196 Obesity Treatment
and also has some interesting effects on the individual’s psychological state.
The results from this study suggest that adherence to the drug was related
to being motivated to lose weight by a life event rather than just the daily
hassles of being obese. Further, if the unpleasant highly visual side effects
were regarded as an education into the relationship between fat eaten and
body fat, then they helped to change the patient’s model of their problem
by encouraging a model which emphasized behavior. Such a behavioral model
of obesity was then related to behavior change. This is in line with research
in other chronic illnesses which shows the importance of coherence between
an individual’s beliefs about the cause and solution of their problem
(Ogden and Jubb, 2008). For example, if a person believes their heart attack
was caused by overexertion, then they are unlikely to follow advice to exer-
cise as this solution does not match their cause. Similarly, if a person believes
their obesity is caused by their metabolism or genetics, they are unlikely
to change their diet. Orlistat may work because it brings beliefs about causes
and solutions in line with each other.
Surgical treatments of obesityThe final approach to obesity is surgery, which is reserved for the severely
obese and is offered when all other attempts at weight loss have repeatedly
failed. Although there are 21 different surgical procedures for obesity
(Kral, 1995), the most popular are the gastric bypass and gastric banding
(see figures 9.4 and 9.5). Both these procedures impose dietary control on
the patient and therefore remove the need for the patient to restrict their
own eating behavior. The gastric bypass involves excluding most of the stom-
ach, the duodenum, and a 40 –50 cm segment of the proximal jejunum.
This promotes weight loss in two ways. First, it reduces the amount of food
that can be eaten, as large quantities of food cause discomfort; and, second,
it reduces how much food is absorbed once it has been eaten. The gastric
bypass is irreversible except under extreme circumstances. In contrast,
gastric banding can be reversed more easily and involves the use of a band
which is filled with fluid that isolates a small pouch of stomach of about
15 ml away from the remainder of the stomach. This procedure promotes
weight loss by restricting food intake, as once the pouch is full any further
food induces vomiting until the pouch has emptied its contents into the
rest of the stomach. Halmi et al. (1980) reported high levels of weight loss
and maintenance following surgery, with accompanying changes in satiety,
body image, and eating behavior. Stunkard et al. (1986a) suggested that