Weight loss strategies for better health
It’s that time again. “New Year, New You” advertising along with encouragement to set resolutions to look and feel better and, of course, lose weight.
With U.S. adult obesity rates currently hovering around 37%, shedding pounds is certainly a worthy goal.
From GLP-1 weight loss drugs to bariatric surgery, people have many options to lose weight safely and effectively under a doctor’s care.
But often the first step is changing one’s thinking about obesity, says UCI Health surgeon Dr. Annie Wang, who specializes in minimally invasive gastrointestinal and weight loss surgery.
How should we view obesity?
“Experts are now conceptualizing obesity as a chronic, relapsing and remitting disease,” Wang says. “That means when you treat it for only a little bit and stop, the weight will come back.”
Worse, it’s a disease that has consequences for all your organ systems.
“My patients usually feel acid reflux first,” she says. “They can get bad joint pain from carrying around the extra weight all of the time. They also are at very high risk of heart attack, stroke and many different cancers."
Other consequences of obesity include type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, metabolic dysfunction-associated liver disease and gallbladder diseases.
Obesity can be a sensitive topic for most people because it is so visible and can be a big part of our self-image. When we view the topic of obesity through of lens of chronic illness, we can start to separate the disease from ourselves and address the problem without shame or guilt, Wang says.
“It’s an important conversation to have, to let them know they can avoid open heart surgery down the line or a cancer diagnosis,” she says. “Sometimes they’re not ready to hear it, but usually it opens up a discussion about other things they were worried about telling me. If your weight is on your mind, please bring it up with your doctor.”
GLP-1s vs. bariatric surgery
Losing weight with GLP-1 medications or bariatric surgery doesn’t have to be an either-or proposition.
“I don’t see it as an antagonistic relationship between the two,” says Wang. “The patient is the captain of the ship; it’s their body. My job as the doctor is to provide all the options, to see what fits the best at this moment in life.”
Still, Wang favors bariatric surgery for durable long-term weight loss.
In large, randomized, controlled trials, bariatric surgery helps patients achieve 25-30% total weight loss and these results persisted 10 years after surgery.
“When we talk about success with weight loss, the numbers that we can compare are how long you have kept the weight off,” she says. “We have decades of follow-up data from bariatric surgery patients, and they’ve successfully kept the weight off long-term.”
Conversely, GLP-1s have been on the market for just two to three years. They’ve helped many people to drop weight and some people do really well with these medications.
“What we also know about these meds is that the weight bounces back up when you stop taking them,” Wang says. "In the randomized controlled trials for semaglutide, patients were able to achieve 10-15% total weight loss; however, when the medication is stopped, the weight recurs to 5% total weight loss within just a few weeks."
Understanding obesity as a chronic disease, the durable weight loss makes bariatric surgery the preferred option for patients who are ready for it.
Bariatric surgery choices
Two operations are the current standard of care in bariatric surgery: gastric sleeve and gastric bypass.
“The gastric sleeve procedure is the most commonly offered weight loss surgery in the United States,” says Wang. “If you think of the stomach as a purse — and that’s what it looks like in the operating room — for the gastric sleeve we’re cutting the purse to look like a banana, reducing the amount of food your stomach can accommodate.”
The operation takes approximately one hour and there is an expected overnight stay at the hospital after surgery.
The other surgery, gastric bypass, has been around the longest but it is more complex and restrictive.
“We cut the purse down to the size of an egg and connect it to a lower section of the small intestine, then reroute the remainder further down the digestive tract,” she says. “So now, not only do you eat less, but the calories also have a shorter highway to get absorbed.”
Patients can expect two overnight stays at the hospital after gastric bypass surgery.
Both are great options for lowering the risk of heart attack and stroke and controlling diabetes, hypertension and cholesterol.
"We can assess your overall health and determine the optimal surgical plan for your weight management as a team," Wang says.
When should a person consider bariatric surgery?
Medical guidelines recommend that if your body mass index (BMI) is 30 or over, it’s time to think about how to tackle the disease of obesity.
“These BMI calculators can be found online. You enter your height and weight, and it gives you a number,” says Wang. “If that number is 30 or higher, make an appointment with your primary care physician or even directly with me and our team, to figure out what weight loss options may work best for you.”
What happens before the surgery?
The first visit involves a comprehensive look at the patient’s medical history, past surgeries and any other medical problems they may have or had.
“We have a whole team of experts to help you succeed, including registered dietitians, nurses and psychologists,” say Wang. “They help you understand your relationship with food and explain how you will need to eat for the rest of your life after surgery.”
Patients will need to lose some weight before surgery to help shrink the liver away from the stomach, which makes surgery easier and lowers the risk of complications.
“It also shows that you are committed to changing your eating habits,” Wang says. “As long as we keep the lines of communication open, we have a lot of different strategies to help you."
Benefits beyond surgery
Beyond weight loss, Wang says her patients are relieved to find their bodies functioning better.
“To me, that is the most important part of having this surgery, they get their life back. They can do the things they want to do. They can swim, run on a field again and keep up with their kids.”
No surgery is without risk for complications, but Wang promises her patients that the entire bariatric surgery team is prepared should problems occur.
“If obesity is something that’s really affecting your life, if it’s something you think about, plug your numbers into that BMI calculator and make an appointment to see me,” she says. “We can figure it out.”
For more insights on weight loss, watch Dr. Annie Wang on the "Live Well with UCI Health" podcast.
Since 2010, the UCI Health Bariatric Surgery program has been accredited by the American College of Surgeons' Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) Program, the gold standard for assessing quality for surgical services.