It is a staple of the New Year’s Resolution circuit, lose weight and keep it off. In the United States almost one in three children or overweight or obese and almost half of senior citizens are as well so it is a fitting resolution. However, it is very difficult to stick with diets and exercise regimens to achieve lasting weight loss.
Why is lasting weight loss so hard to achieve? Evolutionarily, we are programmed to over eat in times of plenty to get us through times of scarcity. So when faced with plenty of food that never ends, it is hard to overcome our natural instinct to put on extra pounds even though it is harmful to us. Add to that the impact of eating low fiber refined starches and the growing portion sizes which make us less able to determine how much we should be eating at a meal.
At the end of the day, studies have found that each of the main types of diets, high protein-low carb diets like Atkins, high fiber-low fat diets like Ornish, and hybrid diets like the Zone all provide the same amount of weight loss over time, about 8-10 pounds in most people. However, many people cannot stick with these diets and they end up gaining back their initial weight. While that is demoralizing, losing weight and gaining it back several times a year is better than a steady increase in weight over the entire year which for many Americans is the alternative. So yo-yo weight loss is not optimal but better than continued weight gain. Exercise is an important supporter of weight loss and weight maintenance but by itself doesn’t create much weight loss.
Over the past year we discussed a number of weight loss medications in detail but in a nutshell, these drugs can help you lose an extra 5 to 10% of weight over dieting alone. These drugs are stimulants, mood elevators, or antiseizure drugs that also help with weight loss. They should only be used in people who are seriously overweight because they can have some important side effects.
In lap band surgery a fillable band is put around the stomach and can be inflated or deflated to constrict the stomach making you feel fuller. It is only for the obese. People can lose up to 30-50% of their body weight with this procedure but it does require an hour of surgery and then adjustment to get you the right level of inflation. Gastric bypass is a surgical procedure where the stomach is bypassed entirely or altered so you feel fuller when you eat. It take three times as long to do as lap band surgery and can make it harder for your body to absorb nutrients it needs but it provides even greater weight loss than lap band surgery, around 50-60% reductions in body weight. If there is an issue with the procedure, the lap band can be removed but it is difficult to reverse the gastric bypass procedure. Doctors will usually require people to be able to lose several pounds and maintain it for several weeks before being a candidate for the procedure so they can maintain their weight after the procedures are over.
Dr Michael White from the UCONN School of Pharmacy
