For people struggling with obesity, the challenge can feel relentless. It's not easy to change your body or your life, but the efforts could make a truly life-altering difference.
Beyond the basics of diet and exercise, there are medical options to help people lose weight, feel better, reduce their risk of disease and live their best, most functional lives.
Dr. Adam Beall of AnMed Piedmont Surgical said that for some, bariatric surgery proves to be the best option.
Candidates for bariatric surgery typically have tried other weight-loss methods before, including weight-loss drugs like GLP-1s. Any degree of morbid obesity qualifies patients.
"Bariatric surgery is a treatment that's almost exclusively offered to people who've tried and failed other weight-loss efforts," Dr. Beall said. "That certainly includes diet and exercise, and that could include one or more trials of medical treatments like appetite suppressants to help with their control of their caloric intake."
Weight-loss drugs have changed the conversation
Dr. Beall said that because every person is unique, what works for one patient may not work as well for another.
"The most recent medications, the hormone peptide medications, represent a huge advance in obesity management," he said. "Patients have different goals when it comes to managing obesity. Some simply want to be off some of their medications, and a 15 - 20% loss in their excess body weight may be enough for those patients. They may get off their blood pressure medications or off their diabetes medications if they're early in the course of the disease, and that's great."
But some patients want to reduce their lifelong risk of developing or worsening medical problems. Dr. Beall said bariatric surgery offers a powerful solution to reduce risk in the future and to correct the risk that a patient has now.
Why bariatric surgery might be a good option
Cost: Weight-loss medications can be very costly. "Some of the most effective medications are prohibitively expensive for patients who don't have good insurance coverage or insurance coverage at all," Dr. Beall said.
Lower-cost compounded hormones might have different quality, and their effects might vary.
Side effects: "We know that as much as half of the patients, no matter what medication we put them on, are probably not going to tolerate it," Dr. Beall said.
Newer medications can have unpleasant side effects in some patients, according to Dr. Beall, like abdominal discomfort or retention of food in their stomach for longer periods of time, bloating and constipation, or in rare cases, even severe side effects like pancreatitis.
Long-term use: Dr. Beall said the human body tends to adapt to a dosage of medication, so the dosage must be increased over time.
"When we give patients injectable drugs that help them lose weight, they rapidly need to increase the doses of those drugs to maintain the same appetite suppression over months' time," he said.
Preexisting conditions: Some patients with preexisting conditions like high blood pressure may not be able to take certain stimulant medications because of the effect the drugs can have on their health.
Wraparound support
For those considering bariatric surgery, Dr. Beall said it can be perfectly safe and effective for weight management.
"Bariatric surgery is one of the safest types of major surgery in the world, of any kind that is offered. The reason for that is, not only do we do an excellent job from a technical standpoint doing the procedures safely and effectively for the patients, but we also take great pains to optimize the patient and take precautions so that their medical problems are well controlled."
Weight-loss surgeries are elective, not emergency surgeries, so Dr. Beall said patients are prepared physically and mentally before surgery.
"We don't hesitate to send patients to see therapists to get psychiatric assistance if they need it," Dr. Beall said. "We get them care that they need from a primary care and specialist standpoint, so their medical problems are well controlled and optimized on medications and otherwise, with appropriate therapies beforehand, so that when they go through that surgical process that they're really getting the smoothest possible course, so they're not having setbacks that would otherwise be avoidable."
Personalized care for each patient
"We really have to tailor our medical therapy approach to the individual patient," Dr. Beall said.
"We try to identify the goals of the patient and help them get the most appropriate therapy. Sometimes, it's not immediately bariatric surgery. Sometimes we recommend people try additional medical weight loss and lifestyle change efforts first, because we're really just trying to provide the best possible service to our patients at any given time."