The Healthy Way to Weight Loss

Sammamish resident Chris Huff, 58, is a vibrant woman with an irrepressible sense of humor. A respiratory therapist, Huff has a demanding schedule both professionally and personally. Recently, she and her husband, Gary Huff, took the trip of a lifetime to Machu Picchu and the Galapagos Islands. Despite strenuous hiking at high altitudes, oxygen deprivation and hours of snorkeling, she felt energized and ready for the next challenge. But it wasn’t always this way, confesses Huff. Last year, she hated the person she had become and had very low self-esteem. “I felt crummy and lousy all the time, both physically and emotionally,” Huff says. “I felt like a total failure.”

Huff’s nemesis was her weight. “I grew up skinny and ate anything, anytime—no problem,” she says. As an adult, for a time, she could still do it. “But I married into a foodie family. I baked. I had a couple of kids. Over time, the weight crept up on me. I tried many different weight loss programs over the years—and lost weight on each one—but the pounds didn’t stay off.”

By early 2012, Huff, who is 5 feet 2 inches tall, weighed 173 pounds and wore size 14 pants. She had a body mass index (BMI, used to estimate overweight or obesity) of 31.6, which in medical terms categorized her as obese. Alarm bells went off. Since Huff works in the medical field, she is very aware of the health risks associated with obesity. At a minimum, the condition impairs quality of life and diminishes life expectancy. Health risks include some of the leading causes of preventable death in the nation, including type 2 diabetes, heart disease, high blood pressure, stroke, arthritis and some types of cancers, including breast, colon and kidney. According to government reports, more than two out of every three adults in the United States are considered overweight or obese, and a child’s likelihood of being overweight is 60 to 80 percent if both parents are overweight. These trends are alarming, and come with an annual price tag of $190 million in health care costs—higher than smoking.

Huff had to make changes and knew she couldn’t do it alone. She found her solution when she watched a friend quietly lose 30 pounds, looking and feeling fabulous, through Swedish Weight Loss Services. “Ours is the most comprehen-sive multidisciplinary bariatric program in the Northwest and is designed to provide people with positive options for weight loss,” says Dr. Ross McMahon, medical director of Swedish Weight Loss Services (WLS) and a bariatric surgeon who built a nationally renowned bariatric weight loss program at Duke University. Options at Swedish include both a nonsurgical, medically supervised weight loss program, as well as surgical options such as gastric bypass or gastric band surgery. “A comprehensive multidisciplinary approach with physicians, surgeons, dietitians, psychiatrists and other experts assures positive long-term results by providing everything necessary for a patient’s success,” explains McMahon.

At Swedish, Huff was under the care of Dr. Rick Lindquist, medical program director for nonsurgical weight loss and one of only four certified bariatric physicians in the state, which means he has received specialized training in medical weight management.

Lindquist can relate to his patients’ frustration with weight gain. “I had been pencil thin most of my life,” he says. “But in 2000, I found myself in my early 50s with an extra 50 pounds I couldn’t get rid of. He found the answers in bariatrics, the field of medicine that treats overweight and obese patients.

The key to success in weight management, explains Lindquist, is a long-term, sustainable approach that includes an understanding of the biology behind weight gains and losses, how to control hunger, the proper nutrition and the importance of moderate exercise. “We are a nation that is expert at dieting, but we are generally unsuccessful at main-taining our desired weight,” Lindquist says.

Boxes of Kleenex are liberally spread throughout the Swedish Medical WLS offices. “By the time they come to see me, people are wrecked emotionally,” Lindquist says. “They feel like they’ve failed. They blame themselves. My job is to help them under-stand that their methods have failed, not them.”

On the first visit, Lindquist reviews a patient’s medical and diet history, takes weight and body measurements, and discusses goals, motivation and concerns. He talks about the science behind healthy weight loss as well. Most of his patients assume they have a willpower or psychological problem, but he helps them understand the biology by drawing a simple chart showing how carbs convert into sugar instantly, and if we aren’t physically active enough to use it up in two hours, our body stores it as fat. Especially lethal are foods that have both high starch and fat content such as french fries and chips. White and refined foods are out. Protein rules. The keys to success: Reduce carbs, increase protein, eat small meals every two to three hours and reduce total caloric intake. Lindquist designs an individual plan for each patient based on their goals and what motivates them, and they leave the first visit with sample eating plans, grocery lists and behaviors they can model for a lifetime of weight management. They can even purchase foods specially designed for programs like this to augment what they have in pantries. It’s all about making it easy to be successful on day one. While most of his patients feel optimistic, a few are apprehensive. Huff says she was one of the latter. “I trudged out of the first appointment feeling disappointed,” she says. She had hoped there was a secret, easier method and worried she could not follow through. “I wasn’t sure I could do it. It was daunting.”

Lindquist meets with his patients regularly to discuss concerns and progress. He asks: How do you feel? Have you had any issues? Are you journaling? Are you exercising? He reinforces the keys to success: Have a plan and goals. Know what motivates you. Be willing to change the way you think about food. Many find the program to be easier than they thought it would be.

When Huff returned for her first follow-up visit, she was a changed person. “By then, I understood the power of the diagram. I understood why I felt the hunger and cravings. I also understood I could control them. I had lost 10 pounds and was thrilled, she says. “I hadn’t been able to lose even 5 pounds in years.”Huff remained in the program for six months. At her last visit, she weighed in at 147 pounds and was wearing size 8 or 10 pants, depending on the brand. Her BMI had decreased to 26.9. For her, the program has been a success because it teaches self-correction skills. “My body looks completely different, and I am healthier. I am really happy; I feel empow-ered. My self-confidence is back. I now have the skills and knowledge to succeed going forward. Dr. Lindquist gave me back myself, the person I used to know and love.”

Medical (nonsurgical) weight loss is generally recommended for overweight and obese patients with a BMI of 34 or lower. But bariatric surgery, or surgical weight loss, is a strong consideration for those with a BMI of 35 or higher. According to Dr. Saurabh Khandelwal, a board-certified surgeon at UW Medicine who performs weight loss surgery and is an assistant professor of surgery at the University of Washington, surgery is often a good choice for patients with a BMI of 40 or higher, or those with a BMI of 35 or higher with significant weight-related medical problems, such as diabetes, heart disease, sleep apnea or high blood pressure, especially if the patient has been overweight for more than five years and when the patient has tried and failed at other weight loss attempts. Patients need to commit to life-style changes that include increasing exercise, refraining from smoking and being willing to follow the dietary rules required after surgery. “Surgery is just one component. Nutrition, diet, exercising and behavioral change are essential parts of success-ful, long-term weight loss,” Khandelwal says. With commit-ment, the results can be impressive. Patients lose significant amounts of weight, and medical conditions such as high blood pressure or type 2 diabetes may significantly improve or disappear completely.But while methods for remedying overweight and obesity are part of the solution, McMahon and Lindquist would also like to see the health care system prioritize prevention, with insurance companies offering coverage for medical weight loss programs before patients become obese.

Lindquist says it is critical that primary care providers receive better training in weight loss management so they can be more proactive with patients. McMahon believes that people in general, including many primary care physicians, don’t understand the dangers of obesity, don’t take it seriously enough, and don’t recognize the high mortality rate and shortened life expectancy that results from the medical complications caused by obesity. “Weight loss and weight loss surgery isn’t about looks,” he says, “it’s about getting back to a healthy lifestyle.”