Obesity is epidemic. There are solutions readily available in Ocala, but first, you must be educated on the basics of bariatrics, the science behind severe weight loss.

Story: Paige Sams

With the increasing dependency that our society has on fast-food restaurants and inexpensive junk food combined with the lack of health education and insufficient exercise, obesity rates are extremely high and continually growing. It is estimated that about 2 out of every 3 adults is overweight and the complications involved with obesity compile to form the number one cause of preventable death. In order to combat this growing problem, bariatric consultants and physicians are doing all that they can to help improve weight loss methods. The branch of medicine that offers solutions toward achieving and maintaining an ideal weight is known as bariatrics. Diet and exercise should always be the first go-to, but that alone doesn’t always work. If cases are severe, weight loss medicine supplements can be prescribed and even surgeries can be performed as a last resort.

Weight Loss Supplements

Weight loss supplements can be both over the counter and prescription. Either way, these serve to suppress the diet of patients as well as increase metabolism rates in order to expedite weight loss. They can be vital to some individuals who can’t control their eating habits and constant thoughts about hunger; however, it is necessary to take caution when using these “quick fix” drugs as they may contain caffeine and other various stimulants. When combined with the proper weight loss coaching, diet and exercise, these medications can allow for the maximum weight loss and best results. These can provide patients with rapid weight loss and help to decrease the symptoms associated with obesity, however, they can be extremely controversial due to the hormones that they release. One in particular is Human Chorionic Gonadotropin (HCG).

HCG: Human Chorionic Gonadotropin

Human Chorionic Gonadotropin, otherwise known as HCG, is a three step program that enables rapid weight loss. This hormone is the same that increases in women’s bodies during pregnancy which greatly affects the portions of the hypothalamus that control thyroid and metabolism. The program starts with the initial step of overeating for two days. Following that step, the “HCG diet drops” suppress the appetite and patients are only allowed to eat 500 calories a day for 3 weeks. Lastly, during the “maintenance phase” patients are to raise their calorie intake to 1,500 calories per day. Following these steps, HCG should have changed the diet and eating behavior of patients due to a reset of the hypothalamus. Many people have success with this, but it can be an unrealistic and unsustainable form of weight loss.

What does Bariatric Surgery entail and what are the benefits of it?

Bariatric surgery achieves the goal of weight loss in obese individuals by either removing a portion of the stomach or reducing the size of the stomach. These surgeries can allow patients to not only look and feel better, but to obtain a significantly better quality of life as well as lessen the risks of preexisting and future conditions associated with obesity. Some of the benefits may include: reduced hypertension, recovery from diabetes, the elimination of sleep apnea and many more. Bariatric surgery has also been proven to help increase fertility for both males and females according to Kelli Potenza, the Bariatric Clinical Coordinator at Ocala Health Systems.

Bariatric surgery should be a last resort for weight loss, only after all other natural dieting and exercise methods have been exhausted. However, when yo-yo dieting and exercising has reached a plateau or patients believe that they are not capable of maintaining a healthy weight, surgery can solve those problems. It is important to remember, as Dr. Michael Holloway M.D., founder and medical director of Ocala’s Lifestyle Solutions explains, that these surgeries are just a mechanical change and patients need to be committed to making a lifestyle change following these procedures.

The National Institutes of Health (NIH) recommend that people with BMI’s greater than 35 are candidates for weight loss surgery. BMI’s account for height and weight in measuring body fat. A BMI of 30 or above is generally considered obese.

A note on surgeries: Most forms of gastric surgeries are performed laporscopically, meaning that the surgeon makes multiple smaller incisions as opposed to one large one. These surgeries are also followed by recovery and support plans, as discussed below.

Factors to keep in mind when choosing a program:

• Past outcomes. When looking for a suitable program, patients should first research the history of programs. What have past patients said about the program? Is it reputable throughout your area? Patients should go with the most experienced and well proven, exceptional surgical outcomes. Reputation of the hospital and surgeon are key.

• Extent of the post-operation program. Are there support groups offered? Follow-up care? Dietary support? Many of the programs have these details listed on their sites concerning the surgery. If not, physicians can be consulted to ensure that these assets are offered and have provided beneficial results. Kelli Potenza adds, “…Ultimate success is having not only an excellent surgeon, but excellent support and post-surgical support groups. Support equals success!”

• Insurance coverage. Does your insurance policy cover the procedure that you are looking into? Many plans cover this type of surgery because it has many long-term health benefits, so make sure that the hospital you choose accepts your insurance.

Procedures offered:

Gastric Banding. This type of surgery entails placing a silicone band with an inflatable inner collar around the upper portion of the stomach to restrict food intake. This serves to create a narrow passage into the lower stomach which delays food from emptying and causes the filling of fullness to last longer. The silicone band can be adjusted tighter or looser to expand or restrict the size of the passage.

Gastric Bypass. There are two forms of Gastric Bypass. First, there is Roux-en-Y, which does not remove portions of the stomach. Oppositely, the biliopancreatic diversion bypass is a less common form where portions of the stomach are removed to attach the stomach to the final section of the small intestine called the ileum. This allows the absorption of nutrients to decrease due to the “bypass” of a large portion the small intestine. Both of these procedures are performed under anesthesia and have the risk of under nutrition.

Gastric Sleeve. In this procedure, up to 85 percent of the patient’s stomach is removed causing it to take the shape of a sleeve or tube. This is often followed by a gastric bypass surgery or a duodenal switch surgery because fewer risks are associated with those after having gastric sleeve surgery. Other commonly used names for this procedure include vertical sleeve gastrectomy, tube gastrectomy, sleeve gastrectomy, or laparoscopic sleeve gastrectomy.

Duodenal Switch. This surgery follows a vertical sleeve gastrectomy (as described above). It is similar to the biliopancreatic procedure in that it bypasses a large portion of the small intestine. Following this surgery, patients consume less food than usual, but still more than other gastric surgeries. This procedure is not covered under many insurance policies, however, it is considered to be one of the most effective routes to weight loss.

Incision-Free Methods. In these methods such as gastric balloon, endoluminal sleeve, stomaphyX, Transoral Gastroplasty Surgery, and Transoral ROSE, bariatric surgeons use natural orifices to insert equipment and perform weight loss procedures. These are not very common yet, especially in the US, but constant research and new technology hints that they may be a new and uprising form of weight loss for obese patients.

Local Contacts in Bariatrics:
Ocala Bariatric Center-Ocala Health System
Bariatric and Laparoscopic Center of Ocala
Munroe Regional Medical Center
Lifestyle Solutions

Diet and Exercise

It may be helpful for people experiencing trouble losing or maintaining a healthy weight to meet with a consultant in order to provide realistic, sustainable solutions. Dr. Michael Holloway M.D., founder and medical director of Lifestyle Solutions, says that the psychology of weight loss is extremely important. It is necessary for patients to see the end goals of the work and to have a medical professional that coaches and educates them on how to manage a diet and weight loss routine on a daily basis. Individualized plans may be based on factors such as medical history, weight history, as well as home and work environments. “This is not a diet program,” says Dr.Holloway, “we’re trying to coach you on how to have a healthier way of life.”

The first few visits may even rely heavily on educating patients on their metabolism based on tracking their calories and exercise. Dr.Holloway shares that recording the amount of calories consumed each day by keeping a journal is usually the core of kick-starting the program. “Nine out of ten people that walk into this office--if not more-- have no idea how many calories they consume in a day,” says Holloway. “It’s like going out and just using your debit card all over the place and not having any idea how much money is in your bank account.” For the first few months of the program, at least, patients are to consult with their coach weekly in order to establish accountability and persistency.