Obesity has increased dramatically in the U.S. over the past 30 years and has now reached epidemic proportions. More than a third of adult men and women meet the criteria for obesity, and clinically severe cases are rising even faster than moderate ones. While bariatric surgery has proven a useful tool for many, it’s not reliable or effective enough to stave off the obesity epidemic.

Procedures like gastric banding, gastric sleeve, and other bariatric surgeries can lower body mass index, the risk of diabetes, and the risk of cardiovascular disease — but only temporarily. And the qualification requirements for such surgeries are extremely strict. Also, bariatric procedures don’t typically produce satisfying, long-term results, and you could be at a high risk of gaining most or all of your weight back.

Eating disorders are also on the rise, and they’re often an underlying cause of persistent obesity and the long-term failures of bariatric procedures. No matter how skilled the surgeon or how successful the procedure, an uncontrolled eating disorder can defeat the purpose of weight-loss surgery and potentially cause serious post-surgical complications.

The Shortcomings of Bariatric Surgery

Every year, approximately 200,000 bariatric surgeries are performed, and many patients rely on the procedure alone to help them become healthier. Yet bariatric surgeries come with a host of possible complications, including an increased risk of alcohol abuse (even if alcoholism was not present before the surgery).

Other potential pitfalls include exorbitant subsequent costs for proper nutritional counseling, the need for cosmetic surgery for excess skin, and life-long vitamin supplementation. Also, invasive surgery can disrupt an individual’s physiology, exposing them to serious health complications.

For example, gastric bypass permanently alters the anatomy of the stomach and intestine, which can result in chronic malabsorption malnutrition, disruption in the gut microbiome, and an increased sensitivity to alcohol. Other procedures may be less invasive but suffer from unacceptable rates of failure (sometimes up to 70 percent).

Still, when used as only one of many tools for improving weight and overall health, bariatric surgery may be effective. Through proper nutrition education, a good exercise regimen, and a few strategic lifestyle changes, individuals have a much better chance of preventing or reversing weight gain after bariatric surgery.

The Keys to Unlocking Successful Lifestyle Changes

Nonsurgical lifestyle intervention is often considered ineffective because it’s typically defined as one or more half-hour sessions discussing written materials with a nutritionist or dietician. When thought of as such, intervention can seem vastly inferior to bariatric surgery. However, an integrated lifestyle intervention program consists of much more than just a few short discussions, and it’s designed to achieve the results that bariatric procedures can’t accomplish alone.

According to a study that measured the effectiveness of individual lifestyle intervention for patients with severe obesity, behavioral programs offer significant hope for fighting the rising obesity epidemic. For such programs to be successful, they must consist of several essential components that revolve around therapeutic, nutritional, and physical needs. Here are four of those essential components:

· A comprehensive medical evaluation: Medical evaluations can uncover metabolic, hormone, and sleep disorders that exacerbate obesity and health complications. For example, sleep apnea affects more than 12 million people in the U.S., but it’s often undiagnosed. Nevertheless, sleep apnea is a significant factor in serious cardiovascular health issues and is common throughout overweight and obese populations.

· Behavioral therapy: Behavioral therapy should include an assessment for eating disorders and other psychiatric issues that often go undiagnosed. Therapy, especially cognitive behavioral therapy, can treat eating and other psychological disorders, body image issues, and unhealthy relationships with food to address the root causes of obesity and produce long-lasting health benefits.

· Nutritional education: You need to understand how foods affect blood sugar levels (i.e., glycemic index/glycemic load), the concepts of attuned eating, proper food pairings, insulin resistance, and more. Knowledge is power, and proper nutritional education will give you the power to make more informed decisions when grocery shopping and eating out.

· Directed physical activity: Maximize the body’s potential to burn energy and nutrients by participating in physical activity. Besides staying fit, regular exercise can lead to personal empowerment, significantly higher self-confidence, and improved mental and physical health.

How to Succeed at Lifestyle Intervention

For lifestyle intervention to last, the program must be long enough to truly effect behavioral change. In many cases, an integrated program can result in weight loss and improved blood sugar, blood pressure, and lipid profiles in as little as 30 days. However, true change requires at least 90 days of consistent adherence to diet, exercise, and behavioral modification, preferably working with a committed team of health professionals.

There are several online resources and self-help publications that discuss weight loss, eating disorders, and lifestyle intervention. Some can even shed light on the concepts for people who are new to them. But for most people, active involvement in a program is the only way to see real results and succeed at long-term physical and behavioral change.

Like recovery programs for alcohol and substance abuse, or group therapy sessions for people who have experienced similar trauma, lifestyle intervention programs offer a supportive environment for those struggling with obesity and eating disorders. Whether residential or outpatient, in the community or away at a retreat, lasting change is easier when we have others to help keep us accountable and on track.

The most critical component of overcoming obesity and related psychological disorders is cognitive change. Surgery may temporarily reduce obesity, but it does nothing to change its underlying causes. The best way to achieve deep-seated cognitive change is through integrated individual lifestyle intervention so you can actively reinforce good behaviors and participate in your personal self-improvement.

Author's Bio: 

Dr. Mark Calarco is the national medical director of American Addiction Centers, a leader in drug and alcohol abuse treatment. He is a pioneer in treating hormone imbalances in recovering individuals and has served as a board member for the State of Tennessee Medical Laboratory Board and the American Academy of Anti-Aging Medicine. Dr. Calarco was also the first board-certified anti-aging and regenerative medicine specialist in Tennessee.