Remember the big weight loss challenge that happened earlier this year? Thousands of people signed up and teams were formed to give individuals that boost, that encouragement to stay the course in getting fit and losing weight, but in the end the average weight loss was a meager six pounds.

New Jersey-based surgeon Dr. Amit Trivedi did the math and used the figure to point out that for most, diet and exercise are not enough to shed significant pounds. Personally I need to lose 30lbs and if I lost only six after a concentrated effort I'd be discouraged.

Of course this figure is an average which means that some people lost more and some people lost less but Dr. Trivedi's assertion gave me reason to more than pause, I had to completely stop…. and think.

Passionate about the dangers of obesity, Dr. Trivedi a specialist laparoscopic surgeon, spends the majority of his time working with people who desperately need to lose weight. He offers what he feels are the most realistic methods for people to shed pounds and keep them off. Gastric bypass surgery and lap band surgery are the two methods he most commonly uses.

I spoke with him the day after he had performed three lap band surgeries in Bermuda.

"We kept all patients overnight at the hospital and already we've noticed significant improvement in their health," he said. "The blood pressure of each one was improved and in the case of one lady her GP was so pleased with her readings, he told her she could stop taking her blood pressure medication,' he said.

And Dr. Trivedi said the situation for the patients he had operated on would only improve. "As they lose more and more weight they will need less medication."

And that's not just blood pressure medication it could also be medication for diabetes, a disorder often directly caused by obesity. Other serious conditions and diseases the weight loss often corrects include sleep apnea – a condition where the sufferer has to sleep with a machine that pumps in oxygen, osteoarthritis, hypertension and depression.

It was the first day Dr. Trivedi performed lap band surgery in Bermuda but it wasn't the first time he had operated on Bermudians. A laparoscopic surgery specialist with the Hackensack Medical Center in Hackensack, New Jersey, Dr. Trivedi had patients in Bermuda who were referring friends and family to him. Finally Dr. Christopher Johnson suggested a partnership of sorts and now Dr. Trivedi also spends some time every few weeks in Bermuda, conducting surgeries, meeting with old patients and consulting new ones.

Completely new at the programme he was enthusiastic about the impact his work can make in the lives of locals. In an introductory presentation to people interested in learning about the surgeries, Dr. Trivedi pointed out that in terms of obesity, Bermuda ranks fourth in the world.

This is according to statistics released almost a year ago and which Government Health Promotions Coordinator Jennifer Attride-Stirling felt were underestimated.

According to Dr. Trivedi, only by reducing the physical size of a stomach will someone be able to shed significant weight.

This is because receptors that tell the brain that the stomach is full are located at the neck of the stomach. When food is not in contact with these receptors, they fire, telling the brain that the person needs food. The person then becomes hungry and has to eat or face being very uncomfortable.

In both gastric bypass surgery and lap band surgery the stomach is made smaller, this results in food having more contact with receptors in the neck of the stomach. Because these receptors sense that the stomach is full, that's the message that gets to the brain. And because the brain knows that the stomach is full, it doesn't send any hunger messages to the body. When the person doesn't feel hungry he or she doesn't have to eat.

Of course out of habit or for some psychological reasons people may want to eat, but the feeling will be different, it will not be based on hunger and therefore will be easier to overcome.

Lap band surgery and gastric by-pass are the two methods Dr. Trivedi uses most frequently for his patients battling obesity.

He does both by the minimally invasive form of surgery called laparoscopy. In this method small incisions are made close to the site through which the surgical tools are placed. A small camera or scope is also inserted. It is connected to a monitor that allows the surgeon to see the area in which he is working.

Dr. Trivedi uses the Roux-en-Y method of gastric by pass. In this technique he actually staples the top of the stomach to a small pouch size and connects the end of the pouch directly to the middle of the small intestine. For people who have had the surgery, food bypasses the middle and lower parts of the stomach and the upper part of the small intestine.

In the lap band technique a sterile silastic material is inserted into the body and fixed around the stomach such that when tightened the stomach becomes a small pouch.

The choice of surgery is a personal one and Dr. Trivedi discusses the pros and cons of each method with each of his patients. While gastric bypass is more invasive and irreversible, some patients opt for this method to force themselves to always be mindful of what and how much they eat.

Dr. Trivedi will next be in Bermuda October 6 to October 9 when he will perform three surgeries at King Edward VII Memorial Hospital. Anyone interested in scheduling a consultation can call 292 2000.

Why consider surgery?

l Diet and exercise only work in one in 20 people who are morbidly obese

l Benefits of surgery outweigh the risks of morbid obesity

l Weight loss has the potential to cure of significantly improve conditions caused by obesity

l Weight loss can reverse the decreased expectancy seen with morbid obesity