Controlling weight is not just about diet and exercise, but requires education and long term commitment to fight obesity, say weight loss experts.
"My job is to build a specialty program that deals with medical weight management, providing a long-term care model to treat obesity as the disease it is,'' Dr. Jamy Ard from Wake Forest Baptist Medical Center said.
Ard's approach is shared by the leaders of other weight-control programs at Wake Forest Baptist, including those for children and older adults. All of these programs stress education-not just for the people facing weight issues, but for their families, too - and long-term commitment to changed habits in addition to healthier diet and exercise practices.
Some people view bariatric surgery as a quick fix for obesity, but at Wake Forest Baptist more is expected of patients than just showing up for the procedure.
Patients are encouraged to lose weight or at least stay "weight neutral" in the month or so before undergoing bariatric surgery, which reduces the size of the stomach or limits its capacity to process food.
By adopting new habits during this period, most patients lose a significant amount of weight before the operation, said Dr. Adolfo "Fuzz" Fernandez, co-director of the Weight Management Center and head of its bariatric surgery program.
"The goal is making those lifestyle changes,'' Fernandez said.
"Obesity is a disease. Surgery is the most successful treatment, but without life modification - portion control, healthy choices and exercise - even surgery will not be successful in the long term," Fernandez said.
In other words, patients who have undergone bariatric surgery can put weight back on if they haven't changed their habits.
"We offer a monthly post-op support group - group therapy so to speak - and most of those patients do really well,'' Fernandez said.
"We don't see a lot of recidivism," Fernandez said.
Susan and Allen Fletcher had bariatric surgery at Wake Forest Baptist after years of following diets that only worked for brief periods. She was 288 pounds at her heaviest and now weighs about half that. She started by losing 50 pounds before having the surgery. Her husband is down to 180 pounds from a high of 450.
The benefits, she said, "have been life-changing."
When she had a work conference in New Orleans and her husband went with her, she said, they immediately discovered the pleasure of being able to fit comfortably in airplane seats. Better yet, she said, during conference down time they were able to explore.
When it comes to young people with weight problems, Dr. Joseph Skelton believes giving parents tools to raise healthier children is just as critical as working with the children themselves.
"You improve those parenting skills, you can improve the children's weight," Skelton, director of the Brenner FIT (Families in Training) program at Wake Forest Baptist's Brenner Children's Hospital, said.
Weight problems may be different but are no less critical for older adults, according to Barbara Nicklas, Ph.D., who leads weight-management efforts for seniors through the Sticht Center on Aging at Wake Forest Baptist.
"We believe there are specific challenges to older folks that we need to address in our programs, different motivations to start with," she said.
"Why would a 70-year-old want to lose weight?" she said.
As obesity rates have soared, so, too, have related health problems such as heart disease and diabetes. Consequently, Ard and his colleagues fear that the next generation may have a lower life expectancy than the current generation.