A conceptual application of health behavior theory in the design and implementation of a successful surgical weight loss program

Obesity (BMI greater than or equal to30 kg/m(2)) is recognized as a primary risk factor in the pathogenesis of several leading causes of morbidity and mortality, most notably hypertension, diabetes, and coronary artery disease. Despite numerous preventive approaches, the number of Americans who are overweight and obese has reached pandemic proportions and continues to increase. Moreover, the "fat are becoming fatter" as evidenced by the increasing prevalence of morbidly obese individuals (BMI 2:40 kg/m(2)). For the morbidly obese individual with potentially life-threatening comorbidities, the support for and use of surgical treatment options as a corrective mechanism is growing. Weight reduction results for bariatric surgery average 30-80% of excess body weight, depending on the length of the follow-up and the surgical technique. The demonstrated effectiveness of surgical treatment as a weight-reduction method coupled with the increasing prevalence of severe obesity is certain to increase the popularity of surgical treatment options. With this increased popularity, comes a responsibility for health-care professionals to guard against patients' perception of surgical treatment as a panacea. To counter this possibility, three recommendations are presented as components of a treatment paradigm by a multidisciplinary team of health professionals, which incorporate surgical and non-surgical treatment components, increase patient responsibility, promote lifelong health behavior change and effect permanent weight loss.