For anyone who has considered a Weight-loss program, there is certainly no shortage of choices. In fact, to qualify for insurance coverage of Weight-loss surgery, many insurers require patients to have a history of medically supervised Weight-loss efforts.

Most nonsurgical Weight-loss programs are based on some combination of diet/behavior modification and regular exercise. Unfortunately, even the most effective interventions have proven to be effective for only a small percentage of patients. It is estimated that less than 5% of individuals who participate in non-surgical Weight-loss programs will lose a significant amount of weight and maintain that loss for a long period of time.

According to the NIH, more than 90% of all people in these programs regain their weight within one year. Sustained Weight-loss for patients who are morbidly obese is even harder to achieve. Serious health risks have been identified for people who move from diet to diet, subjecting their bodies to a severe and continuing cycle of Weight-loss and gain known as "yo-yo dieting."

The fact remains that morbid obesity is a complex, multifactorial chronic disease

For many patients, the risk of death from not having weight-loss surgery is greater than the risks from the possible complications of having the procedure.

That is the key reason that in 2000, approximately 40,000 Weight-loss surgical procedures were performed and why the American Society for Bariatric Surgery estimates that 50,000 weight-loss surgical procedures were performed in 2001. Patients who have had the procedure and are benefiting from its results report improvements in their quality of life, social interactions, psychological well-being, employment opportunities and economic condition.

In clinical studies, candidates for the procedure who had multiple obesity-related health conditions questioned whether they could safely have the surgery. These studies show that selection of surgical candidates is based on very strict criteria and surgery is an option for the majority of patients.

Weight-loss surgery
Diet & behavior modification
Exercise
Over-the-counter & prescription drugs

Weight-loss surgery 
Weight-loss surgery is major surgery. Its growing use to treat morbid obesity is the result of three factors:

Surgery should be viewed first and foremost as a method for alleviating debilitating, chronic disease. In most cases, the minimum qualification for consideration as a candidate for the procedure is 100 lbs. above ideal body weight or a Body Mass Index of 40 or greater. Occasionally a procedure will be considered for someone with a BMI of 35 or higher if the patient's physician determines that obesity-related health conditions have resulted in a medical need for weight reduction and, in the doctor's opinion, surgery appears to be the only way to accomplish the targeted Weight-loss. In many cases, patients are required to show proof that their attempts at dietary Weight-loss have been ineffective before surgery will be approved. More important, however, is the commitment on the part of the patient to required, long-term follow-up care. Dr. Thomas requires patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight-loss surgery (see Life After Surgery).

Diet & Behavior Modification 
There are literally hundreds of diets available. Moving from diet to diet in a cycle of weight gain and loss - yo-yo dieting - that stresses the heart, kidneys and other organs can also be a health risk.

• Low-calorie diets (LCDs) are individually planned so that the patient takes in 500 to 1,000 fewer calories a day than he or she burns.
• Very low-calorie diets (VLCDs) typically limit caloric intake to 400 to 800 a day and feature high-protein, low-fat liquids.

Behavior modification uses therapy to help patients change their eating and exercise habits. Like LCDs, behavior modification, in most patients, results in short-term success that tends to diminish after the first year.

Exercise 
Starting an exercise program can be especially intimidating for someone suffering from morbid obesity. Your health condition may make any level of physical exertion next to impossible. The benefits of exercise are clear, however. And there are ways to get started.

• results in modest Weight-loss in overweight and obese individuals
• increases cardiovascular fitness, even when there is no Weight-loss
• can help maintain Weight-loss

• Park at the far end of parking lots and walk
• Take the stairs instead of the elevator
• Cut down on television
• Swim or participate in low-impact water aerobics
• Ride an exercise bike

Over-the-counter & prescription drugs 
New over-the-counter and prescription Weight-loss medications have been introduced. Some people have found them effective in helping to curb their appetite. The results of most studies show that patients on drug therapy lose around 10% of their excess weight and that the weight-loss plateaus after six to eight months. As patients stop taking the medication, weight gain usually occurs.

"Since many people cannot lose much weight, no matter how hard they try, and promptly regain whatever they do lose, the vast amount of money spent on diet clubs, special foods and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted." (New England Journal of Medicine)