Obesity Treatment: What Really Works

At the same time, healthy eating and regular physical activity remain the foundations of managing and treating obesity and associated conditions.

Please also note that it’s important to discuss any of the following options with a healthcare practitioner before you start treatment. Read on to learn about obesity treatment, including more on medications, surgical options, and lifestyle changes that can help.

Lifestyle changes like healthy eating and exercise will always be the first-line treatment for overweight and obesity. Medications for obesity are also getting safer and more effective every year.

Your doctor will likely consider factors such as your medical history, any other medications you are taking, and your BMI before prescribing a particular drug. They may also consider the cost, the amount of weight loss required, potential side effects, and the impact it may have. Here are some of your options for obesity treatment medications.

GLP-1 Agonists

GLP-1 agonists work by mimicking the effects of the hormone glucagon-like peptide-1, which your intestines release in response to eating. Glucagon and GLP-1 both signal to your brain that you’ve eaten enough, causing a feeling of fullness. They also slow down your gastrointestinal tract, causing food to stay in your stomach longer, which means you feel full for longer and are less likely to overeat.

• liraglutide (Saxenda)
• semaglutide (Wegovy)

• Bloating
• Fatigue
• Gas
• Headache
• Heartburn
• Nausea or vomiting
• Diarrhea or constipation

Phentermine

Phentermine is an oral appetite suppressant that’s often combined with the anti-epileptic drug topiramate. The combination of phentermine and topiramate is known as Qsymia; it is approved by the FDA for long-term use and recently became available in a generic form.

• Faster heart rate or elevated blood pressure
• Sleeplessness
• Nervousness
• Constipation

Bupropion-Naltrexone

Bupropion can increase blood pressure and heart rate. You should not take Contrave if you have a seizure disorder, if you take opiate pain medicines, if you have an active eating disorder, or if you have advanced kidney or liver disease. Contrave is FDA-approved for long-term use.

Orlistat

Orlistat, helps your body absorb less fat by blocking the enzyme intestinal lipase, which breaks down fat.

When you take orlistat, the fat that your body didn’t absorb is excreted with your feces. That means a lot of orlistat’s side effects are bowel related:

• Bowel incontinence and an urgent need to go
• Diarrhea or loose stool
• Headache
• Oily or fatty stool
• Oily spotting in your underwear or when you pass gas
• Stomach pain

Bariatric surgery refers to a group of surgical procedures designed to help people with obesity lose weight. Bariatric surgeries are sometimes called weight-loss surgeries. Healthcare professionals tend only to suggest bariatric surgery as an option if other methods of weight loss have been unsuccessful.

Candidates for bariatric surgery generally either have a BMI of 40 kg/m2 or over, or a BMI of 35 to 39.9 kg/m2, plus an obesity-related condition like diabetes or heart disease. Most types of bariatric surgery can be performed laparoscopically, which is a minimally invasive technique using smaller incisions and smaller tools than traditional open surgery. This may cut down on the rate of post-op complications and shorten recovery time.

Weight loss surgery isn’t for everyone, and it’s important to discuss the possible risks with your doctor. Your insurance company may have specific requirements, such as proof of trying other methods first. Continued weight loss — and eventually maintenance — may be achieved when surgery is combined with diet and lifestyle changes.

Here are some of your surgical obesity treatment options.

Sleeve Gastrectomy

After five years, you can expect to have lost up to 60 percent of your excess weight (approximately 20 percent of your starting body weight). Short-term complication rates are generally low but can include surgical site infection, leakage, and internal bleeding. Common long-term complications include nutritional deficiencies, weight regain, and a roughly 25 percent risk of worsening of heartburn.

Some centers are now performing sleeve gastrectomy endoscopically (through a scope, rather than with incisions). This procedure leads to weight loss that is somewhat less than with surgical sleeve gastrectomy (approximately 10-15 percent of starting body weight after five years). But most insurance plans do not cover endoscopic sleeve gastrectomy.

Roux-en-Y Gastric Bypass

Gastric bypass (also known by the French phrase Roux-en-Y) is the second most popular form of bariatric surgery.

This operation reduces the size of your stomach (even smaller than a sleeve gastrectomy) and reroutes your gastrointestinal tract to skip most of the stomach and the first half of the small intestine. This means that fewer calories are both consumed and absorbed.

You can lose 70 percent or more of your excess weight within two years of gastric bypass (approximately 25 percent of starting body weight). Complications mirror those of sleeve gastrectomy, with the addition of possible long-term risk of bowel obstruction dumping syndrome (when food moves too quickly through your GI tract), hypoglycemia after gastric bypass, and less commonly, internal hernia. The risk of alcohol use disorder also seems to be higher after gastric bypass. Risk of nutritional deficiencies is also higher after gastric bypass.

Biliopancreatic Diversion With Duodenal Shift (BPD-DS)

BPD-DS is a more aggressive procedure in which a sleeve gastrectomy is combined with a more extensive bypass of the small intestine. It is sometimes done in one operation and sometimes done in two separate operations. It carries a higher risk of nutrient malabsorption because of the longer bypass in the small intestine. It produces the largest weight loss on average but also comes with the highest risk of nutrient deficiency.

Because of its technical difficulty, BPD-DS is performed in fewer centers than sleeve gastrectomy or gastric bypass. It’s usually reserved for people with very high BMI. Surgical complications are similar in rate and nature to gastric bypass.

Gastric Balloon

The gastric balloon is one option for people needing to lose weight before they can safely undergo a permanent bariatric procedure (sleeve, bypass, or BPD-DS). A surgeon uses a long, flexible tool called an endoscope to place a balloon into your stomach, which is then filled with saline or air. It takes up room in your stomach, which keeps you from eating too much. After you’ve lost some weight, you have the balloon removed. The balloon is not a long-term solution for obesity treatment because it has to be removed. It should be viewed as a step toward another treatment modality (medication or surgery).

Complications are generally mild, and may include nausea, stomach pain, constipation, and acid reflux. A gastric balloon is generally not covered by insurance.

Eating less and moving more is Weight Loss 101, says Dr. Webb. “Everyone should start with lifestyle modifications: diet and exercise.” But, he cautions, “90 percent of weight loss is diet and only 10 percent is exercise.”

Your healthcare team might want to see what progress you can make for at least six months before you think about medication or surgery. If you haven’t lost at least 5 percent of your starting weight, says Webb, most providers will start thinking about adding medication or weight loss surgery.

Changing your eating patterns is easier said than done. Webb has tips.

• Mind your snacks. “Dieting starts at the grocery store,” he says. “If the junk gets home, you’ll eat it, so it’s best to just leave it at the store. If the only snacks at home are grapes, strawberries, and peaches, that’s what you’re going to snack on.”
• Think of your least favorite vegetable, then search Google Images along with the term “recipes.” “There’s always one that [my patients] find that looks good and they’re willing to try based on the image,” says Webb.
• Start exercising with 30 minutes of walking. “My patients who do this start to lose weight and are amazed that the pain in their knees, back, hips, feet, and other joints is less, they have more energy, and they’re sleeping better. Overall they feel better,” says Webb.

• Reduce your daily calorie intake gradually.
• Consider adding more plants to your diet.
• Gradually add physical activity that you enjoy to your daily life, and ask your doctor how to safely begin an exercise program.

“I have my patients set a [weight loss] goal of one pound a week,” says Webb. That means eating 500 fewer calories than you burn every day. “That is safe, sustainable weight loss,” he says. Starting small — say, a nightly 30-minute walk and substituting veggies for pasta — can lead to that 500-calorie deficit, says Webb.

• Meditation
• Mindful eating
• Yoga

“Any complementary treatment that the patient is willing to stick with is helpful,” says Webb. “The ones I have found to be most helpful in my patient population have been hypnosis, acupuncture, and yoga.”

Remember, “complementary” is the important part. All these therapies work best when combined with proven treatments.

• GLP-1 agonists, like Saxenda and Wegovy, are popular weight loss drugs, with potential weight loss of up to 15 percent, though they have side effects and risks such as nausea and pancreatitis.
• Bariatric surgery options, including sleeve gastrectomy, gastric bypass, and gastric balloon, offer effective long-term weight loss but come with risks and require a commitment to lifestyle changes post-surgery.
• Lifestyle changes, especially dietary adjustments and exercise, are key to weight loss success. Try gradual calorie reduction, a largely plant-based diet, and consistent physical activity alongside other treatment methods for best results.