Scott G. Winterton, Deseret News
Dr. Scott Hansen

As anyone who has ever tried to lose weight or control cholesterol can tell you, the challenge is as much about mindset as it is about getting more exercise and counting calories.

That "all in your head" focus on behavioral therapy to help people change how they approach exercise and food is a key component of the Gateway to Wellness Program at LDS Hospital, according to medical director Dr. Scott Hansen.

He is one of two specialists that will answer questions about weight loss and cholesterol control during Saturday's free Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Hansen and dietitian Jessica Metz, also a member of the Gateway team, will answer questions from anyone who calls in. The conversations are confidential. Call 801-236-6061 from the Salt Lake area, or toll-free 1-800-925-8177.

Hansen said many people need to deal with their own mental framing of food and exercise before they can make significant changes in their physical health. "That comes with education, exercises, self-review and evaluation and practicing," in order to change behavior patterns that have become imprinted over time.

"Behavioral therapy for weight management has significant credibility and is achieving very good effects," he said.

Most patients who come to the clinic already know what they need to change, "but persisting with those changes long enough to develop a habit and having someone to help them identify barriers seems to be the most significant thing."

He said those who have struggled to lose weight on their own see better results with a supervised weight loss program, and "if they can persist for at least six months, the results tend to be more lasting."

In Hansen's experience, "there are certain genetic and family lines with a greater disposition" for being overweight or obese, though usually "there is a fair amount of environmental and personal choice that has led to the condition."

Researchers are still trying to identify specific genetic markers for those who are more prone to obesity, and if those patients can at some point be identified, "they may respond to some types of treatment better than others," he said.

For example, there is some research that says "people process different food types differently," which would allow health care workers to select the kind of behavioral modification and diet that would best suit the individual.

But for now, patients learn best through trial and error, he said, looking at which food restrictions or food group combinations work best for them. "We help them do that. The real key of our approach is first, to provide appropriate motivation and direction."

Team members identify the patient's medical risk factors, help them understand the benefit of weight loss, and help them identify all the areas that can move them toward success.

Medication and pre-surgical evaluations are part of the process for patients who require that level of intervention, Hansen said.

"Medication is an adjunct to proper diet, exercise and behavior management," rather than providing some kind of quick fix that is only temporary, he said.

Four medications used in weight loss therapy are: sibutramine, which is used for three to six months under physician supervision; orlistat, which acts as a fat blocker but can often have side effects; phentermine, an appetite suppressant that can be used for up to three months; Wellbutrin, which is used for patients with stress-related or emotional eating habits, Hansen said.

Surgical options are the last resort for weight loss, but can be helpful to some patients. Lap band surgery limits the entry of food into the stomach, and gastric bypass surgery controls food absorption. "They're only for people who are in the marked or morbidly obese categories, who have extreme health risks and are not able to lose weight on a structured program."

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Because the risk for heart disease, diabetes and some cancers increases for patients who are overweight, losing weight and keeping it at a healthy level becomes "the foundation piece" for keeping those conditions at bay or in check in the long run, he said.

Health hotline Saturday

Weight loss and cholesterol control are the topics of Saturday's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Dr. Scott Hansen and dietician Jessica Metz of the Gateway to Wellness Program at LDS Hospital will take phoned-in questions. From the Salt Lake area, call 236-6061. Elsewhere, the toll-free number is 1-800-925-8177 (only operational during hotline hours).