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Form Fitting

Surgery or exercise: ways to win the weight-loss battle.

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Tbe fat or not to be fat is not the question. That one's easy: Don't be fat.

No, the real question is, how to not be fat. Ay, there's the rub.

Ever since vegetable oils first got hydrogenated over a century ago, the Western diet has been a glutton's paradise. Thankfully, the technology of losing weight has started catching up with the science of gaining weight. Be it weight-loss surgery or a carefully planned fitness regime, finding the real you under the flab is more possible now than ever.

The weight-loss option that has been grabbing headlines these days is surgery. There are a number of FDA-approved procedures that can effect dramatic loss of weight, but there are two primary ways to do it: reduce the capacity of the stomach, thereby restricting how much food is needed to make you full, or limit the absorption of calories by your digestive system, called malabsorptive procedures. Each has drawbacks or risks, but such techniques are shown to be very effective in patients who comply with the doctor's orders.

At the Center for Surgical Weight Loss at St. Francis Hospital in Memphis, two common procedures are the Lap Adjustable Gastric Banding and the Roux-en-Y Gastric Bypass. Banding is a less-invasive, reversible way to restrict the stomach so that you require less food to make you feel full. Leslie Albers, RN, program coordinator at the center, says, "With the band, you can expect to lose around 50 percent of your excess body weight in 18 to 24 months if you are compliant with the program."

The gastric bypass is more invasive but is potentially more effective at helping you shed those pounds. It's a double whammy, being both restrictive — reducing the size of the stomach capacity — and malabsorptive. "The stomach size is reduced substantially with this type of procedure," Albers says. "With the bypass, you can expect to lose around 60 to 80 percent of your excess body weight in 12 to 18 months if you are compliant with the program."

Not everyone is a good fit for surgical weight-loss options. Only those who suffer from morbid obesity or have co-morbidities (other diseases or disorders) that exacerbate their obesity — such as diabetes, hypertension, or heart disease — are considered. Albers says that, in conjunction with the recommendation of the National Institutes of Health, at the Center for Surgical Weight Loss, "Candidates would be between 18 and 65 years old with a body mass index [BMI, a statistic that measures weight against height to determine obesity] of 40 or more or a BMI between 35 and 39.9 with documented co-morbidities or health problems caused by their weight."

According to Albers, the pros of surgery are simple: "It will work if you do what you are supposed to do. It will help tremendously people who are unable to lose weight by other means. It will help get you to a healthier weight."

But don't undergo the surgery without being ready to overhaul your lifestyle. Your diet and especially your eating habits, beginning during the weeks after surgery, will never be the same again. That need not be a bad thing, Albers says. "One hundred percent of our patients say that their quality of life has improved after surgery."

Short of surgery, science has also made inroads into more effective methods of fitness, including new kinds of exercise equipment and tailoring fitness regimes to the individual. For the morbidly obese, that can mean easing in to an exercise system rather than jumping in with both feet.

Billy Tune, Fitness Manager at Collierville's Prairie Life Fitness Center, says, "The more weight [someone's] got on them, it's going to be really hard on their joints. Somebody who is severely obese who is starting off running — it's not going to be the best activity for them. They're going to get tendonitis, their hips are going to bother them, their back might hurt, feet, you're going to get all sorts of problems there." Instead, Tune recommends water aerobics, elliptical machines, or riding a non-weight-bearing stationary bike to start with.

InsideOut Gym, in Midtown, has a program called SweatShop, an intense, six-week boot camp replete with homework exercise for serious-minded overweight people. "It builds toward the end," Lisa Buckner, co-owner of the gym, says. "[Participants] exercise like crazy, but they also [learn] how to exercise." Past participants have lost 12 to 15 pounds or have lost 14 inches in six weeks. "They get an exercise prescription," Buckner says.

For fitness to work, Tune and Buckner both say, it needs to be a part of your everyday life: a lifestyle change. Buckner takes that idea personally. As she says, "I'm the former 260-pounder who lost 100 pounds and kept it off."

Tune says fitness is a necessary part of everybody's health plan, even for those who have gotten weight-loss surgery. "I always tell them, even if they get that surgery, they still need to come in [to the gym], or they're going to end up right where they were before," he says. "The surgery's going to be negated.

"That's the problem. You can slowly stretch your stomach back out again to where it was before. If you keep taking in more calories, go back to those old habits, you're going to put the weight back on down the road."

Furthermore, Tune feels that, to really impress the importance of fitness on those who are going to have weight-loss surgery: "They should start exercising before the surgery, because then they get that habit, and once they get out they can continue exercising. I just hate to see people who get that surgery and then go right back and think they can start eating again. The surgery's going to help, but long-term, they definitely need to exercise and diet correctly.

"Even if you look great on the outside and you get the surgery, the most important muscle in your body is your heart. If you're not training your heart and you're not eating right, you can look great but still not feel great."

Buckner says that careful monitoring of the exercise of those who have had weight-loss surgery is very important: Since they don't eat as much, they use up their food energy much more quickly.

Surgery or no-surgery fitness? Making that choice can be very difficult. Albers says, "Deciding between surgery or other weight-loss methods is very personal. By the time most people reach us, they have tried every diet out there. They have struggled with their weight and the problems caused by their weight for years. We know that only a very small percentage of people can lose weight with diet and exercise and maintain that weight loss.

"In addition, most people can only lose 5 to 10 percent of their excess body weight with diet and exercise, and if you have 100 pounds to lose, 5 to 10 pounds is not very helpful. The surgery helps get people on a level playing field with the rest of us who are trying to maintain. Without surgery, a large number of people cannot get close to a healthy weight."

Neither surgery nor strict fitness is a panacea. Diet is the essential, once-and-future number-one rule for wellness. Health begins with nutrition, no matter what else you do. Albers says, "Diet is very important with both surgeries, and exercise is the catalyst that really jumpstarts weight loss. Weight-loss surgery is only a tool. Both surgeries require a lifestyle change to be successful."

Tune says, "Most people just come in [to the gym] and they do the [weight training], but that's only about 10 percent of it. Diet and cardio are everything. Your cardio and your diet are going to really be a difference in your body composition — mainly your diet."

But getting the pounds off and keeping them there is Rule 1A. If you can do that, you're well on your way to a life spent living well.

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