However, the guidelines do not recommend any bariatric procedure as preferable over the others for patients with severe obesity. FDA approves weight-management drug Qsymia. However, few trials have addressed this issue, and those performed thus far have had mixed results. In addition, the South Beach diet distinguishes between what are considered to be good and bad carbohydrates on the basis of their glycemic index. A specific goal has a much greater chance of being accomplished than a general goal does. Segmental bioelectrical impedance analysis:
Patient Screening, Assessment, and Expectations
The investigators found that Emerging data suggest that gastric pacing achieved by using implantable electrodes may have significant weight-loss effects. This outcome was initially discovered with the use of gastric pacemaker devices for gastroparesis in patients with diabetes. Other adjunctive procedures that may be performed but that have an unclear utility include visceral fat removal, omentectomy, subcutaneous fat panniculectomy, and large-volume subcutaneous fat liposuction.
Klein and colleagues indicated that liposuction in itself has no utility in improving cardiac risk factors among patients with obesity.
Some procedures, such as jaw wiring and insertion of a gastric balloon or a gastric wrap, are no longer popular because of their poor results compared with those of newer procedures and because of their high complication rates. Vagotomy has also declined in popularity, as the weight lost is typically regained within a few years.
The mortality rate associated with standard bariatric surgical procedures in an experienced center should not exceed 1. The surgical mortality rate is less than 0. In addition, gastric-specific operations can be associated with persistent vomiting and metabolic alkalosis. These operations are also more commonly associated with weight-loss failure and inadvertent splenectomy than are other surgical methods.
Malabsorptive procedures gastric bypass can lead to deficiency of thiamine, iron, vitamin D, and vitamin B Prevalences for adverse events with gastric resection procedures with or without bypass are approximately as follows [ ]:. Patients who receive bypass procedures are particularly prone to micronutrient deficiency states, especially of calcium, vitamin B, folate, and iron, as well as protein malnutrition.
Rare cases of postural hypotension and severe hypoglycemia from nesidioblastosis have been reported. Life-threatening hypoglycemia usually requires partial or total pancreatectomy, while severe postural hypotension that cannot be corrected with fludrocortisone and midodrine requires reversal of the surgery. The following are among the major specific complications associated with malabsorptive operations:. Failure rates based on weight loss are controversial. The overall failure rates for malabsorptive procedures are relatively low, although the need for reversal of the surgery because of resulting adverse effects appears to be relatively high.
Despite the morbidity and mortality risk associated with bariatric surgery, the few reports involving follow-up on patients undergoing these procedures suggest overall improvement in quality of life. Even more convincing than this finding is that most subjects who undergo these procedures, despite their postoperative complications and difficulties, indicate that they would undergo the procedures again if necessary. Inpatient evaluations of obese patients are important in the immediate postoperative period after antiobesity surgery.
In addition, hospitalization may be required for the management of major complications, such as clinically significant respiratory or cardiac compromise. Weight-management programs may be based in an outpatient or inpatient setting.
No rigorous evidence suggests that inpatient programs are necessarily superior to outpatient programs of similar structure and content, however. Inpatient programs may offer the convenience of easy access to patients and ease of monitoring, but they are not only expensive to run and difficult to reimburse, they also generally cause considerable disruption to the patients' regular routine.
In addition, they offer little guarantee of sustained effect. Because of the sheer prevalence of obesity and the anticipated worsening of the pandemic in the next few decades, prevention is by far the most desirable means to curb the medical and economic consequences of this condition.
However, few trials have addressed this issue, and those performed thus far have had mixed results. Given the global proportions of obesity, a concerted approach is needed to address the problem and should involve the development of a massive public health education program aimed at adults and children as a means of changing their eating, activity, and behavioral habits.
Cooperative efforts will also be needed among public health authorities, caterers, the fast food industry, and organizers of sports and outdoor games. Results of some public health education initiatives in Singapore and parts of China that are only now being evaluated suggest, as hoped, that such programs have the potential for reducing the incidence and prevalence of obesity and may also have an impact on the major comorbidities of obesity, such as type 2 diabetes and hypertension.
Until advances in gene therapy permit the alteration of genes that predispose to obesity, such programs are the only preventive options available. In select cases, consultation with a psychiatrist may be indicated. Psychiatric consultation should be sought for patients with psychiatric disorders and personality disorders eg, severe depression, mania, obsessive disorders that may be worsened by attempts at weight loss if not adequately treated and controlled.
As with the management of other chronic medical conditions eg, diabetes mellitus, hypertension, bronchial asthma , long-term success in the management of obesity is contingent on long-standing follow-up with the weight-loss program.
Experience obtained from the lifestyle intervention group of patients in the Diabetes Prevention Program and information drawn from the ongoing Diabetes Prevention Program Observation study have borne out the importance of regular follow-up. Patient visits may not need to occur as frequently during follow-up as during the initial weight-loss phase.
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Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight through diet and exercise or have serious health problems caused by obesity. There are different types of weight loss surgery. They often limit the amount of food you can take in. Some types of surgery also affect how you digest food and absorb nutrients. All types have risks and complications, such as infections, hernias, and blood clots. Many people who have the surgery lose weight quickly, but regain some weight later on.
For a great snack on the run, take a small handful of almonds, peanuts, walnuts, or pecans. Research shows that when people munch on nuts, they automatically eat less at later meals. Skip the apple juice and the applesauce and opt instead for a crunchy apple.
One reason is that raw fruit has more fiber. A Harvard study followed more than , people for a decade or longer. Yogurt, of all the foods that were tracked, was most closely linked to weight loss.
Yes, grapefruit really can help you shed pounds, especially if you are at risk for diabetes. Drinking grapefruit juice had the same results.
But grapefruit juice doesn't have any proven "fat-burning" properties -- it may just have helped people feel full. You cannot have grapefruit or grapefruit juice if you are on certain medications, so check the label on all your prescriptions , or ask your pharmacist or doctor. Load your shopping cart with lots of lean protein, fresh veggies, fruit, and whole grains, says food scientist Joy Dubost, PhD, RD.
The most important thing, when it comes to lasting weight loss, is the big picture of what you eat, not specific foods. Delicious foods that help you diet? It sounds too good to be true.