As a Nation, are more overweight than ever before. That's interesting indeed. There seems to be some sort of connection between the strategies that we use to lose weight and our ability to actually lose weight...and to actually keep it off.

But for many a desire to lose weight or maintain weight loss doesn't necessarily dictate success. Weight loss and weight maintenance are tough work and successful strategies vary based on how much weight a person needs to lose. Some people can succeed with diet and exercise alone, others need more invasive interventions like surgery. And even for those who are lucky enough to realize their desired weight, maintenance, although more straight-forward, can be even more difficult than the initial weight loss.

According to the Department of Health and Human Services, people with BMI's between 18.5 and 24.9 are considered normal weight. People with BMI's between 25 and 29.9 are considered overweight. Those with BMI's between 30 and 39.9 are classified as obese. Finally, people with BMI's greater than 40 are categorized as morbidly obese.

For Americans who are simply overweight, self-control measures are a good place to start. Medical intervention is best reserved for obese individuals or overweight people who have medical problems or have failed self-managed diets on numerous occasions. Although exercise is important in any weight loss or weight maintenance regimen, research shows that diet is the most effective means of weight loss. A successful diet is a diet which is both balanced and calorically-restricted.

Going Under the Knife

For some, achieving desired health goals goes beyond diet and exercise alone. Obesity can be life threatening and going under the knife is a remedy that some doctors recommend. 

Bariatric surgery may be the best option for people who are morbidly obese (BMI's greater than 40) or people who are obese with BMI's greater than 35 and have medical problems such as diabetes, sleep apnea or coronary artery disease. Bariatric surgery has proven to curb medical conditions such as diabetes, heart disease and sleep apnea and drastically improve quality of life. There are two types of bariatric surgery: restrictive and malabsorptive.

Restrictive bariatric surgical procedures such as the gastric laparoscopic band (LAP-BAND) are becoming the most popular option for most morbidly obese patients. Restrictive bariatric procedures reduce the volume of the stomach and cause people to feel fuller faster. The LAP-BAND surgery involves placement of an adjustable band around the top of the stomach by a highly-qualified surgeon. Procedures such as the LAP-BAND have few medical repercussions and less than one percent of all people undergoing such procedures die afterwards. Qualification for the LAP-BAND isn't easy and varies by insurance carrier, but most insurance carriers require a history of failed attempts at diet and exercise and a battery of health visits with nutritionists, psychiatrists and other health professionals.

Furthermore, anybody desiring to undergo the LAP-BAND should be ready for a long commitment. The band must be rigorously maintained after surgery. Nevertheless, the LAP-BAND is an excellent option for those interested in losing a large amount of weight gradually and maintaining this weight loss.

Malabsorptive baratric surgical procedures such as the "Roux-en-Y" are more effective, resulting in more weight loss, but are also more dangerous. Patients receiving such surgical intervention have a surgeon remove part of their gut to interfere with absorption of foods. Following surgery, patients must be careful to eat certain types of foods and take proper nutritional substitutes. Furthermore, unlike the LAP-BAND, malabsorptive bariatric procedures are irreversible and carry a higher risk of medical problems stemming from nutrient deficiency, small bowel obstruction and infection.

Weight Maintenance: A Life long commitment & the Most difficult path

So you've lost the weight or you're happy with the weight you are at, now all you need to do is to maintain. But in this land of plenty, weight maintenance is difficult. Seemingly, candy bars grow from convenience store counters and McDonald's line every major throughway. What's the health-conscious John Q. Public to do?

Now more than ever maintaining a healthy well-balanced diet and exercise regiment is integral. Lifelong diligence is key. 

As with weight loss, there's a psychology to weight maintenance:

Visual cues: Health researchers, most notably Dr. Brian Wansink author of "Mindless Eating: Why We Eat More Than We Think," find that people eat with their eyes not their stomachs. For example, Dr. Wansink found that people presented with a "bottomless" self-refilling bowl of soup ended up consuming 73% more soup than they would have otherwise. Furthermore, they didn't feel any more sated after doing so. Without a point of reference like an empty bowl, people just keep on eating. Anybody who's interested in maintaining their weight can take advantage of this simple psychology by buying small plates, smaller bowls, 100-calorie "snack" packs, and avoiding all-you-can-eat buffets altogether.

Taking a day off: Health researchers also discovered that once physically fit people loose restraint they are more likely to keep on eating. In a quaint experiment, researchers fed obese and physically fit subjects a milkshake and then offered them as much ice cream as they wanted. The thinner subjects, who are normally restrained in their eating patterns, threw caution to the wind and ate more ice cream than their obese counterparts. This line of thinking influenced the common recommendation that everybody take off one day a week from strict diet maintenance. 

With respect to weight loss and maintenance, everybody controls their own destiny. It's important for all of us to realize that healthy living is within our control. Determination is the key to proper weight loss and maintenance. We all hold the keys to our own slimmer and healthier selves.

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Source: Dr. Amir Rassoli, a long-practicing internist and emergency room physician.