According to Centers for Disease Control and Prevention (CDC), 66 percent of all U.S. adults are overweight or obese. Faced with conditions of heart disease, high blood pressure and diabetes, many Americans are shopping for bariatric surgery to help manage these conditions and, in some cases, cure them.

What should a consumer look for in a bariatric program? Here are five tips from Nick Nicholson, M.D., medical director of weight loss surgery program at Baylor Regional Medical Center at Plano, an American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Surgery Center of Excellence®.

Take your time choosing a program

Weight loss surgery is a not a magic bullet but requires life style changes to be effective. A good-quality program will tell you up front about the different options for weight loss surgery and the post-operative work exercise and changes in diet required for each option. Weight loss surgery is not an emergency, take time to thoughtfully consider at least two programs.

Be flexible

Consult with a surgeon or surgeons who perform more than one type of weight loss surgery. As a consumer, you can select gastric bypass, adjustable gastric banding or the gastric sleeve procedure. “One procedure may be more effective for you than another, so explore all options,” urges Dr. Nicholson.

Numbers do matter

Numerous studies have shown that complication rates from weight loss surgery are highly dependent on the surgeon’s prior experience. Because previous experience is tantamount to success, ask your surgeon how many of each proposed operations he or she has performed.

Chemistry matters

In many general surgical cases, you have limited interaction with your surgeon. Not so with weight loss surgery. You may see your surgeon at least four or five times in the first year. Be sure that the surgeon and support staff is genuinely interested in you and your success.

Support matters, too

To succeed, weight loss surgery requires hard work from you. What support can you expect post-surgery? Does the program offer support groups, psychological support, exercise or physical therapy? Are dietitians involved to help you develop better eating habits and food plans? “I frequently tell our patients that 90 percent of their long-term success is in their hands, not mine,” says Dr. Nicholson.

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A review of research examining the effectiveness of different obesity treatments has concluded that no matter what other forms of therapy are offered, changes in lifestyle are imperative if patients want to maximise and maintain their weight loss. This review, presented at the annual Society for Endocrinology BES meeting in Harrogate, shows that lifestyle interventions provide benefits at all stages of obesity management and should be encouraged no matter what other forms of therapy are offered.

He found that when weight loss drugs are given on their own, with no other changes in lifestyle, they produce an average weight loss of 5 kg, the same amount of weight you lose if you go on a calorie-controlled diet and take regular exercise. However, if weight loss drugs are offered in combination with behavioural therapies, their effectiveness can be increased by over 100% (from 5 kg to 12 kg average weight loss). He found that the story was the same with bariatric surgery. Patients who exercise and lose weight prior to surgery are less likely to have postoperative complications and lose more weight at a quicker rate after surgery than those who didn’t.

Overall, this review indicates, that when treating obese patients, weight loss drugs and bariatric surgery are significantly more successful if they are offered in conjunction with improvements to diet and exercise.

Full results of the review are:

- Exercise alone produces an average weight loss of 1.8 kg. The more you exercise the more weight you lose.

- Diet alone produces an average weight loss of 5.0 kg. This effect peaks 6-12 months following the start of the diet and wanes after this point. No diet is better than any other in the long term but the greater the reduction in calories, the greater the initial weight loss.

- Behavioural therapies (e.g. cognitive therapy, psychotherapy, relaxation therapy, hypnotherapy) produce an average weight loss of 2.3 kg.

- Exercise plus diet result in an average weight loss of 10.7 kg and helps to maintain weight loss for a longer period.

- Exercise plus diet plus behavioural therapies result in the greatest average weight loss of 12-15 kg.

- Taking weight loss drugs with no changes in lifestyle result in an average weight loss of 5kg. Taking weight loss drugs, in combination with behavioural therapies, leads to an average weight loss of 12 kg.

- Patients that lose more than 10% of their body weight prior to bariatric surgery are 2.12 times more likely to achieve a 70% loss of excess body weight.

Researcher Dr Rob Andrews said:

“People often forget is that there is no quick fix to obesity. Overeating and decreased activity are the fundamental problems underlying the development of obesity. Any therapy aimed at helping obese patients must have a dietary and exercise component in order to be successful. This review shows that patients who are taking weight loss drugs or have bariatric surgery lose significantly more weight if they combine these treatments with regular exercise and a calorie-controlled diet. Maintaining a healthy, balanced lifestyle is the key to maximising and maintaining weight loss.”

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