Increasing physical activity is essential for any weight-loss regimen to be successful. With the AGB, this is particularly accurate. However, it is clear that it might be difficult to exercise regularly when you are extremely overweight, both physically and psychologically.
Almost 80% of the patients we treat had previously participated in some kind of exercise program. Many people have used personal trainers and joined multiple local fitness facilities. They've heard it time and time again: just exercise consistently and you'll lose weight. Personal trainers frequently have a strong passion for exercise, making it challenging for them to understand the issues faced by someone who is morbidly obese. It should come as no surprise that they encourage the workout regimens that have been successful for them and are typically eager to get you started. The lack of noticeable weight reduction after spending hours working out on a machine, however, can frequently have a profoundly negative psychological impact, despite all the encouragement in the world. A lot of individuals simply give up. It's just too difficult.
Another set of fitness experts engages in aggressive mass marketing of various goods or "easy to do" exercise routines. "You too can spend as little as 10 minutes a day getting the body you've always wanted." Does it sound like it could be a scam? They obviously want you to purchase their offering. Professional models appear to complete the exercise with ease and without even breaking a sweat. It's strange that you never see exercise equipment advertising with morbidly fat people actually using the equipment. In certain instances, the equipment may really have a weight restriction that prevents use if you are over a specific weight.
Many patients are quick to mention that they just cannot exercise when the topic is brought up. It goes without saying that morbid obesity substantially reduces a person's physical abilities. This is particularly valid in the case of persistent back, hip, knee, ankle, or foot discomfort. Working with someone who is skilled in identifying these is crucial because of this.
who can create particular physical activities that will boost metabolism and aid in fat loss without exacerbating underlying conditions under various restrictions. An exercise physiologist is qualified to recognize the conditions that limit physical activity and can create an effective exercise regimen for you. Even patients who are confined to wheelchairs due to severe physical limitations can learn exercises they can easily perform.
Although weight in pounds is the most widely used indicator of obesity, it frequently misrepresents your actual physical state. An exercise physiologist will also take additional precise measurements and assess your relative capacity to engage in regular exercise as part of the preoperative evaluation. The exercise physiologist will develop a more complete picture of how obesity is affecting your health by obtaining a more complete set of body measurements and evaluating your exercise tolerance. The baseline that this initial data establishes is crucial, and similar measurements will be taken again in the upcoming months and years to gauge your success beyond just weight loss. Many of my patients, especially those who have reached a weight-loss plateau, have found great encouragement in the inches they've lost. This initial evaluation is a crucial step in laying the groundwork for future success and support.
From a psychological perspective, speaking with the exercise physiologist before surgery is crucial. Everyone will agree to exercise more if they can have the AGB surgery, as it has been repeatedly stated that regular exercise of some kind is essential to your success. Sadly, these commitments are frequently rather ambiguous and are easily forgotten. It is necessary to have a clear plan that specifies every aspect of your exercise regimen. Then you must resolve to do it. This involves yet another specific behavior change and is one of many lifestyle changes that all entail altering your way of thinking.
What about Teenage Obesity Surgery?
The topic of bariatric surgery in morbidly obese children and adolescents has received a lot of attention recently, both in the media and among the medical and surgical communities. The issue of childhood obesity is spreading at an alarming rate, and all indications are that things are only going to get worse. The estimated costs for treating obese children as they grow into obese adults are staggering. Similar to this, child psychologists are increasingly concerned about the psychological and social effects of childhood obesity. The obvious question is: Should we operate on obese teenagers in the same way we operate on obese adults? The verdict is still out, but an increasing number of pediatric surgeons are at least considering this possibility.
There are a number of issues to consider before deciding whether to operate to treat adolescent obesity. These are listed below: Are we sure the child is going to remain obese through and beyond puberty? Are we sure the child is mature enough to understand the ramifications of bariatric surgery and the restrictions it imposes? Is the child capable of dealing emotionally and socially with what may be a newfound "celebrity status" among their peers? And what procedure is appropriate for a person who is still developing physically?
Checklist: Questions to Ask before Surgically Treating Adolescent Obesity
Are we sure the child is going to remain obese through and beyond ✓puberty?
Are we sure the child is mature enough to understand the ✓ramifications of bariatric surgery and the restrictions it imposes?
Is the child capable of dealing emotionally and socially with what ✓may be a newfound "celebrity status" among their peers?
What procedure is appropriate for a person who is still developing ✓physically?
There seems to be little doubt that if a person is obese as a child they are very likely to be obese as an adult. Many of my patients relate that they
actually began gaining weight in their preteen years and have struggled with obesity their entire life. Certainly, a case can be made for intervening early in this process, before major medical problems, such as high blood pressure and diabetes, become well established. However, it is hard to know when and if these problems will actually develop, when surgical intervention is warranted, and when it isn't. After all, we aren't dealing with a long medical history, since by definition these are children we are talking about.
Another argument that is frequently made suggests that teens who are morbidly obese suffer from impaired social development, so obviously they should benefit from bariatric surgery as a psychosocial development tool. Unfortunately, most children under the age of 18 have limited insight into their psychosocial situation and are generally most comfortable maintaining the status quo. They are often quite uncomfortable drawing undue attention to themselves, especially if it involves their appearance. Assessing the child's motivations and likely response to a major change in body image is perhaps the most critical part of any adolescent bariatric program. One program I'm familiar with requires one full year of psychological assessment and counseling before any child is considered a candidate for surgery. It is also extremely important to identify the motivations and the role of the parents in this process. The decision to explore weight management through surgery must be shared by both child and parents if there is any hope for success.
We all know how important "image" is, especially to a child around the age of puberty. Assuming that a high school student who is recognized by their peers as the "big man" or "big girl" on campus suddenly begins to lose a large amount of weight, they will undoubtedly become the subject of considerable interest, some positive and some negative. This unusual level of attention can potentially cause a number of problems. They may achieve sudden "star" status, or sudden "freak" status. Either way can lead to a variety of behavioral changes, including juvenile delinquency, poor performance in school, and even drug use. Children who undergo bariatric surgery must be followed very closely by an experienced child psychologist or psychiatrist to help identify such behaviors before they become a serious
problem. These kids should also be compelled to be involved in a support group of their peers as well as a supervised exercise program.
If a well-adjusted, emotionally stable, morbidly obese child and their parents make the decision to have weight-loss surgery, it only makes sense to employ the lowest risk procedure possible, and preferably one that is reversible. It is certainly possible that within the next few decades one or more medical treatments will come along in the form of a new diet pill or a genetic re-engineering process that may make bariatric surgery obsolete. Should that occur, it might be advantageous to reverse whatever weight-loss procedure a young man or woman may have had performed when they were an adolescent.
The entire subject of bariatric surgery in children remains very controversial, but it is one that will continue to spark considerable debate in the years to come. At this time, if any parent is considering bariatric surgery for their child, they should first seek the advice of their pediatrician. It is also important to recognize that there are only a handful of centers capable of providing all the special testing and care required to be successful. Remember, children have special needs. They are not just small adults.
Conclusion
Assuming you are a candidate for the AGB, your overall success will depend on many factors, beyond the operation itself. The complexity of obesity as a disease requires more than just an operation. In the next chapter, we'll look into why you need a comprehensive approach to treat your obesity and what you should be looking for in the way of a program.