In obesity due to genetic cause surgery may not help, identification of obesity due to a single cause is very difficult

hence is a question really mind boggling as many patients may not afford the cost of surgery. Hope my answer is of some help.

In my clinical practice, obesity has become a daunting challenge. The high prevalence and the difficulty in its treatment became almost insurmountable challenges. In my opinion, the solution to the obesity epidemic is drastic change in lifestyle. The work of the group of Professor Gary Fraser should be used as large-scale interventions for the treatment and prevention of obesity. More than that, we need to change the paradigms associated with obesity. More important than weight loss, more important than weight control, you do it all for a superior reasons. In my opinion, the highest reason is that we find in 1 Corinthians 6: 19 and 20, and 1 Peter 1: 18 and 19 (Bible). These reasons are transcendent, incomparable. In summary, lifestyle and higher reason.

The most prescribed treatment for obese peole is diet and exercise, however, in the case of exercise it is not clear neither what routines are for a specific individual, to what intensity and how long. Therefore the exercise prescription remains to be a very confusing indication for these patients, in terms of diet, though specific menus adapted for the patient are available, the rate of non compliance is too high.

Prescription drugs for obesity are very limited with unpleasant side effects such as diarrhea with orlistat. Other drug have been withdrawn from the market such as sibutramine. Old drugs with an effect on Central Nervous system are not been used anymore, either because their risks, very limited availability and strong regulations for its comercialization

So, the options for the patient with overweight o mild or moderate obesity are very limited and the outcomes are not very encouraging. Weight regaining after one year of therapy is over 85%, depending on the series reviewed.

For some reason I still do not understand, pharmaceutical companies are not investing on R&D for antiobesity drugs.

On the other hand, surgery carries more risks than non surgical treatment, but the benefits are also significant, particularly for those patients with metabolic syndrome, whom diabetes is a component

This very important question requires further research as it has not been answered yet.

Obesity is very treatable if the underlying metabolic abnormality is considered. Epidemiologically excessive sugars intake this the most likely causal explanation and therefor the most critical intervention is removing all the sugars (and starches rapidly broken down to sugars) from the diet. Our obsession with fats and the energy in energy out model are failures of pathophysiology and critical thought

The problem of surgery is that not a long-term treatment. Most patients recover the body weight after surgery. In my opinion more important than treating obesity is to control it through food education or to create eating habits. If this does not happen after surgery, the patients return to eat without control. It is also important of course to avoid a sedentary lifestyle.

Of course it is treatable. Have seen the amazing results of many people who have lost over 100 pounds with wonderful systems such as Isagenix. Contact me for more info if you'd like.

I am a mental health professional who works with eating disorders, including binge eating disorder. I work along side doctors, psychiatrists and registered dietitians. We all come across the shadow-side of gastric surgery regularly.

Long-term outcomes of stomach surgeries have not been adequately studied. Please do NOT consider surgery at this time! Not only can the surgery be life-threatening, but the long-term implications of very quick weight-loss may also be life-threatening due to too many toxins being released too quickly into your bloodstream. (Our fat stores almost every heavy metal, pesticide, and chemical residue we've ever breathed in or been exposed to. The liver needs a long time to process it all.)

Also, the inability of stomachs which have been surgically reduced to properly absorb important nutrients is being looked into as a precursor to other diseases and illnesses in people who have had gastric surgeries. Finally, anyone can eat their way past a stomach surgery. The post-surgery/post-weightloss relapse rate is higher than you might imagine.

ALWAYS enlist the help of an informed medical doctor or endocrinologist when trying to improve your health. There are so many medical conditions that will slow or prevent weight loss. Why wait until you are frustrated to ask a doctor? For example, have you had your thyroid, insulin and fasting blood sugar checked? All three panels of thyroid readings? And, most doctors don't ask for an insulin level. Vitamin D, calcium, and magnesium levels also effect one's ability to metabolize well. Save yourself the time and hassle of having to assess these areas later.

Binge eating disorder is still rare, though is accounts for more than 40% of the eating disorders found in men. The vast majority of people with obesity do not have binge eating disorder. However, it is reasonable to be assessed for the condition, just in case. When the disorder is diagnosed treatment is augmented with education about the disorder, some amount of cognitive/behavioral therapy, and possible some short-term medication to assist with impulse control, depression and/or anxiety which tend to co-occur with the disorder.

Obesity is treatable almost entirely with a lifetime change in eating habits. Proper nutrition and proper portions will take care of weight loss without exercise in the first 6 months to a year. HOWEVER, moderate exercise is mandatory in order to continue to lose weight and to be able to keep it off. You might be surprised how much easier it would be to change your eating habits and exercise easily and moderately compared to how overwhelmed you feel when you read those last two sentences. People's anxiety about making changes in eating and exercise is always bigger than the changes themselves.

The best current research in nutrition, weight-loss and physical well-being written for the lay-person that I have found is by Dr. Steven Gundry. He is easy to find on the web. He wrote a book in 2008 called Diet Evolution that explains how the science of Atkins and the science of Dr. Dean Ornish are both right, but need to be implemented at different stages of weight loss. His research helps us understand the biology of why people are compelled to eat high-fat, high calorie, highly processed foods. There is no blame or shame, just science. And he shares his own problems with obesity. It's a good read.

I haven't tried his entire plan myself--yet. I have started with a lot of small changes and am working up the motivation for making the big changes. However, his data and theories and experience are sound and current. And, he is a doctor in private practice, so if you had the ability to retain his services, he could be a big help.

Good luck and please don't give up on your health! Life is waiting for you to feel better. And you can most certainly recover!!

Obesity is treatable and requires a multipronged approach that recognizes and respects the complexity of the condition. The fact that one loses weight is not a testamony to the success of a particular method. Why? Weight is not the problem-high body fat levels are the problem. There has not been a universally successful method for sustainable weight loss-not surgery, not pharmacotherapy and certainly not diets. The reason for this is partly that complex conditions such as obesity are made up of a constellation of variables not the least of which are behavioral and lifestyle factors which are crucial to effectively manage this condition. What is the point of any bariatric surgery if the behavioral elements are not addressed? Obesity management must involve strength exercise (not exercise for caloric expenditure) rather exercise that will facilitate a shift from non metabolic tissue (adipose tissue) into metabolic tissue (lean muscle mass) and we do this with strength training, not aerobic training within a fat burning zone. The average caloric expenditure for a 170 lb male having run a marathon is 2600 Kcal. A pound consists of 3500 Kcalories. This will give you some idea of the nonsensical approach of trying to use exercise, by itself, as a form of weight loss. The real value of exercise is in it's ability to build metabolic tissue or muscle mass--this is why we use strength training with seniors of all ages to accomplish the same goal in combating sarcopenia or age related muscle mass loss. The analogy I use with my patients is this: I have 2 cars, one with a 289 cubic inch engine and another with a 455 cubic inch engine. They both travel at the same speed to the same destination 50 miles away. The 289 uses 2 gallons of gas while the 455 uses 5 gallons of gas. The point is--build yourself a larger engine and you will burn more fuel doing the things you normally do throughout the day. This is one of the reasons very lean people have difficulty putting on weight they simply have proportionately more metabolic tissue which means they are burning fuel constantly.So, to treat obesity, our disease management center utilizes a multi-pronged approach involving nutrition counselling, behavior modification/stress management, lifestyle modifications (very important), regular exercise, metabolic testing with subsequent caloric recommendations and periodic body composition testing to verify changes and measure progress. We do not use weight or the BMI measure in outcomes tracking since weight by itself is not a factor when performing a risk assessment for heart disease.

I have a lot of experience with severe obesity. For some obese because of the amount of kilos the right way to solve the problem is the surgery. But, from my experience (I am a member of an obesity treatment clinic called Doctors' Hospital in Athens with a number of cases around of 30000) there are only way to solve the problem with full health is only the diet because is the only mechanism to adjust the metabolic profile of patients and in some cases surgery with diet.

Only a small amount of cases can solve the problem with only surgery but finally with so much collateral abnormalities to become their normal weight is a dream!

Obesity is not a disease and does not require treatment. Obesity is mainly a risk factor for other risk factors, such as high blood pressure and high circulating levels of glucose and lipids. Obese patients treated with anti-hypertensives and lipid lowering agents show improved survival. Indeed, the benefits of drugs are often greater in the obese than in lean patients.

Obesity is a disease, still subject to surgical treatment when necessary to achieve stable, long-term and rapid effect. The first operational method is applicable as a first step for other surgical procedures. preferable in this case the execution of gastroplasty. the introduction of balloon implant into the lumen of the stomach. Nonsurgical treatment of obesity may be applied to intact patients, where possible long-term medication, psychotherapeutic treatment.

I would like to know if you have looked at in specific cases eg polycystic ovary syndrome patients as obesity is a common symptom and several genes have been identified as candidate genes, as obesity is a disease

My short contribution: on a population level obesity seems hardly treatable (reversible) with very few exceptions if one does not want to count in war-related or economic-desaster related population weight loss. So prevention is the key.

And on an individual level (where obesity can be a disease but not necessarily has to be one, depending on the severity, duration and co-factors) treatment is in many cases possible with a variety of meant (so there is no one-solution-fits-all); however, is it not easy as a large proportion of weight regainers remind us.

In case of obesity, "prevention is better than cure." Because it is due to the negligence and unhealthy food habits. The obesity can be controlled if you do regular physical exercise as well as low consumption of carbohydrate and fats (improve feeding habits). Then, it can be prevented from reaching to the need of surgery. Therefore, surgery is the late option. Health promotion is very important, thus, public health should be active rather than medication and surgery here. However, the question for the research is that to what extend we need to exercise, what degree of obesity?

The question is if surgery is the only viable option . . .Of course not! Diet and activity are paramount. A "twelve step" program for food addiction works wonders.

Very interesting posts here. I am a Nurse Practitioner, PsyD candidate, and previous bariatric surgery patient. I do believe that obesity is a precursor to many illnesses; however it can also be the result of many psychological and physical illnesses. The "treatment" resides in the cause. In our present state of reactivity (as a society) proactivity is often left out; thus many tend to treat symptoms and not causes...think about it

The Agency for Healthcare Research and Quality just put out a paper for comment on treatment strategies for adult obesity. You may want to consult it. There is also the NIH Guidelines for treatment which is a bit old and currently being updated. The AHRQ document is at http://www.effectivehealthcare.ahrq.gov/index.cfm/research-available-for-comment/comment-draft-reports/?pageaction=displayDraftCommentForm&topicid=317&productID=1106&ECem=120523

Dear colleagues! We must treat patient but not disease! I think may be better to join surgical and non- surgical methods treatment obesity, however it all depends by type and stage of obesity. In My country surgical treatment of the obesity on the last step.

Good question. Obesity is it treatable.. This question has a lot of work up to be done. First, to ask why was there any weight gain, type of weight gain, classification of obeisty, after all this work up then the question of treatment. Weight gain is easy but not loss. It reqiures a lot of patience and determiation. The question posed was more of dissatiafaction.

The question was meant to highlight a prevalent attitude in the medical community which suggests that obesity is in most cases untreatable.

Writers who suggest that clinicians should help patients focus on healthy eating and exercise and forget about losing weight seem to base this suggestion on the idea that intentional change in eating and exercise is feasible, but intentional weight change is not.

But logically, improvements in eating and exercise would lead to improvements in weight and body composition, so that intentional eating and exercise change essentially = intentional weight/body composition change.

One cannot conceive of weight change without eating and exercise change, and it is also inconceivable that changes in eating and exercise would not lead to changes in weight/body composition.

Thus, the extent that individuals can intentionally change their eating and exercise behavior represents the degree of control they can have over their weight.

eating too much, alcohol, and lack of exercise are the most important factors for weight gain. Garb J, Welch G, Zagarins S, Kuhn J, Romanelli J. Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding an dlaparoscopic gastric bypass. Obes Surg. 2009;19:1447-1455.

Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-873. the above are aa few references that may be useful to you.surgery for weigght loss has been basically bariatric surgery but followed by dieting and exercise..the topic is too big to b discussed

I agree that the topic is far too large to be discussed. However we have to stick to facts: more than one well conducted studies demonstrate that after non-surgical therapies for severe obesity (well established diet regimen followed closely by physician) the failure rate at one year exceeds 95%. Obesity is not untreatable however is a chronic condition and, as such, needs a permanent change either in metabolism or in eating behavior and lifestyle: we cannot think to treat a chronic lifetime disease with only a temporary regimen aimed at reducing weight. The only way we have today to achieve such a permanent change is surgery and surgery it is considered, nowadays, the only effective cure for severe obesity once the disease is established. We also know that id a surgical procedure is reversed, for whatever reason, after an adequate weight loss, we will have a weight regain in most cases, confirming that a permanent modification is needed.

You gain weight by eating. This is simple. But you dont loose weight by not eating. This is the problem. But the dilema is how much sholud one eat to gain weight. This question has only one answer. You only have to loose weight the way you gained it. There is a famous saying. Look where you lost you will regain only there. You gained weight that means you lost health. Regain it by healthy eating. The only answer to loose weight is to work hard.

I think treating the cause of obesity is the first line of treatment. Physical activety and healthy diet should be followed routinlly even with syrgery to avoid failureof reduction of weight.

the question here is not if you can lose weight effectively in a way that does not involve surgery or not: we know very well that you can lose weight by diet and exercise! The question involved is id surgery is the only way to effectively treat obesity, and we know that dieting and physical activity are not enough to treat effectively the disease (i.e. they are not effective to achieve a PERMANENT weight loss in most cases -Adkinson et al., Am. J. Clin. Nutrition, 1994;

Yanovsky et al., NEJM 2002; Eliosoff 1997; Sjostrom NEJM 2004;Obrien J Laparoendosc Adv Surg Tech A. 2003 - just to cite a couple of well done reviews about non-surgical treatment) at least for severe cases (grade II and III). So:

1. Can you lose weight without surgery: YES

2. Can you permanently lose weight without surgery: NO in 95% of cases (of course if you are lucky and belong to the remaining 5% you can do it, but I wouldn't count on it).

That is why all guidelines and consensus conferences since at least 1991 state that "Surgery represents the only effective therapeutic modality for morbid obesity" Consensus Conference NIH 1991,1996; Consensus Conference ASBS 2004. And this is the "state of the art", the standard up to today (of course tomorrow this can change, if we can discover something else).

The post also implies another question: surgery is not available for everyone. This part is not clear: it is not acvailable because a large number of patients have a BMI

At the top of this page is the question and the wording does not include "morbid obesity". Perhaps the original post did and if I missed that I apologize. Before we make statements we need to be clear what the question is. Some posts make reference to morbid obesity, others do not. There is a vast difference between the two. In regards to morbid obesity which represents a very small fraction of the total population classified as obese, and using the BMI measure (>40) as the primary index, exercise and dieting have not been shown to be effective interventions and bariatric surgery does need to be considered an option. However, for those of you who are firm pro-surgery advocates for morbidly obese patients, you might want to consider other less invasive options that are emerging in the marketplace including non surgical lipo and/or cold laser mediated fat emulsification methods (I-lipo, Zerona etc) I have not seen any outcomes data yet regarding these technologies but they are certainly worth exploring within the spectrum of options. For non morbid obesity, the treatment of choice will always remain lifestyle related changes including properly guided exercise combined with food management (farm-acology not pharmacology) within the context of behavioral paradigm. Without education, reflection and even coaching to facilitate behavioral change (the cause) there can be no sustainable improvements in body composition. The obesity epidemic is driven by poor choices including those who are truly genetically predisposed. Any therapy (intervention) that does not consider behavioral change is doomed to fail--including surgery.

Obesity is far too much discussed.. Basically obesity must be treated lik any other disease, and the treatment unfortunately is patient dependent unlike other diseases. Surgery is a part of the treatment

I agree with the important distinction stressed by Tiziano Marovino about morbid and non morbid obesity. And also I agree with him when he stresses the importance of behavioral changes. I think that couple of things need to be clarified.

When we talk about surgery we do not think that anatomical changes "per se" can be the key to health regain:

1. I never perform surgery unless a behavioral evaluation has been completed and agrees that surgery is the way to go (but generally it does, unless a major mental illness or a major eating disorder is found), actually often the behavioral evaluation helps to choose the type of surgery most likely adequate to change the behavior.

2. I always introduce surgery to my patients by stating that we can classify bariatric surgery into two main types (besides the usual restrictive/malabsorbitive classification): operation that act by changing permanently your eating behavior and operation that do not. In other words surgery acts mainly by making eating changes possible: it does it either by restriction or by metabolic changes (reduction in hunger for reduction of ghrelin, faster transit time, increase in GLP-1 for example) .

About non surgical lipo and/or cold laser mediated fat emulsification methods (I-lipo, Zerona etc) however, has to be very clearly stated that those are option to lose weight but NOT to take care of obesity. In fact is well proven that the metabolic changes that cause the disease "obesity" are related not to the amount of subcutaneous fat but to the visceral fat: reducing visceral fat we improve health (reducing cardiovascular events, diabetes, and so on) while ablating subcutaneous fat we only address the cosmetic (and, if you want, the social) component of the disease "obesity", leaving unchanged all risk factors that we are supposed to address. It is not a matter of technology, here, but of rationale of the treatment

The operation is not the first choise for the treatment of morbid obesity, the patient will die on the table probably, First he loses weight then have the operation. And the operation is not the absolute solution also, if you eat much after the operation, you'll gain weight again. Life-style behaviours, and consiousness first then the surgery

In my opinion, bariatric surgery and lifestyle intervention should not be viewed as in opposition as many colleagues in this post seem to do. Most of the bariatric literature showed that the results are better, particularly in long-term, when patients are properly followed also at the behavioural level. So, bariatric surgery and lifestyle modifications are additive in making optimal results. I agree with Fabio Campanile that in most patients lifestyle intervention alone can not obtain sustainable results. But this not means that if you operate a patient you may left away behavioural modifications. Why not to consider surgery and lifestyle as the two cornerstone of morbid obesity treatment instead of two "enemies" ?

Luca-I don't think anyone is actually considering the two approaches contradictory or in opposition, although sometimes when we post, we sacrifice accuracy (completeness) for brevity, and so it might sound as if they are in opposition. I think the last few posts acknowledge the value of combining therapies or approaches when we are talking about "morbid obesity" and further operationally define the term. I think Fabio also has emphasized that with morbid obese patients he recognizes and values both lifestyle and behavioral components as being integral to the change process after bariatric surgery. Thats important to hear from a surgeon because not all bariatric surgeons approach the problem in this same way. So, yes I agree wholeheartedly with you Luca that an integrated approach is superior to one or the other in isolation.

I appreciate your comment Tiziano. I continue to be disturbed by this sort of eternous debate between advocates and opponents of bariatric surgery. Bariatric surgery is to date the most effective therapy for morbid obesity and its use is supported by all international EBM guidelines. Our problem is: how we can maximize the benefits minimizing the risk or the side effects of surgery?

I met people who treated surgery as the only option - a miracle to their problems. It never worked well - they didn't want to change their lifestyle (eg. they even melt ice creams)!

Interesting that we talk about lifestyle and behavioural change without definition. From an epidemiologist's perspective, the current pandemic has a single underlying cause, increase in sugars (plural deliberate). So any intervention that does not focus on the reduction of glucose and maybe even stricter, fructose intake is to focus on associations rather than cause. Many of you are not old enough to remember upper gastrointestinal tract ulcers and bleeds and the many associations and their interventions, including surgery. All this changed, albeit slowly, when a bacterial infection due to H pylori was found to be the cause. There is still surgery but far less now that antibiotics are used. Obesity has no such "magic bullet" but until we focus on the cause rather than associations we will make few gains. Need a reference or two? Try Gary Taubes either Good Calories Bad Calories or What Makes Us Fat or for a more biochemically focussed book The Art & Science of Low Carbohydrate Living by Volek and Phinney. In spite of the evidence, some people smoke as they perceive its benefits (short term) as being greater than the risks (long term). Until we tell people as specifically as possible how to modify their life style and food intake behaviours, we impose solutions that are indirect. Some people will respond, some will not but at least we can empower people to make their own choices, with as Atkins pointed out, a reasonable change of success.

A new undestanding of obesity might give some one a new way to reduce weight

http://jcem.endojournals.org/content/92/2/386.abstract

Hello

Obesity has a "magic bullet" in order to find it you need to focus on the cause of the problem...not the symptoms. What would the outcome be if we no longer consider the fat as the cause.... fat might be the solution our body chose to cope with the underlying cause ....

Why is all the fat around the waist loaded with toxins ??? Why are these toxins there??

What if the fat is made to prevent further damage by toxins stored in it ???

What is the universal cleaning agent in our human physiologie system, my understanding is we only use "water" as dissolvent, cleaning agent.

Do the test and measure the Body Composition from people with obesity, you will find dramatic dehydration levels, way below the required levels...

Very simple non invasive test to have a body composition made by scale with bioelectric impedance analysis.

64% water of body weight equals 12% fat mass

54% water of body weight equals 26% fat mass

44% water of body weight equals 39% fat mass

34% water of body weight equals 52% fat mass .... more then half the person's weight is fat !!!!

ISBN : 978-1-903571-54-5

Bariatric surgery appears to be a clinically effective and cost-effective intervention for severely obese people. However, uncertainties remain about patient life quality; impact of surgeon experience on outcome; late nutritional complications and duration of comorbidity remission. I agree with Luca Busetto that bariatric surgery and lifestyle modifications are additive in making optimal results.

Dear all when we talk about obesity many of us are overweight. think for a moment what is best for you, to reduce weight. why should one control eating and when should one start control on eating.

is eating the only cause of obesity,

morbid obesity has many more reasons other than overeating,

bariatric surgery may be an alteration of vagotomy practised for gastric ulcer and partial gastrectomy which also was done for peptic ulcers.these patients did surfer from nutritional deficiencies and how justified is the process of bariatric surgery for a case of obesity, when the need is to control the mind rather than the belly.

When fat from liposuction is analyzed, they find it to be loaded with toxins !!! What would happen if we re-inject these toxins back into the body...??? That is what happens after bariatric surgery ... you force the body to consume the fat ... what happens to the toxin stored in it .?????? They will cause damage to vital organs in the long run...

Mr. Mathiasis answer is on topic, except for the fact that as researchers found in developing the Health Belief Model, that regardless of the amount of education, resources and advocacy we provide if someone does not want change they will not go forward with the behavior or will not continue to follow the behavior. We need to access the answers as to how do we determine who those individuals are and how to engage change within them.

I have strong genetic basis for obesity; many members of my mother's family were obese. I've gone through long years of having struggled with my own yo-yo obesity problem, having tried many methods other than surgery (drugs, Weight Watchers, other commercial outfits, etc.) I finally concluded that rigorous counting of calories is the only non-surgical method that works. I use a spreadsheet that contains a database of all the foods I regularly eat. It calculates a running total of calories consumed through the day. I've built and tweaked the sheet over the years. When I'm away from home, I bring the sheet with me on my MacBook Air or iPad. By keeping track of calories, I lost 40 lbs., and I've maintained BMI between 25 and 30 for more than 15 years (now 26.4).

Richard, as long as you struggle with a yoyo effect, you are treating the symptom ... not the cause, once you treat the real cause there is no yoyo....!!! ( means you need to keep on doing what created the loss , this means to me that there is no healing effect ) and as long as you need to keep on doing the problem is only hidden...the warning light is still burning only you covered it up so you can't see it ......

It's been too long since I have been on this discussuion and I see more posting. I am intrigued at your perspective on this topic Yves. A physician colleague of mine who practices functional medicine referrs to "sick fat cells" which I believe is consistent with what you're saying as well. Perhaps body fat levels are associated with environmental toxin exposures and/or genetically predetermined succeptibility to certain toxins--interesting thought. Haven't seen any convincing evidence, but refreshing to get a new perspective on causation. I think you're right on Jacqueline with your alluding to behavioural change being pre-eminant, and is where our disease management company focuses much of our research on. But I am not convinced that obesity, at any level, is simple or unidimensional regarding causation. I suspect we need to take a multi-pronged approach to these problems and need to consider all possibilities--thats why I really liked the idea of toxicity exposures. And, Yves, we too have noticed for many years that persons having higher than average body fat levels have concomitant lower than ideal body water levels-many are dehydrated depending on your dehydration cut point measure. What we also see and measure, is that when there are compositional "shifts" in persons engaging in strength training exercises (not aerobic exercises) , the water levels normalize (rise). One could argue that as we exercise we tend to drink more, but I suspect the water percent increases are more a function of lean mass having substantially greater amounts of water than fat, so as you become leaner, you automatically raise levels of water. We have evidence for this because simply drinking more water has zero to minimal effects on body water levels as measured during body composition analysis-regardless of the field method used to measure body fat, i.e. NIRS, US, impedance, calipers etc.

Yves, I figure, if its working don't fix it. So I'll keep doing as I do.

Obesity is treatable and surgery is not the only viable option. Long-term metabolic complications such as nutrient deficiencies can be considered the main risks of metabolic surgery and its restrictive and malabsorbant surgical procedures. Restrictive bariatric procedures can be associated with well-known surgical problems such as pouch dilatation or band migration, e.g., after gastric banding. After sleeve gastrectomy, emerging reflux disease can become a substantial problem. The most frequent deficiencies after restrictive procedures are related to B-vitamins whereas iron, folate, vitamin B1 and B12 and vitamin D deficiencies are associated with the malabsorptive procedure such as biliopancreatic diversion, duodenal switch and Roux-en-Y gastric bypass. Due to possible metabolic and surgical complications after bariatric surgery, patients need to undergo life-long medical follow-up investigations..

Is bariatric surgery a "behavioral" intervention?

The primary proximal cause of weight change following bariatric surgery is reduced energy intake.

At some point following surgery, exercise begins to explain more of the variance in weight change, and at very long intervals post-surgery (e.g. 5 years or more), individual differences in exercise are likely to prove the most important determinant of successful weight loss maintenance.

Increases in exercise are obviously not directly related to the surgery, but result from shifts in the motivational contingencies such that exercise begins to look a little more attractive as the person loses weight. Increases in intrinsic motivation for exercise is the key attitude change that we're hoping for.

If bariatric surgery is essentially a behavioral intervention, then it is evident that the question is to understand the behavior change process. This will allow rational construction of more effective interventions, both for surgical and non-surgical patients.

Gastric bypass, duodenal sleeve as well as sleeve gastrectomy to a lesser extent have shown that it reverse diabetes within days of the surgery or the implanted plastic bypass tube, also oral pill bypass like with Aphoeline, showed an acute response decreasing insulin resistance within hours of intake, therefore you cannot call that behavioral in the sense that it alter the conscious decision making of the individual. On the other hand the lap band with the restrictions imposed to oral intake does not stop the hunger nor fix the diabetes therefore does not change anything except restricting food and long term reduces weight and slowly correct diabetes. The hidonous hunger associated with obesity in bypass is immediate. Yes it does change the attitude but the unconscious one not the conscious one, therefore making patient satisfied and back to normal in a true body signaling that they have calories intake enough to satisfy their body true need. it is true that gastric bypass has a lot of side effect that are the results of having the wagon in front of the horse rather than vice versa .From our non knowledge of determining the right segment that is supposed to be hocked up as well as to consider the anatomical variation of the individual distribution of the L cells as well as the segments that are not responding anymore to the food absorbed. There is more science to be done and research to be planned to get where we want to be, both with and without surgery like oral therapy. The reason why we will still need surgery is for the massively obese where any non surgical intervention will not prevent them on time from the morbidity and mortality associated with obesity.

the recent publications in the NEJM, that strict control of calories diet exercise in diabetes type 2 , does not prevent vascular events consistent with the finding that calories reduction alone without reversing the basic metabolic problems that started it , will not stop the pathology . The F/S index (FAYAD/SCHENTAG ) to measure the metabolic risk and monitor progress shows that it produces the same results as the finding in the NEJM, and predicts that gastric bypass and to a lesser extent Aphoeline ,reverse and decrease the trend . the fat theory with the non responsiveness could be explained in part from the insulin resistance .

In conclusion gastric bypass is not a psychological intervention it is a true intervention that needs a lot of scientific refinement.

It depends on age and metabolic status of individuals. Weight losing is much easier in childhood compared with adulthood. i think a multi-component strategy to combat obesity works well. I mean a combination of diet, reduction of physical inactivity and at the same time increasing physical activity plus behavior therapy can work. Surgery is the last option for people who have been super obese for years and tried all methods for weight reduction in advance.

Surgery is not the only option , it was the predictor and the teacher of what is going on , showing us the way that the disease in obesity is not a simple intake of excessive calories because we like to indulge ,it is the results of many etiologies that ultimately ends in a non reversible blindness of the body metabolically to the food we absorbed , and ending to progressive alteration and poor maintenance of the organs ,the metabolism and immunology of the body and deteriorations of the parts that starts in the portal gut itself where the absorption happens then spreading throughout to ultimately involve the biomes interaction and the nervous system .understanding the model is extremely important and follows Bacons law . The only way to reverse it without much side effect is to learn how physiologically the body work then tries to reproduce it. We came a long way since Dr S. Bloom first mapped the gi hormones, and demonstrated intraluminal stimulation via food, and Jolts, and Drakar, describing the characteristics of the hormones. Since V. marks showed abnormal stimulations of the stimulation with obesity and diabetes, and the bypass surgery showing some alterations back towards normal, we showed that oral stimulations of the unaffected segment can also achieve similar reversal as well. I do agree much more and multipronged approach will be needed, but it will be useless to change the windows when the house foundations are failing. We will get to the point of individual initial assessment on multiple levels to include anatomically, and to determine an individual plan that will fit the subject best to have maximum efficiency with least side effect.

Weight loss surgery is not the only option

Weight loss surgery leads to deficiencies in almost all known nutrients. We are seeing diseases like beriberi and kwashiorkor that were unheard of before this surgery and diseases like Korsakoff's and Wernicke's that were only seen in terminal alcoholics. The complications of obesity include high blood pressure, high cholesterol and high blood sugar (diabetes). There are safe and effective medications for these conditions, which are far safer than surgery and also more effective, with the exception of diabetes, which is more effectively treated by surgery.

There is a very simple answer, based on the biochemistry of food intake. The first of the newer observations is that fat is not the villain it has been accused and apparently convicted of being. Several recent articles, recently in the BMJ editorial,(Saturated fat is not the major issue BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6340 (Published 22 October 2013) Cited as: BMJ 2013;347:f6340) have looked at the meta-analyses available that find fat innocent of the charges fat is a metabolic danger made in the late 50's and 70's. The villains of this piece are glucose and fructose and their disruptions of homeostasis. As we know with many substances, it is the dose that determines the poison and the dose of sugars has climbed to a damaging levels.

This makes the solution not surgery but diet. Reduce simple sugars intakes dramatically. In obesity, developing ketosis is an excellent marker for the metabolic success of the dietary restriction. But, do not restrict calories or the effect is unsustainable. From a restriction point of view, restricting artificial sweeteners is also necessary as the metabolic/hormonal responses to them mimic those of sugars.

If dietary restrictions of sugars are made to the point of ketosis, many, most, or all medications aimed at reducing the effects of metabolic syndrome effects will need to be stopped, especially and quickly, anti-hypertensive medications and insulin.

The food processing industry and pharmaceutical companies would prefer an additive solution but it is a subtractive solution, sugars restriction, that will directly address the homeostasis imbalances seen in metabolic syndrome and obesity.

Saturated fat is not the major issue BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6340 (Published 22 October 2013) Cite this as: BMJ 2013;347:f6340

@paul, good point. Many negatives associated with weight loss surgery.

Absolutely correct! Further, "Wouldn't it be wonderful if the problem was needing to trick the stomac and outsmart the brain with dimenished signals"! Flying a Brain-or self-regulation and obesity is more complex than these "overly simplex" answers! The surgical approach is a "technique" not a "treatment plan"! It is good to have techniques, to help with rough spots and some of the symptoms of a syndrome, but if we can't capitalize on neuroplasticity and change the way the brain processes signals, converts them to strategies, evaluates the strategy and refines it periotically, and with these repititions grows autoreceptors (breaks) and new neuronal connections and cell assemblies-we are committing a "delusional thinking system ourselves" and looking for oversimplification to allieviate our "anxiety" and to "sell techniques"!

Dear Stephen

The cause of obesity is multifactorial where genetics and sedentary lifestyle associated with hypercaloric diets contribute substantially to its development with significant increase in morbidity and mortality . The most common comorbidities are: heart disease , diabetes , hypertension , joint disease and sleep apnea .

The clinical treatment should be recommended for cases of obesity that is not classified as morbid .

The morbidly obese are those with excessive weight 45kg above their ideal weight ( greater than or equal to 40kg/m2 BMI ) and therefore bring with them a high rate of complications associated with fat accumulation in the body diseases .

Are cases where conventional clinical treatments of obesity did not show satisfactory results , or the loss or maintenance of weight lost

Bariatric surgery is the treatment of choice for morbid obesity and its objectives are to reduce the signs of hunger , increase satiety signals producing controllable state of malnutrition

Obesity is not caused by genetics, and sustainable weight loss and weight maintenance is possible.

The most prominent cause of obesity is infectious diseases and inflammation, and the term infectobesity was coined by Dr. Nikhil V. Dhurandhar in 2001:

Article Infectobesity: Obesity of Infectious Origin1

We have proposed that up-regulated (xenophagy) autophagy turns the eliminated pathogens and dysfunctional cell components into nutrition and energy, which contributed to obesity. And morbid obesity is the result of sustained up-regulated autophagy:

Article Sustained upregulated autophagy (SUA) without anorexia-Aetio...

If one has fully developed sustained upregulated autophagy, daily regular restrictive eating is necessary to maintain a healthy weight and a well functioning gastrointestinal tract.

Obesity. Weight gain. Becoming fat. Increasing waist size. Altered body morphology all are being seen in recent days.

An explosive epidemic has gripped the world and it is not uncommon to see children young adults and middle aged to big bellies and waists.

Who can be blamed. The genes or the food or the lack of interest or negligence or a sheer absence of physical work.

Yes the sheer absence of physical work combined with luxury of living so called. Travelling by bikes and cars than by cycles.

Overwork the motor cycle and invest in high end car and the return of investment is seen in Physical obesity.

Since obesity is not seen as life threatening nor as. Significant inducer of illness the importance given to weigh loss is minimal.

Diet. This is mainly carbrich and protein poor.

Lack of proper guidance for food intake and mushrooming of oil based and fat based fast food centres.

Self awareness. And Regular.self appraisal to be healthy to maintain a good health and an hour of Strength exersice.

These may help.

But lots more. To learn. May be the mothers. Need to be first taught about good nutrition techniques.

Dear Satyaprasad Venkata

You are right. Obesity is not life threatening, and it is not necessary leading to illness.

There is a lot of misconceptions about obesity, and its relation to diseases. The so called obesity epidemic is overblown, as a 2006 Scientific American paper stated:

https://www.scientificamerican.com/article/obesity-an-overblown-epidemic-2006-12/

I agree with the important distinction stressed by Tiziano Marovino about morbid and non morbid obesity.

Obesity is normally measured by BMI. Yet, the big contributor to BMI is the subcutaneous fat, which is protective and normally harmless. But one relatively small component of the obesity, the excessive visceral fat and ectopic fat that surround the organs or enter the organ tissues, are very dangerous, which contributes to morbid obesity, and is associated with numerous diseases.

For morbid obesity, daily regular restrictive is necessary, and one still can live a long and healthy life by doing so.

Dear @Ligen Yu.

Thank you for the answer.

Yes the subcutaneous fat may be the major contributor to obesity and visceral fat may be life threatening.

Today with an ease of availability of foods and more emphasis on ready made fast foods coupled with non and alcoholic drinks have made people more obese. This is what I feel