For many people in the United States, trying to lose weight can feel like a losing battle. Every year, about 45 million Americans go on a diet and spend about $33 billion on weight-loss products.
Some people do lose weight and keep it off, but others have little success or lose excess weight only to gain it back. When diets don’t work, weight loss medication or bariatric surgery may be options.
In this video, San Diego Health host Susan Taylor talks about medication and surgery for weight loss with Jennie Luna, MD, an endocrinologist at Scripps Clinic Hillcrest, and Mark Takata, MD, a bariatric surgeon at Scripps Clinic Torrey Pines.
More than 40% of American adults and almost 20% of youth are obese, which means they have a body mass index (BMI) above 30.
Many factors can contribute to obesity, including an increase in the amount of processed and fast foods in our diets, lower levels of physical activity and a more sedentary lifestyle in general. Genetics also play a role, as do environmental and economic factors, such as the cost and availability of healthy foods and exercise options.
All of these can make it challenging to maintain a healthy weight and lower the risk of serious health conditions linked to obesity, such as type 2 diabetes, heart disease and certain cancers. Even with strict adherence to diet and exercise, many people still can’t achieve the results they want.
“Most of our patients are doing everything correctly. They have great lifestyles, they’re exercising and eating healthy, but they’re unable to lose weight because of those non-modifiable factors, such as genetics, age or hormonal issues,” says Dr. Luna. “That’s why it’s so important to look at them holistically and see what other factors could be influencing their weight, and what treatments might help them.”
Among these treatments are GLP-1 medications. Originally developed to improve diabetes management, GLP-1 medications not only help stabilize blood sugar, but also reduce appetite, which leads to weight loss. Results vary among individual patients, but the goal is to lose one to two pounds per week up to 15% of total body weight.
GLP-1 medications can have side effects; nausea is most common, along with constipation or diarrhea. It’s important to stay well-hydrated while taking these medications and increase dosages slowly to minimize side effects. Most patients will need medication long-term to control their weight, but again, this depends on the individual.
Bariatric surgery is a minimally invasive surgical procedure that reduces the size of the stomach to decrease food intake. It can also decrease appetite and help with type 2 diabetes and other chronic diseases associated with obesity.
“Well over 90% of people will lose more weight with these operations than if they had not done the operation at all,” says Dr. Takata. “People should expect to lose between 50 and 100 pounds, or sometimes more than 100 pounds, depending on how much weight they need to lose and what weight they’re starting at.”
Patients considering bariatric surgery have several meetings with the surgeon and other doctors to determine if they are candidates for the procedure. In general, full recovery from bariatric surgery takes about three to six weeks.
For some patients, combining weight loss medication and bariatric surgery produces the best possible results.
“Some patients would benefit from medications before surgery to get them down to a healthier weight, and then some patients that have surgery might need to lose a few pounds after to get to their goal,” explains Dr. Luna. “There is a lot of synergy and it’s great that we have different options for patients.”
“This is a hopeful time for patients who suffer with obesity and the diseases that go along with it,” adds Dr. Takata. “There are more and more options to help patients get treatment, and depending on the severity of the problem, surgery and/or medical therapy can be very successful.”