Dr. Gage is an endocrinologist and attending physician at Lenox Hill Hospital in New York City. He is also clinical instructor in the Department of Medicine at New York University.
The incidence of obesity and comorbid conditions, such as type 2 diabetes and metabolic syndrome, have increased to epidemic proportions in the United States and other Western nations. While 75% of individuals attempting weight loss are initially successful at dieting, 5% manage to maintain weight loss for extended periods of time. Concomitantly, use of aggressive treatment modalities for weight reduction, including the use of appetite suppressing medications, weight loss surgery including gastric bypass and adjustable gastric banding, low calorie diets, and behavior modification therapy have also increased exponentially.
This wide range of alternative treatments have been touted as providing obese patients with successful weight loss with proven long-term maintenance. To date, only behavior modification and surgical intervention have proven valuable in long-term therapy for weight loss and maintenance treatments.
Most studies of patients who have lost significant amounts of weight have addressed physical improvements, such as decrease in blood pressure, blood sugar, and need for medication; improved ambulation; and resolution of sleep apnea syndrome. However, there is less clarity about the psychological consequences found in the weight loss patient, both before and after treatment, or conversely, relating to those factors that will have a bearing on long-term outcomes of treatment. There has been an effort to pre-screen patients prior to obesity surgery. Negative outcomes have been shown in patients with poor behavioral and cognitive skills, borderline personality, binge behavior, and nighttime eating syndrome. However, some of these patients can do well post-operatively in an aggressively supervised behavior modification program. Patients in surgical weight loss programs must deal with post-operative biological change and need supervised programs for behavior modification and cognitive counseling. Patients must develop anticipatory skills as well as avoid binge behavior and vomiting. They must also be prepared to handle issues related to changes in their body image, in particular continued dissatisfaction with body image despite medically successful weight loss.
