With obesity rising at an alarming rate within Western Society and the consequent increase in the number of people suffering from morbid obesity, the American College of Physicians have recently issued a set of clinical practice guidelines for obesity and morbid obesity treatment with five main recommendations.
Morbid Obesity Treatment Guidelines
The first recommendation is that people with a Body Mass Index (BMI) over 30 (the point at which you are classed as being obese) should be counseled on diet, exercise and behavioral changes to effect weight loss. They should also be set a realistic goal for weight loss. [This is thought by many to be of little practical use and is felt to be more 'political' in nature than medical.]
Diet and exercise programs used morbid obesity treatment produce an average weight loss of about 8% of total body mass which, while it may not sound a lot, can result in significant health benefits. The problem however is that studies also show that 80-95% of obesity dieters will put this weight on again within a period of two to five years. The debate over dieting will continue for some time to come, but a number of health specialists are starting to conclude that the body’s natural mechanisms for regulating weight are extremely robust and that their vigorous defense against weight loss means that dieting may be more harmful than simply remaining overweight.
The second morbid obesity treatment recommendation is that, where dieting fails, pharmacotherapy should be offered to the patient and the patient fully briefed on the possible side-effects of such treatment. The patient should also be advised that, in many cases, there is a lack of long-term data on the safety and efficiency of this form of treatment. (Note: pharmacotherapy in this context means the use of appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety.)
The third recommendation is that, where the patient opts for pharmacotherapy, drugs such as sibutramine, orlistat, phentermine, diethylpropion, fluoxetine and bupropion should be used in the first instant with stronger amphetamine and methamphetamine drugs being used selectively in severe cases of obesity (morbid obesity) or where first-line drugs prove to be ineffective. The morbid obesity treatment guidelines go on to look at a number of other drugs but note that there is at present insufficient evidence to support their use.
The fourth recommendation is that where a patient with a BMI of more than 40 fails to respond to dieting and, if chosen, to drug therapy and also shows signs of developing obesity-related complications, the patient should be considered for bariatric surgery.
The final morbid obesity treatment recommendation is that patients considered suitable for gastric bypass surgery should only be referred to high-volume referral centers as evidence suggests that surgeons who not only specialize in weight loss surgery but who also perform such procedures on a frequent and regular basic meet with far fewer complications.
Morbid Obesity Treatment Increasingly Means Surgery
Although these guidelines do little more than formalize a practice that many doctors are already following it nevertheless reinforces the view that surgery, despite its growing popularity, remains very much the option of last resort.
Whether or not this will change in the years to come remains to be seen but as more and more doctors conclude that dieting simply doesn’t work and that drug treatment is also a somewhat questionable option, pressure will continue to mount for an early adoption of surgery as the only really effective form of morbid obesity treatment.