The medical treatment of Severe Obesity has always been based on a combination of calorie intake reduction – usually a Very Low Calorie Diet (VLCD) – and an increase in calorie utilization – an exercise program. A VLCD has a goal of less than 1200 calories per day for women and 1400 calories per day for men. There are literally hundreds of variations on how to achieve these goals, e.g. liquid meal replacement formulas. Unfortunately, these diets are a radical departure from “normal food” choices and have not been shown to be very effective after a year or so. Data from long-term studies – from 3 to 5 years – show that most patients with higher BMIs (>35) will not maintain weight reduction, and, therefore, do not reduce their long term medical risk.* More than 90% of morbidly obese patients will not have sustained weight loss on a medical weight loss regimen. This is the main reason that surgery has been recognized as a more effective means of treating morbid obesity. Surgery has a better chance of keeping weight off for the long run.*
Nevertheless, medical weight loss – like a VLCD – is part of the comprehensive care of a person with morbid obesity (BMI > 35). Many insurance plans will require the patient to undergo a physician supervised diet for a period of months (usually 3 to 6 months), prior to authorizing a surgical procedure. A common perception is that if the person does well on the diet, he or she will have adequate weight loss with the operation later. Data on this subject is conflicting and we do not feel that this point carries much merit. A better reason to institute a supervised weight loss program is to begin the education and training that a person will need to make better food choices after the operation. Many obese people have developed bad eating habits based on misperceptions or misinformation. Some of this can be corrected preoperatively.
Our approach is to closely analyze the eating habits of our patients, educate them on counterproductive behavior, institute basic changes, and ready them for the changes required after surgery. Doctor Marvin sees each patient for an initial assessment, which includes a diet review and counseling for a VLCD. We feel that patients do better if they reduce the most harmful part of their usual diet and augment the healthier part – not start on a completely foreign liquid formula. The target is 1200-1400 calories a day.
Recommendations are patient specific, but there are general rules that apply to almost everyone. Keeping a food diary is essential to account for all sources of those calories. Doctor Marvin will review the food diary with the patient at each visit.
All manufacturers are required to provide the information discussed below by the FDA. Label reading is mandatory to ensure that the patient is consuming exactly what she/he is expecting.
Doctor Marvin has been very successful in helping morbidly obese patients lose significant amounts of weight with a medical weight loss regimen.* This can also help control some of the associated medical problems related to obesity such as high blood sugar (diabetes), high cholesterol and high blood pressure.* At Houston Surgical Specialists, we consider this an important part of the comprehensive care of Severely Obese people.