Severe
obesity is a serious medical condition experienced by people with a
body mass index of 40 or above. Previously called morbid obesity, it
affects an estimated six million American adults, or about 1 in 33 of
the adult population. Associated with a range of complex metabolic
disorders including type 2 diabetes, insulin resistance syndrome and
raised blood-fats, plus other weight-related health problems, this
condition should not be confused with overweight (BMI > 25) or
regular obesity (BMI > 30). It is a serious disease requiring
professional help.
Since I started my weight loss consultancy over 24 years ago, I have met
and spoken at length with hundreds of severely obese individuals
weighing 300 pounds or more. For most of them, their weight was a major
source of discomfort - both physical and emotional - yet over the years
most had "adapted" to their growing waistline and were resigned to
remaining seriously overweight for the rest of their life.
For doctors and other health care specialists who work with obese
patients, this type of patient-resignation to lifelong obesity is no
surprise. But in fact it is only one of many obstacles to long-term
weight loss. Many clinically obese individuals struggle with a variety
of psychological issues to which they have trained themselves to respond
by overeating. Some of these issues - for example, the early loss of a
parent - require sophisticated counseling and even then may remain
unresolved. In addition, many obese people struggle with family,
educational or financial difficulties which further reduce their
treatment and recovery options. Given the complex causes, responses and
conditions surrounding obesity, it comes as no surprise that many
conventional treatments remain largely ineffective. Sadly, many people
of normal weight - including members of the medical profession - still
find it difficult to accept the intractable nature of the condition,
which only adds to the sense of alienation and guilt experienced by the
very obese.
Obesity Treatment Options
How effective a treatment is in helping severely obese patients to
reduce weight, largely depends upon its ability to tackle the root
causes of the condition. Most treatments deal with symptoms (excessive
calorie intake) rather than causes (why obese individuals overeat).
Conventional Weight Loss Diets
Now that the low carb approach championed by Atkins Diet seems to have
run its course, leaving many obese dieters close to if not heavier than
their initial starting weight, the efficacy of conventional weight loss
diets is more questionable than ever as a means of reducing obesity.
Whatever their dietary composition, most reduced-calorie diets offer
insufficient support to help obese patients make the necessary changes
to their eating and exercise habits.
Bariatric Surgery
Gastric reduction surgery is a vital "last resort" treatment option for
patients with severe weight-related health problems. It typically leads
to very significant weight loss and health benefits, but it deals with
symptoms not causes. So although it compels patients to eat less, thus
forcing them to lose significant amounts of weight in the 2 year period
following their gastric bypass or banding operation, it tends to have
less success in dealing with the root causes of disordered eating which
have built up in the patient's mind over the years. As a result, about
2-3 years after their operation, a large percentage of bariatric
patients find it too difficult to follow the recommended dietary
guidelines and end up regaining most if not all their starting weight.
Obesity Drug Treatment
The increasing number of obesity drug prescriptions issued to patients
shows that doctors continue to lean heavily on pharmaceutical
intervention for weight reduction. Furthermore, with obesity now
labelled as the "trillion dollar disease", drug companies continue to
invest heavily in their search for a scientific breakthrough. Yet
clinical trials of FDA-approved obesity pills continue to show minimal
long-term weight loss benefits for severely obese patients, almost
certainly because drugs are not yet capable of dealing with the
fundamental causes of disordered eating.
Does This Mean Obesity Is Untreatable?
In view of the limited success of conventional diets, surgery and drugs,
does this mean that obesity is untreatable? No. It simply means that
more specialised or support-based options are necessary. The first step
in finding the best treatment option for any obesity condition is to
talk to a doctor, who should be able to outline what specialised
treatments are available. For example, there are a number of excellent
medically-supervised weight loss programs run by hospitals and clinics
in the US and Canada, that offer real support and counseling. Self-help
support groups like Overeaters Anonymous (505-891-2664) or TOPS
(800-932-8677) can also be extremely helpful. Alternatively, contact the
American Dietetic Association (800-366-1655), or the American Obesity
Association (202-776-7711) for further information.
Some Practical Tips If You Are Obese
For anyone who is 300 pounds or more, seeking medical advice and getting
proper support is essential. Relying upon pills, diets or willpower
alone is not enough. However, you can do a number of things to help
yourself and improve your chances of losing weight. Here are a few
suggestions.
Stop Telling Yourself That You Can't Lose Weight
Whatever your size or shape, and whatever your history of weight gain,
the truth is you can lose weight and you can keep it off. In 24 years I
have yet to meet anyone who was unable to lose weight, although I have
met lots of people who lacked the motivation to stick to their diet! The
point is, not being able to do something is quite different from not
really wanting to do it. Yet most dieters confuse these two things. They
think they can't lose weight, whereas in fact what they are really
describing is an unwillingness to make the necessary changes to their
eating habits. So stop telling yourself that you can't lose weight -
because it's not true. The real question is: do you want to reduce
weight, and if so, why?
Start Telling Yourself Why You Want To Lose Weight
The messages we transmit to ourselves in the form of thoughts have the
same effect as radio commercials. The more often we hear a particular
message, the more we believe it. Tell yourself every day that you want
to lose weight and gradually it will become a bigger and bigger
priority. But don't stop there. In addition, tell yourself how losing
weight will improve your life. Maybe your goal is to receive more male
attention; or maybe your aim is to fit into a pair of regular jeans; or
perhaps you think a leaner body will boost your confidence. Frankly, it
doesn't matter what benefit you think weight loss will give you, the
important thing is to advertise this benefit to yourself at every
possible opportunity. Start today and try it for three months, and I
guarantee it will help you to lose weight.
Start Understanding Your Body Chemistry
There are three things you need to know about body chemistry and obesity
control. First, the longer you go without food, the more likely you are
to overeat later. So eat something small at least once every three
hours. This reduces the risk of bingeing and helps you burn calories at
the fastest possible rate. Second, the less chewy and more easily
digestible a food is, the easier it is to overeat. By comparison, chewy
foods tend to contain more fiber and therefore keep us fuller for
longer. A good example of an easily digestible food is a creamy dessert.
Even after a huge meal, most of us can demolish a serving of cheesecake
or a bowl of rich ice cream, without much difficulty. In comparison,
eating 5 oranges or 6 apples after a large main course would be almost
impossible. So include plenty of high fiber foods in your daily diet.
They contain fewer calories, they fill up your stomach, and they keep
hunger at bay for longer. Thirdly, most women experience food cravings
in the week before TOM. This is perfectly natural as well as forseeable.
So make sure you have an extra supply of healthy snacks to keep
yourself satisfied. Above all, don't try to deny yourself the extra food
your body craves - you won't succeed - just make sure you have healthy
options available.
Don't Try To Be Perfect
God doesn't create perfect people, he creates humans. And humans enjoy
tobacco, alcohol, double chocolate chip muffins and truck-sized boxes of
movie popcorn. So unless you come from Mars, don't try to be a perfect
dieter because it ain't gonna happen! Every dieter has bad days, bad
weeks, sometimes even bad months. But so what? Losing weight isn't a
race - it's a journey. How long it takes to arrive at your destination
is not important. The only thing that matters is that you do eventually
get there. Besides, once you accept that your diet-wagon is going to
lose a wheel from time to time, you can plan how to react when it
happens. Whereas if you assume your diet is going to be trouble-free,
you are less likely to be prepared when disaster strikes.
Stay Guilt-Free Under All Circumstances
Suppose you are 300 pounds. You start a diet, you start exercising with a
neighbor, things go well and you lose 30 pounds, you feel on top of the
world, then you have a huge bust-up with someone. Result? Your diet
falls apart, you stop exercising and start comfort-eating. How can you
prevent this from happening? Answer: you can't. This is Life. This is
what happens. All you can do is go with the flow. If this means bingeing
for a week until you feel better, so be it. But whatever you do, DON'T
FEEL GUILTY. Because guilt will eat you up and will keep you obese for
ever. In my experience, a dieter's initial bout of overeating is rarely
the problem - it's the guilt which it inspires that does the damage and
causes them to quit. Losing weight should be a guilt-free zone, and
don't believe anyone who tells you different. On my weight loss program
and forum there is no guilt, no matter what happens.
Join A Weight Loss Community
If you are connected to the Internet, try to find an active forum where
you can post your weekly weight, keep a food or weight loss journal,
swap ideas with other dieters and generally have fun. Many people regard
weight reduction as a totally serious matter. But it's not. It's a
journey from A to B. And just like any journey, it passes more easily
when we have fun and learn interesting things along the way. My weight
loss forum is a very supportive place, but there are dozens of other
forums to choose from. One of the biggest benefits of an active dieting
forum is the opportunity it gives you to express your feelings. You can
vent about your personal success or failure and also show your support
for other people, which is equally therapeutic. So look out for a
suitable online weight loss community and watch your obesity gradually
disappear into thin air!
