Weight Loss Surgery or Medical Intervention: Which Is Right for You?

Losing weight is simple, right? You just restrict the calories in your diet and hit the gym. That’s true for some people, especially if you’re young or genetically blessed with a fast metabolism. For many others, though, reaching and maintaining a healthy weight can be a lot tougher in practice than in theory — if you’re among the one-third of American adults who are obese, it can be close to impossible.

The good news? You don’t have to do it alone. Weight loss surgery and medical weight loss programs can provide much-needed support for those struggling with the effort to beat obesity and improve their health. Before you start the conversation with your primary care physician, take a look at this overview of the available options.

Medical Weight Loss Programs

Maintaining a healthy weight isn’t just about looking better — it’s also about feeling your best and optimizing your long-term health. Carrying around extra pounds can sap your energy and increase your risk for type 2 diabetes. Obesity is associated with serious, potentially fatal chronic diseases, including diabetes, heart disease, sleep apnea, stroke and some cancers.

That’s why obesity medicine is one of the fastest-growing medical specialities. Many health systems now offer medical weight loss programs where you work with a multidisciplinary team of physicians, nutritionists and behavioral health specialists.

Medical weight loss programs generally include:

  • Treatment of obesity-related conditions.

  • Nutritional counseling, including personalized diets or meal replacement plans.

  • FDA-approved weight loss medications.

  • Counseling to address psychological reasons for weight struggles.

  • Lifestyle modification and emotional support.

Some medical weight loss programs even offer nonsurgical procedures. Lahey Hospital & Medical Center is one of the nation’s first hospitals to offer the new SmartByte weight management tool, an oral device that helps you control portion size and focus on mindful eating.

ReShape is another nonsurgical option for those looking to lose weight. Two balloons are inserted in the stomach endoscopically and filled with saline to simulate a “full” feeling. With the balloons occupying space in the stomach, patients can eat less and work on portion control.

“This option is a great one for those looking to kick start their weight loss journey. ReShape is only inserted for six months, allowing patients to take the eating and portion control lessons they have learned into the next phase of their weight loss,” said Amanda Powell, MD, medical director of the Center for Medical Weight Loss at Lahey Hospital & Medical Center

A medical weight loss program provides the expertise and support you need to lose weight in a healthy way. Your doctor can help you to determine whether you need weight loss surgery and if it would be a sustainable option for you.

Weight Loss Surgery Options

If you’ve tried diet, exercise and medical options but still can’t lose enough weight, you might be a good candidate for weight loss (or bariatric) surgery.

To qualify, you must have a body mass index (BMI) of:

  • 40 or greater, or be at least 100 pounds overweight for your height.

  • 35 or greater, if you have obesity-related diseases.

Most insurers, including Medicaid, require documentation that shows you’ve tried other methods to lose weight.

The most common weight loss surgeries include:

  • Gastric Bypass Surgery: A surgeon separates your stomach to create a small pouch at the top and then connects this pouch to the small bowel so that food bypasses the rest of your stomach and parts of the small intestine. This prevents you from overeating and reduces the amount of calories that your intestine absorbs. It also reduces hunger and helps to improve or even resolve diabetes in many people.

  • Sleeve Gastrectomy: A surgeon removes the outer part of your stomach, which decreases the amount of food it can hold by about 90 percent. This allows food to pass more quickly into your intestine, which decreases appetite and can improve diabetes. While this procedure is less involved than gastric bypass, it can worsen acid reflux and is less effective at curing diabetes.

  • Duodenal Switch: This operation combines a sleeve gastrectomy with an intestinal bypass. It’s the most effective bariatric surgery, resulting in about 80 percent of excess weight loss, but it’s also associated with higher complication rates during and after the operation. Surgeons typically only recommend this procedure if your BMI is 50 or higher.

Find the Right Path for You

Weight loss surgery can be very effective. While half of bariatric surgery patients eventually regain about 5 percent of the weight, according to the American Society for Metabolic and Bariatric Surgery (ASMBS), most people maintain successful weight loss long-term. Bariatric surgery also reduces the risks associated with obesity-related diseases. Compared to obese people who have never had surgery, bariatric patients are 60 percent less likely to die from cancer, 90 percent less likely to die from diabetes and more than 50 percent less likely to die from heart disease.

Of course, with these benefits come risks and challenges. Because most bariatric surgeries are now performed laparoscopically, they only require a small incision, so they’re less invasive and safer than they once were.

“Many people don’t realize that bariatric surgery has become one of the safest operations out there, in fact, it is now safer than gallbladder surgery or knee replacement surgery,” said Dmitry Nepomnayshy, MD, FACS, a bariatric surgeon at Lahey Hospital & Medical Center.

As with any major surgery, however, complications are possible, and there is a very small risk of death — about 1 in 1000 people, according to ASMBS.

Most importantly, weight loss surgery is not the easy way out. It changes how you eat for the rest of your life and requires you to stay active to stay healthy. You’ll need regular follow-up care to ensure you’re getting enough vitamins and nutrients. In other words, it’s a big commitment.

If it’s a commitment you’re ready to make, or if you’re interested in learning more about medical weight loss programs, talk to your primary care doctor about what’s available in your area.

*The content on this website is for informational purposes only and is not medical advice. Please consult a physician regarding your specific medical condition, diagnosis and/or treatment.

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