The mainstay for treating obesity has traditionally been medical. Medical treatments employ education, dieting, exercise, behavior modification and drug therapy. These modalities should be the first line treatment for obesity, however their effectiveness is marginal at best and even worse for those in the category of morbidly obese. Although acceptable weight loss can be achieved in some individuals through medical treatments, the vast majority of patients will regain their weight and often put on additional weight. The phenomenon of "the wall" that many people experience, where the amount of weight lost seems to stop after a regular routine of diet and exercise are established, can best be explained by a re-setting of the "metabolic thermostat." When we diet, our bodies interpret this change in caloric intake as "starvation" and our metabolism adjusts accordingly, becoming much more efficient in storing the energy that we consume. We have no effective, durable and safe medical treatment to combat this phenomenon yet.
According to the National Institutes of Health (NIH) in their Technology Assessment of Methods of Voluntary Weight Loss (1992), "Although acceptable weight reduction may be achieved, a major drawback to the non-surgical approach is failure to maintain reduced body weight in the vast majority of patients." The group of patients referred to by the NIH in the above statement is the morbidly obese.