Severe obesity is a serious medical condition experienced by people with a body mass index of 40 or above. Previously called morbid obesity, it affects an estimated six million American adults, or about 1 in 33 of the adult population. Associated with a range of complex metabolic disorders including type 2 diabetes, insulin resistance syndrome and raised blood-fats, plus other weight-related health problems, this condition should not be confused with overweight (BMI > 25) or regular obesity (BMI > 30). It is a serious disease requiring professional help.

Since I started my weight loss consultancy over 24 years ago, I have met and spoken at length with hundreds of severely obese individuals weighing 300 pounds or more. For most of them, their weight was a major source of discomfort – both physical and emotional – yet over the years most had “adapted” to their growing waistline and were resigned to remaining seriously overweight for the rest of their life.

For doctors and other health care specialists who work with obese patients, this type of patient-resignation to lifelong obesity is no surprise. But in fact it is only one of many obstacles to long-term weight loss. Many clinically obese individuals struggle with a variety of psychological issues to which they have trained themselves to respond by overeating. Some of these issues – for example, the early loss of a parent – require sophisticated counseling and even then may remain unresolved. In addition, many obese people struggle with family, educational or financial difficulties which further reduce their treatment and recovery options. Given the complex causes, responses and conditions surrounding obesity, it comes as no surprise that many conventional treatments remain largely ineffective. Sadly, many people of normal weight – including members of the medical profession – still find it difficult to accept the intractable nature of the condition, which only adds to the sense of alienation and guilt experienced by the very obese.

Obesity Treatment Options

How effective a treatment is in helping severely obese patients to reduce weight, largely depends upon its ability to tackle the root causes of the condition. Most treatments deal with symptoms (excessive calorie intake) rather than causes (why obese individuals overeat).

Conventional Weight Loss Diets

Now that the low carb approach championed by Atkins Diet seems to have run its course, leaving many obese dieters close to if not heavier than their initial starting weight, the efficacy of conventional weight loss diets is more questionable than ever as a means of reducing obesity. Whatever their dietary composition, most reduced-calorie diets offer insufficient support to help obese patients make the necessary changes to their eating and exercise habits.

Bariatric Surgery

Gastric reduction surgery is a vital “last resort” treatment option for patients with severe weight-related health problems. It typically leads to very significant weight loss and health benefits, but it deals with symptoms not causes. So although it compels patients to eat less, thus forcing them to lose significant amounts of weight in the 2 year period following their gastric bypass or banding operation, it tends to have less success in dealing with the root causes of disordered eating which have built up in the patient’s mind over the years. As a result, about 2-3 years after their operation, a large percentage of bariatric patients find it too difficult to follow the recommended dietary guidelines and end up regaining most if not all their starting weight.

Obesity Drug Treatment

The increasing number of obesity drug prescriptions issued to patients shows that doctors continue to lean heavily on pharmaceutical intervention for weight reduction. Furthermore, with obesity now labelled as the “trillion dollar disease”, drug companies continue to invest heavily in their search for a scientific breakthrough. Yet clinical trials of FDA-approved obesity pills continue to show minimal long-term weight loss benefits for severely obese patients, almost certainly because drugs are not yet capable of dealing with the fundamental causes of disordered eating.

Does This Mean Obesity Is Untreatable?

In view of the limited success of conventional diets, surgery and drugs, does this mean that obesity is untreatable? No. It simply means that more specialised or support-based options are necessary. The first step in finding the best treatment option for any obesity condition is to talk to a doctor, who should be able to outline what specialised treatments are available. For example, there are a number of excellent medically-supervised weight loss programs run by hospitals and clinics in the US and Canada, that offer real support and counseling. Self-help support groups like Overeaters Anonymous (505-891-2664) or TOPS (800-932-8677) can also be extremely helpful. Alternatively, contact the American Dietetic Association (800-366-1655), or the American Obesity Association (202-776-7711) for further information.

Some Practical Tips If You Are Obese

For anyone who is 300 pounds or more, seeking medical advice and getting proper support is essential. Relying upon pills, diets or willpower alone is not enough. However, you can do a number of things to help yourself and improve your chances of losing weight. Here are a few suggestions.

Stop Telling Yourself That You Can’t Lose Weight

Whatever your size or shape, and whatever your history of weight gain, the truth is you can lose weight and you can keep it off. In 24 years I have yet to meet anyone who was unable to lose weight, although I have met lots of people who lacked the motivation to stick to their diet! The point is, not being able to do something is quite different from not really wanting to do it. Yet most dieters confuse these two things. They think they can’t lose weight, whereas in fact what they are really describing is an unwillingness to make the necessary changes to their eating habits. So stop telling yourself that you can’t lose weight – because it’s not true. The real question is: do you want to reduce weight, and if so, why?

Start Telling Yourself Why You Want To Lose Weight

The messages we transmit to ourselves in the form of thoughts have the same effect as radio commercials. The more often we hear a particular message, the more we believe it. Tell yourself every day that you want to lose weight and gradually it will become a bigger and bigger priority. But don’t stop there. In addition, tell yourself how losing weight will improve your life. Maybe your goal is to receive more male attention; or maybe your aim is to fit into a pair of regular jeans; or perhaps you think a leaner body will boost your confidence. Frankly, it doesn’t matter what benefit you think weight loss will give you, the important thing is to advertise this benefit to yourself at every possible opportunity. Start today and try it for three months, and I guarantee it will help you to lose weight.

Start Understanding Your Body Chemistry

There are three things you need to know about body chemistry and obesity control. First, the longer you go without food, the more likely you are to overeat later. So eat something small at least once every three hours. This reduces the risk of bingeing and helps you burn calories at the fastest possible rate. Second, the less chewy and more easily digestible a food is, the easier it is to overeat. By comparison, chewy foods tend to contain more fiber and therefore keep us fuller for longer. A good example of an easily digestible food is a creamy dessert. Even after a huge meal, most of us can demolish a serving of cheesecake or a bowl of rich ice cream, without much difficulty. In comparison, eating 5 oranges or 6 apples after a large main course would be almost impossible. So include plenty of high fiber foods in your daily diet. They contain fewer calories, they fill up your stomach, and they keep hunger at bay for longer. Thirdly, most women experience food cravings in the week before TOM. This is perfectly natural as well as forseeable. So make sure you have an extra supply of healthy snacks to keep yourself satisfied. Above all, don’t try to deny yourself the extra food your body craves – you won’t succeed – just make sure you have healthy options available.

Don’t Try To Be Perfect

God doesn’t create perfect people, he creates humans. And humans enjoy tobacco, alcohol, double chocolate chip muffins and truck-sized boxes of movie popcorn. So unless you come from Mars, don’t try to be a perfect dieter because it ain’t gonna happen! Every dieter has bad days, bad weeks, sometimes even bad months. But so what? Losing weight isn’t a race – it’s a journey. How long it takes to arrive at your destination is not important. The only thing that matters is that you do eventually get there. Besides, once you accept that your diet-wagon is going to lose a wheel from time to time, you can plan how to react when it happens. Whereas if you assume your diet is going to be trouble-free, you are less likely to be prepared when disaster strikes.

Stay Guilt-Free Under All Circumstances

Suppose you are 300 pounds. You start a diet, you start exercising with a neighbor, things go well and you lose 30 pounds, you feel on top of the world, then you have a huge bust-up with someone. Result? Your diet falls apart, you stop exercising and start comfort-eating. How can you prevent this from happening? Answer: you can’t. This is Life. This is what happens. All you can do is go with the flow. If this means bingeing for a week until you feel better, so be it. But whatever you do, DON’T FEEL GUILTY. Because guilt will eat you up and will keep you obese for ever. In my experience, a dieter’s initial bout of overeating is rarely the problem – it’s the guilt which it inspires that does the damage and causes them to quit. Losing weight should be a guilt-free zone, and don’t believe anyone who tells you different. On my weight loss program and forum there is no guilt, no matter what happens.

Join A Weight Loss Community

If you are connected to the Internet, try to find an active forum where you can post your weekly weight, keep a food or weight loss journal, swap ideas with other dieters and generally have fun. Many people regard weight reduction as a totally serious matter. But it’s not. It’s a journey from A to B. And just like any journey, it passes more easily when we have fun and learn interesting things along the way. My weight loss forum is a very supportive place, but there are dozens of other forums to choose from. One of the biggest benefits of an active dieting forum is the opportunity it gives you to express your feelings. You can vent about your personal success or failure and also show your support for other people, which is equally therapeutic. So look out for a suitable online weight loss community and watch your obesity gradually disappear into thin air!

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