Intensive diet and surgical management of obesity

Abstract

Medically supervised intensive diet and surgery are two established methods for treatment of medically significant obesity. Intensive diet uses a very low-calorie diet that consists of 600 to 800 kcal/d with low fat and carbohydrate levels and high protein contents. A very low-calorie diet can be safely administered under proper medical monitoring using generally accepted standards of practice. This medical therapy results in significant weight loss (10% to 20% of body weight) and metabolic; fitness, based on hormonal and energy balance. Maintenance of the new body-weight setpoint is often difficult without adjunctive use of appetite control medication. Very low-calorie diet should only be used as a part of an integrated weight management program that involves long-term nutrition and fitness therapy as well as lifestyle modifications (ie, restrained eating and increased exercise). Severely obese patients who are resistant to nutritional and medical therapy are candidates for the adjunctive use of gastric restrictive surgery. Two current standard procedures, gastric bypass and vertical banded gastroplasty, are effective in achieving metabolic fitness that is reflected in improved glucose disposal, normal fasting and 2-hour postprandial glucose-to-insulin ratios, and normal levels of aerobic exercise tolerance. Surgery and very low-calorie diets are only adjuncts to an integrated obesity treatment program. Ongoing nutritional management, behavioral modification, and physical and psychological support are required to achieve metabolic fitness and to avoid the disability, morbidity, and mortality associated with obesity. Multidisciplinary care with a comprehensive, long-term weight management program is the only means to avoid the 300,000 lives lost each year and the 100 billion dollars expended in treatment of the disease of obesity.