Last updated: 11/24/2009

Surgical alternatives

The Lap-Band gastric restrictive procedure represents an alternative to gastric bypass surgery. The Lap-Band offers another approach to weight loss surgery for patients who feel that a gastric bypass is not suitable...

for them. It causes weight loss by lowering the capacity of the stomach, thus restricting the amount of food that can be eaten at one time. The band is fastened around the upper stomach to create a new tiny stomach pouch. As a result, patients experience a sensation of fullness and eat less. Since there is no cutting, stapling, or stomach rerouting involved, the procedure is considered the least invasive of all weight loss surgeries. The surgeon makes several tiny incisions and uses long slender instruments to implant the band. By avoiding the large incision of open surgery, patients generally experience less pain and scarring. In addition, the hospital stay is shortened to less than 24 hours, including overnight hospitalization.

Vertical banded gastroplasty (VBG), another commonly used surgical technique also known as stomach stapling, is today considered inferior to RNY gastric bypass in inducing weight loss. It is also associated with several undesirable complications.

Non-surgical alternatives

Dietary therapy is the fundamental non-surgical alternative. It involves instruction on how to adjust a diet to reduce the number of calories eaten. Reducing calories moderately is known to be essential to achieve gradual and steady weight loss and also to be important for maintenance of weight loss. Strategies of dietary therapy include teaching patients about the calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods. Some diets recommended for weight loss include low-calorie, very low-calorie, and low-fat regimes.

Another nonsurgical alternative is physical activity. Moderate physical activity, progressing to 30 minutes or more on most or preferably all days of the week, is recommended for weight loss. Physical activity has also been reported to be a key part of maintaining weight loss. Abdominal fat and, in some cases, waist circumference can be modestly reduced through physical activity. Strategies of physical activity include the use of such aerobic forms of exercise as aerobic dancing, brisk walking, jogging, cycling, and swimming and selecting enjoyable physical activities that can be scheduled into a regular routine.

Behavior therapy aims to improve diet and physical activity patterns and habits to new behaviors that promote weight loss. Behavioral therapy strategies for weight loss and maintenance include recording diet and exercise patterns in a diary; identifying such high-risk situations as having high-calorie foods in the house and consciously avoiding them; rewarding such specific actions as exercising for a longer time or eating less of a certain type of food; modifying unrealistic goals and false beliefs about weight loss and body image to realistic and positive ones; developing a social support network (family, friends, or colleagues); or joining a support group that can encourage weight loss in a positive and motivating manner.

Drug therapy is another nonsurgical alternative recommended as a treatment option for obesity. Three weight loss drugs been approved by the U.S. Food and Drug Administration (FDA) for treating obesity: orlistat (Xenical), phentermine, and sibutramine (Meridia).