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Maybe you first noticed it when you pulled those summer clothes out of storage this year or when you went to put on that suit or dress only worn for a special occasion. Suddenly — sigh —everything is a little bit tight.

Weight gain can easily creep up on all of us. Often we are so busy juggling the demands of work and family that it's hard to always eat right or make time for regular exercise. Aging can also work against us as can our basic genetic makeup.

Working with your doctor can help, says Karly Pippitt, M.D., a family physician at University of Utah Health Care. Pippitt usually starts a conversation about weight issues by asking about the efforts her patients are making to be healthy.

"I try to see where they are in terms of their own acknowledgment (of their weight), rather than be judgmental," she says.

To keep patients within a healthy weight range, physicians rely on the Body Mass Index, which is a calculation of a person's height and weight. It's used commonly to screen for weight categories that leave patients at risk for other health problems, including hypertension, Type 2 diabetes, heart disease and cholesterol problems, according to the Centers for Disease Control.

In adults, a BMI score of between 19 and 25 is generally considered normal and healthy, Pippitt says. From 25 to 30, a person is considered overweight and at 30 and above, obese, she says.

"I would love to see everybody in the 20 to 25 range," says Pippitt. "But if you're doing everything right, like being active every day and eating a healthy diet and your BMI still puts you in the overweight category, I'm not going to chastise you."

For those wanting or needing to lose, Pippitt works to find "easy wins" to patients make small, but measurable changes. Trading soda pop and other sugary drinks for water helps. So does parking the car further away from the door to the store or the office, and taking the stairs instead of the elevator. Even indulging in just one cookie or candy bar instead of a whole bag is a good start.

"It can all make a big difference," says Pippitt. "So what are the little changes we can put into your life that are things you will keep doing?"

Pippitt also encourages setting realistic weight loss goals of one to two pounds each week and encourages patients to pay attention to how they feel.

"Do you have more energy? Do your clothes feel looser? Are you cinching in that belt? Those are things that are real and just as important," she says.

University of Utah Health Care physicians work hard to help patients reach their weight loss goals through diet and exercise first and look to measures like bariatric surgery only when the health benefits to the patients outweigh the risks.

"If you can lose weight without surgery, that's always best," says Eric Volckmann, M.D., director of University of Utah Health Care's Bariatric Surgery Program. "But some people need extra help."

Candidates for the procedure include people with a BMI greater than 40 or individuals with a BMI of 35 or higher who also have other health issues, including obesity-related Type 2 diabetes, heart disease or sleep apnea. Individuals who weigh far more than their ideal body weight —100 pounds more for men and 80 pounds for women —are also good candidates for bariatric surgical remedies.

There are different types of bariatric surgery. Some work by banding or stapling the stomach, while others include the removal of a portion of the stomach. Each essentially work in one of three ways:

—Restricting or limiting the amount of food intake by reducing the size of the stomach.

—Malabsporption, or limiting the amount of food absorbed in the intestinal tract through bypassing a portion of the small intestine.

— Or a combination of both restriction and malabsorption.

Surgery won't cure all of a patient's obesity-related health problems, but it can help to lower blood pressure and blood sugar, reduce or eliminate sleep apnea, lower cholesterol and decrease strain on the heart.

Post-surgery, patients will still need to develop and maintain healthy habits, including eating a balanced diet and daily exercise, but surgery will help individuals feel full after small meals and between meals, Volckmann says. He encourages patients to focus on limiting their daily calorie intake and to keep a daily food log to keep track of what they eat.

"Surgery won't help you correct problems such as improper food choices, such as drinking sugary drinks, not eating enough fruits and vegetables or not drinking enough water," says Volckmann. "In the end weight loss is a simple balance of calories in and calories out."