Losing a little helps a lot

As obesity problems grow, physicians take long-term approach to treatment

Spring has sprung in much of the country, and if it hasn’t arrived yet, it soon will. It’s time to put away the big sweaters and get ready for shorts and swimming suits. That’s a reality that few adults look forward to, but it causes even more angst for those people who are more than just a few pounds overweight. People with medically significant obesity have more important reasons to lose weight than only hoping to look good in warm weather clothes.

The Weight Management Program at Washington University School of Medicine is dedicated to the management of obesity. Patients receive assistance from a team that includes doctors, behavior therapists, registered dietitians and exercise specialists. They tailor weight management and exercise programs to individual patients to help them lose weight and adopt healthier lifestyles.

Because obesity is a chronic illness, long-term treatment is required to help obese patients make the lifestyle changes to lose weight and keep it off.

The center’s new director, Denise Wilfley, Ph.D., associate professor of psychiatry, is an expert in behavior therapy for obesity. She is joined by Robinson Welch, Ph.D., the new behavior therapy director. They join Samuel Klein, M.D., and J. Christopher Eagon, M.D., the center’s medical and surgical directors.

“For many people who are significantly overweight, the problem is primarily behavioral,” Wilfley says. “We try to identify the barriers that prevent people from being more active and eating fewer calories, and adopting a healthier lifestyle. Unless we can help people make long-term changes in behavior, we can’t help them. Obesity is a very serious problem that seems to be getting worse in our society, but with the right treatment, it is possible even for very obese people to lose weight and get healthier.”

Medically significant obesity means having a body weight that is more than 20 percent above normal. The reason it is called medically significant obesity is that weighing that much puts people at risk for heart disease, diabetes, stroke, high blood pressure and cancer. It also decreases quality of life.

Almost two-thirds of Americans are either overweight or obese, and that figure is growing — in both size and number.

Samuel Klein, M.D.

“More than one of every three Americans has medically significant obesity,” says Klein, the Danforth Professor of Medicine and Nutritional Sciences and director of the Washington University Center for Human Nutrition. “In the past several years, the prevalence of obesity in adults in the United States has continued to increase, in spite of more and more research about the dangers of being overweight. The obesity problem has become a major public health crisis.”

The Washington University Weight Management Program is an outpatient program. It uses the most current information to help patients lose weight safely and reduce long-term risks of obesity-related diseases by providing group classes, medical monitoring, nutrition education seminars and exercise education seminars. Individual counseling sessions and long-term maintenance also are included.

Patients in the program are taught how to lose weight and how to maintain their weight loss. The program sets modest, realistic goals for patients because research has shown that even moderate weight loss of five to 10 percent can result in considerable health benefits for those with medically significant obesity.

Many who do lose weight tend to regain those pounds over time. Physical activity is particularly important in sustaining weight loss, so even participants who are extremely overweight are given moderate exercises to do.

For those who have great difficulty losing weight in spite of that assistance, the program also offers surgical alternatives. J. Christopher Eagon, M.D., assistant professor of surgery, offers minimally invasive, laparoscopic gastric bypass surgery to patients who are very obese, especially those patients who have developed medical complications from being obese.

According to Klein, it makes little sense to treat obesity with a program that ends after only a few weeks or months, so a long-term program is critical for long-term success.

“Obesity is a chronic disease, and giving short-term therapy is not going to be effective,” he says. “We would never think of treating a diabetic with insulin for four months and then stopping the therapy. We need to treat obesity in the same way.”