing I`ve tried seems to work over the long-term, but I am inconsistent with dieting (holidays, hectic scheduling) and exercise (injuries and pain issues). At this point, I am wondering if I should consider surgery or try different tactics in my weight loss efforts? Do you have any diets that you think are especially effective, easy to maintain, and tips for staying motivated? Thanks very much.

Answer:

As you’ve found from your experience, dieting or life style modification can be frustrating at times. Couple this with occasional lapses (holidays) and other health problems (chronic pain) and weight loss efforts can seem insurmountable. However, I’m sure you’re aware that the health benefits of shedding excess weight are worth the effort. But how to do it? Energy in (food) and energy expenditure (burning calories) is still the tried and true method of weight loss. A number of options are still available to you.

First, utilizing a “diet” is doomed to fail. People can’t stay on “diets” the rest of their life. However, choosing healthy foods, healthy preparation, and reduced portion sizes are key. If you’ve not consulted with a dietitian, consider doing so. Second, combining a weight loss medication to improved dietary habits is also very helpful. A number of medications are on the market that may be useful to you. However, certainly consult with your primary care provider to discuss the medication options. Often the combined forms of treatment (lower calorie intake, increased activity, and medication) make the difference. Third, I might add that picking an activity that does not re-injure you or exacerbate your pain is important. Water aerobics are useful because there is buoyancy and little impact on joints. Additionally, coping with chronic pain, as well as struggling with excess weight, can lead to mood changes. If depression is an issue, that may be the first order of business to treat and then focus on the weight and pain.

Finally, weight loss (bariatric) surgery would be the most severe treatment. Programs that offer this option observe guidelines for considering potential candidates. These may include a Body Mass Index (BMI) of 35 or greater, past failures in consistent weight loss efforts, psychological stability, no current substance abuse, and strong motivation to adhere to the recommendations of the program. Remember that undergoing bariatric surgery requires significant behavioral changes in how and what one eats.

You also asked how to maintain motivation. There are two questions you can ask yourself.

Success comes most often to those who have internal reasons to change behaviors. That is, you are doing it for you, for your health, for your wellbeing; not for the clothing size, what others think of you, or other external reasons. Regarding the second question, if past attempts at weight loss have not been successful consider why you chose those options and consider if a different option may be more reasonable for you. Also, do you have other people who are supportive of your efforts?

Best wishes for success.

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Response by:

Gerald J Strauss, PhD Gerald J Strauss, PhD
Clinical Assistant Professor of Medicine
School of Medicine
Case Western Reserve University