Why is it that some people only need to go for a run every day for three weeks and they lose weight, while for others it can be a huge challenge trying to get any weight to shift even when they combine exercise with every possible lifestyle change recommended?
Our bodies are all so different and for some lucky people it is just a simple matter of “burn more calories than you ingest” for them to lose or maintain their weight. For others, many factors come into play that make it much harder to lose weight – emotional eating, hormone imbalances, chronic stress, poor mental health, not enough sleep…When you have tried everything and nothing has worked, it might be time to consider talking to a medical professional about other options to achieve weight loss.
These options range from medications, endoscopic procedures to gastric surgery. Find out what you can do to lose weight if your own efforts haven’t worked or if other health conditions mean it is vital that you lose weight.
Weight Loss Medications
Medications can improve health and prevent health problems associated with being overweight or obese such as hypertension, diabetes, heart disease and some cancers.
If lifestyle interventions haven’t been successful there are several different types of medicines available to help. In Aotearoa New Zealand there are four medicines approved for weight loss but they are not funded1. Monthly costs range from around $100 to $500. Your pharmacist can give you a more accurate costing for each medicine.
Medications for weight loss work in a variety of ways. One medication blocks the fat that is ingested with a meal from being absorbed by the body, others can decrease a person’s appetite or control food cravings, increase the amount of energy used by the body and/or create a feeling of being full after eating and feeling full for much longer.
The Ministry of Health2 recommend that weight loss medications can be considered only when a person’s lifestyle changes haven’t produced any clinically significant results after six months and the person has a BMI equal to or above 30kg/m2 (or for people with a BMI of 27 and above if they have at least one weight-related health issue such as high glucose levels, sleep apnea or high blood pressure).
Medications need monthly monitoring for the first three months to check a patient is tolerating it and that there has been some benefit (a 5% decrease in body weight, or more) before continuing on with the treatment. The key thing to remember with weight loss medications is that they don’t replace diet, exercise and behaviour changes – these still need to continue. The medications may not work for everyone and their effects can wane over time.
Risks & Benefits – As with all medications there are side effects that need to be taken into account. These can range from gastric side effects like nausea, bloating, diarrhoea and stomach cramps to dizziness, insomnia, dry mouth and increased heart rate. Sometimes these side effects can be minimised by starting on a low dose and increasing the dose slowly. Some of these medications cannot be taken during pregnancy or breastfeeding and there are other health conditions such as epilepsy, glaucoma and angina where these medications may not be safe for a person to take.
Weight loss medicines can enhance the weight loss achieved through diet and lifestyle changes and some can prevent the re-gaining of lost weight. Their long-term advantages are their ability to decrease the progression of health conditions that are due to being overweight or obese.
Endoscopic Procedures
These are procedures performed under light or general anaesthesia but without any incisions. A gastroenterologist inserts tubes and tools in through the mouth and down the throat into the stomach.
An endoscopic sleeve gastroscopy (ESG) is one option. Stitches are placed in the stomach to decrease the amount of food and liquid that the stomach can hold at any one time. The stomach empties more slowly and people feel fuller for longer. Over time the decreased amount of food taken in helps with weight loss.
An intra-gastric balloon is another type of endoscopic procedure where a small balloon is placed in the stomach and filled with water or saline to decrease the amount of space in the stomach. This means that people feel full when eating less food. The balloon is left in for around six months then can be removed.
Risks & Benefits – The benefits of endoscopic procedures are that they are much safer than surgery, there is a faster recovery time, and often the weight loss is more permanent than with weight loss medicines. Common side effects immediately after a procedure are sore throat, bloating, burping and coughing up blood. More severe risks are infection, bleeding or tearing of the stomach, oesophagus and duodenum.
Bariatric Surgery (Weight Loss Surgery)
Surgery works to either restrict the amount of food intake or limit food absorption in the small intestine – or a combination of both. Surgery can be funded if certain criteria are met. The most common surgeries are:
Adjustable gastric banding – An inflatable band is placed around the outside of the stomach dividing the stomach into two pouches. When the band is pulled tight like a belt, a narrow path is created between the two pouches. Weight loss is slower than with the other surgeries, and the surgery is reversible.
Gastric bypass – A small pouch is made at the top of the stomach. The small intestine is cut a small distance away from the stomach and connected to the new pouch. Any food and liquid will now bypass most of the stomach, flowing instead into the newly made pouch and then into the small intestine. After surgery, a person won’t absorb as many calories. The average weight loss is about 70% of the excess weight in 9 months.3
Gastric sleeve – This is surgery where part of the stomach is removed, creating a much smaller reservoir for food and liquid. This is a less complicated surgery than a bypass. It is permanent and cannot be reversed. The average weight loss after 9 months is 60% of the excess weight.
Risks & Benefits – Surgery is more invasive than endoscopic options meaning recovery time is longer and there is more potential for complications. Risks that come with bariatric surgery need to be fully understood. Physical complications can occur post-surgery such as bleeding, infection, bowel obstruction, ulcers, gallstones, hernia and sagging skin. Along with the risks that come with a general anaesthetic, this surgery can take a toll on mental health, with depression, anxiety and PTSD possible post-surgery. Surgery can lead to nutritional and vitamin deficiencies because of the decreased stomach and intestinal area available to absorb nutrients and calories.
The weight loss one year after bariatric surgery can be significant. Other health markers often improve as well such as remission of diabetes, sleep apnoea and reflux and decreased lipid levels, blood pressure, joint pain and cardiovascular risk. Successful weight loss after surgery depends on a patient’s commitment to making lasting changes.
“Unlike dietary or pharmacological approaches, some types of bariatric surgery can change the body fat ‘set point’ which becomes permanently set to a lower level. A patient can then maintain their new, lower body weight for at least 20 years or more”4. There are multiple long-term benefits associated with bariatric surgery – patients live longer than they would have without the surgery and have a corresponding increase in quality of life.
There is a lot to consider when making the decision to use medical help to lose weight. It is important to understand what each intervention involves, what preparation is needed before surgery if that is the option chosen, what to expect while taking weight loss medications, or what to expect after surgery. The biggest consideration is realising that every intervention also requires commitment to lifelong changes in diet and physical activity to achieve and maintain any weight that is lost.
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