When weight loss attempts fail, problem may be medical
BY ERIKA ROSE
Times Correspondent | Thursday, June 14, 2007
When you can honestly say you've tried and tried to lose weight to no avail, consider the likely possibility it could be in your genes and quite possibly a medical disorder that's going untreated.
Dr. Fatima Jaffer, a bariatric medicine physician on staff at St. Margaret Mercy Healthcare Centers, said a majority of her patients have some kind of genetic reason for their excess weight. The most common is metabolic syndrome, a condition she says is not widely recognized in the medical field as a cause for obesity.
Besides metabolic syndrome -- diagnosed primarily when high blood pressure, high cholesterol and morbid obesity are present along with high insulin levels -- other conditions commonly associated with excess weight, she said, include hypothyroidism, diabetes and conditions that hinder a person's activity level, such as sleep apnea, congestive heart failure, and respiratory and orthopedic problems. Also, many medications, particularly those used to treat diabetes, psychiatric disorders and steroid therapy also may cause weight gain or derail weight-loss efforts.
Donna Kettle, a registered nurse and bariatric coordinator for The Methodist Hospitals' Center for Weight Loss Surgery, estimates more than half of the center's patients have type 2 diabetes.
Those with type 2 diabetes struggle with weight on many fronts. Trapped in a vicious cycle, they either develop diabetes as a result of being overweight, or diabetes itself and the medication to treat it caused weight gain.
Kettle said about 90 percent of the time with patients at the center, diabetes is resolved after weight-loss surgery. The center counsels individuals undergoing gastric bypass surgery, which closes off part of the stomach and bypasses part of the small intestine. Patients undergoing the Lap-Band procedure, in which an adjustable band is placed around the stomach to limit the amount of food intake, also are counseled.
Jaffer, who operates a weight loss clinic in Dyer, said the overwhelming majority of these individuals can lose weight and maintain the loss with nonsurgical methods -- but only with careful, supervised and tailor-made programs.
After first diagnosing any underlying medical conditions through blood test results and medical history, Jaffer tailors individual meal plans and exercise regimens with a person's diagnosis in mind.
While reputable weight-loss programs such as Weight Watchers are effective for the average person, she said those with certain conditions need additional, stricter rules -- simply counting calories and exercising may not be enough. A person with high insulin levels, for example, needs not just calorie control but a low-carbohydrate, high-protein diet to be successful. Someone with high cholesterol needs more attention paid to fat in their diet.
Jaffer said this kind of instruction is critical to long-term success whether a person decides to have weight-loss surgery or not.
"If you don't treat the underlying problems, then even surgery is not a solution," Jaffer said. This is because the person still won't have had an education on what their condition requires of them for a healthy weight.
Programs like Jaffer's usually are a precursor to considering weight-loss surgery. Kettle said that before an insurance company will pay for surgery, patients have to show they've unsuccessfully tried a physician supervised weight-loss program like Jaffer's for six to 12 months.
Medically speaking, Kettle said success is defined as a 20-pound loss maintained over six months.
Kettle said with a morbidly obese person, weight-loss surgery is the only method with consistent long-term results. She said that for nonoperative therapy for the morbidly obese, 90 percent are successful, but fewer than 5 percent are able to maintain the loss.
Before seeking medical assistance, Kettle said it's important to be educated and honest with yourself.
"Some people think they are making healthy choices but they don't have the true facts," Kettle said. It's easy and common, she said. to underestimate what you eat.
Kettle said the bottom line is if you aren't feeling well, you are being true to yourself and the weight is not coming off at a rate of 1/2 to 1 pound per week, seek medical advice.
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