Obesity treatment involves three main courses of action. The most important is food. First, there has to be a decrease in energy intake. If a male patient weighs 300 lbs, he is taking in an average of 3600 calories a day to maintain his weight. Your patient may tell you that volume-wise he is not eating a lot of food. He may actually be correct. For instance, one piece of cheesecake from the Cheesecake Factory is 1000 calories or 9 onion rings is 900 calories. What your patient is eating is energy dense food. If your patient were to have 900 calories of fruits and vegetables, they would have to eat 81 spears of broccoli, 13 apples or 128 cups of spinach. Your patients have to learn the caloric value of the foods they are eating.

The second is cognitive behavioral therapy. In short, the cognitive processes that our patients use regarding food is what’s keeping them from treating their disease. The patients must evaluate what behaviors make them overeat, and what situations they place themselves in that have hindered their efforts to lose or keep weight off. These behaviors may be very simple. One of my patients eats Dunkin Donuts every morning because of the route she drives to work. By changing her morning commute, she no longer had to make the daily decision to eat donuts or not to eat donuts. Patients have to be willing to become regimented in their habits of scheduled eating and portion control. These behaviors must be maintained to maintain weight loss. Often patients cannot wait to get back to “normal” eating. What they need to realize is that the new skills they have learned are normal and that their previous habits were “abnormal.”

The third is physical activity. Exercise is critical for weight maintenance, but as a sole tool for weight loss it is far less effective than changing what one eats. For example, a “number one” at McDonalds is 1300 calories. To burn the equivalent calories while walking, a 150 pound male would need to walk 13 miles.

We know from the National Weight Loss Registry that certain behaviors are characteristic of all individuals maintaining weight loss. They all eat breakfast, exercise daily, use meal replacements, keep food intake journals, weigh themselves frequently, and eat out infrequently.

Successful weight loss takes an aggressive long-term approach. Whether one desires medical or surgical intervention, a program that encompasses all three courses of action will prove successful for patients who desire treatment.

Dr. Gaglione is the medical director of Tidewater Bariatrics in Chesapeake. She is a board certified Internal Medicine physician and a Bariatric specialist.