Monday, February 14, 2011

Diet, Exercise, Lifestyle Modification Before Bariatric Surgery

With overweight and obesity continuing to be worldwide problems, measures to deal with the problems are gaining an increasing amount of attention. And some of the guidelines that health care professionals commonly use to advise overweight individuals may receive modification. Usually, weight loss recommendations are guided, to a great extent, by Body Mass Index (BMI). For example, if the overweight person has a BMI less than 35, bariatric surgery is usually not recommended. Instead, the overweight person is told to follow a low calorie diet, increase physical activity, and modify his or her lifestyle.

But there is new thinking associated with bariatric surgery. The FDA is considering lowering the guidelines for lap-band bariatric surgery, as we recently stated on our blog. There is an opinion, held by some, that weight loss surgery is a better weight loss option than non-surgical approaches. And this opinion appears to be reinforced by some practices of the Tennessee Medicaid program, TennCare.

This state insurance program will cover lap-band surgery if a person qualifies. However, the program will not cover weight loss nutritional counseling. To some, this seems illogical, since counseling for overweight persons with a BMI between 30 and 35 is likely a safer, and less expensive approach to weight loss than weight loss surgery.

After the FDA's thoughts on possibly lowering the lap-band surgical guidelines were made known, the American Society of Bariatric Physicians (ASBP) issued a press release. The release suggests that it is inappropriate for the FDA to reject weight loss drugs, while seeming to embrace weight loss surgery, which is a more drastic approach to weight loss.

While it is true that people achieve weight loss success with bariatric surgery, diet, exercise and lifestyle modification can also lead to weight loss success.

According to Dr. Rena Wing, a speaker at the 2010 Obesity Society meeting, and one of the founders of the National Weight Control Registry, on average, individuals in the Registry maintained a seventy pound weight loss for more than six years. Further, Dr. Wing has outlined activities that these individuals engage in to maintain the weight loss. A low calorie, low fat diet, along with life style modification are significant components of the weight loss and weight maintenance activity set.

Therefore, perhaps the FDA should place more emphasis on diet, exercise and lifestyle modification, before lowering the bariatric surgery guidelines. The agency should point out non-surgical weight loss success, such as that demonstrated by the National Weight Control Registry.

And medical weight loss practitioners should work to change the mindset of stakeholders such as insurers and others who control or influence health care purse strings. These stakeholders should be shown the evidence supporting diet, exercise and modified-lifestyle programs that lead to successful long term weight loss and weight loss control.

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