Obesity Treatment: A Complete Guide

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.

Medication

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

It’s important to discuss obesity medication options with a doctor before starting or combining any new treatments. Here are some of your options for obesity treatment medications. 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, how much weight loss is required, and potential side effects and the impact they may have.

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)

Saxenda is injected daily, whereas Wegovy and Zepbound are injected weekly. Side effects can include:

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

Phentermine

Phentermine is an oral appetite suppressant that’s often combined with the anti-epileptic drug topiramate.

• Constipation or diarrhea
• Difficulty focusing
• Dizziness
• Dry mouth and extreme thirst
• Fatigue
• Headache
• Nausea
• Insomnia

Phentermine alone and Qsymia (phentermine and topiramate) can cause an increase in blood pressure or heart rate, so these need to be monitored. Topiramate (the second drug in Qsymia) can also cause serious birth defects.

Bupropion-Naltrexone

Bupropion-naltrexone (Contrave) is a combination drug used for weight loss. Bupropion works in the brain to reduce appetite and is also commonly used for treatment of depression (it is also used to help people quit smoking). Naltrexone works to boost the appetite control effect of bupropion in the brain.

Orlistat

Orlistat, helps your body absorb less fat by inactivating certain enzymes that break down fat.

When you take orlistat, the fat your body didn’t absorb gets excreted out with your feces. That means a lot of orlistat’s side effects are bowel-related. They can can include:

• 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

Bariatric surgery refers to a group of surgical procedures designed to help people with obesity lose weight. Bariatric surgeries are sometimes also 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 or over, or 35 to 39.9 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.

Here are some of your surgical obesity treatment options.

Sleeve Gastrectomy

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), sleeve gastrectomy is the most popular type of bariatric surgery by far, with more than 160,000 procedures performed in 2022.

WIth a sleeve gastrectomy, a surgeon will remove approximately 80 percent of your stomach. What’s left over is roughly the size and shape of a banana. Not only can your stomach now hold less food, which makes you less likely to overeat, the portion removed also makes the majority of ghrelin. Ghrelin is a hormone that signals to your brain that your body needs food.

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). Complications rates are generally low but can include surgical site infection, leakage, and internal bleeding.

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 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 that of sleeve gastrectomy, with the addition of possible long-term risk of bowel obstruction and dumping syndrome (when food moves too quickly through your GI tract).

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 the weight you want to lose, 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.

Diet and Lifestyle Changes

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.

“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.”

Don’t like vegetables? Don’t be so sure, says Webb. Try this: Think of your least favorite vegetable, then punch it into 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.

For exercise, you can start with 30 minutes of walking, says Webb. “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.”

• Reduce your daily calorie intake gradually.
• Consider adopting a heart-healthy eating plan, such as the Dietary Approaches to Stop Hypertension (DASH) diet.
• Gradually add physical activity that you enjoy to your daily life, and ask your doctor how to safely begin an exercise program.
• Get about seven to nine hours of sleep every night.

“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.

Complementary and Integrative Approaches

• 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.

The Takeaway

• 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, the DASH diet, and consistent physical activity alongside other treatment methods for best results.