Today we will discuss medical weight loss solutions related to obesity. There is a recent study that indicated that over 70 million U.S. citizens are considered obese and over 99 million are considered to be overweight. If you think about it those are some astonishing figures.
Obesity is a serious health condition that affects more than one third of the US adult population, and the number of people who are affected goes up every year. Being obese or overweight increases the risk for heart disease, high blood pressure, bone and joint disorders, and early death, among others.
The Body Mass Index (BMI) is used to calculate obesity. The formula uses height and weight to roughly calculate the percentage of body fat. A BMI over 25 is considered overweight, and 30 and over is obese. Access the official BMI calculator here to find your BMI. However, be aware that the BMI calculation formula ONLY considers height and weight.
This is an issue, because muscle weighs more than the same mass of fat, and someone who is physically fit can have a falsely elevated BMI. For example, I have a friend, a young woman who frequently gets comments about being “skinny”, is relatively physically fit, and has a BMI of 25.7. The BMI guidelines say that she is overweight, but that is pretty obviously inaccurate!
In addition, for most women over age forty their healthy weight will technically be labeled as overweight by BMI guidelines. This is physiologically normal, and the “extra” weight is protective against osteoporosis and other diseases.
Use the BMI calculator as a tool, but be aware of its shortcomings, limitations, and built-in biases. Use the information, but also consider other information, like muscle mass, functional fitness, and body shape. This site provides some alternatives calculators, the most useful of which is a simple waist measurement.
Extra fatty tissue, especially the kind related to insulin resistance gets stored around the waist, so a waist measurement over 35 inches for men and over 40 inches for women is a good indicator of the presence of abdominal fat and the need for weight loss.
If you are among those who are affected by obesity, and you have already tried diet, good nutrition, and exercise, your doctor may recommend medical weight loss strategies.
These fall into three general categories, with the first two being the most commonly recommended, although not the most effective. 1. Drug therapy. 2. Surgical weight loss. 3. Comprehensive lifestyle change weight loss, as typified by the Ornish Program.
Let’s look at these three medical weight loss solutions for weight loss and explore the benefits and drawbacks of each.
Drug therapy is rarely effective without also making significant lifestyle changes. With changes in diet and exercise, those who use prescription weight loss medications lose 3 to 9 percent more than those without weight loss drugs. If you are pregnant or planning to get pregnant, you should not use weight loss drugs, since they may harm the developing baby.
The FDA has approved five drugs—orlistat (Xenical, Alli), lorcaserin (Belviq), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), and liraglutide (Saxenda)—for long-term use.
You can use this table taken from the National Institutes of Health on prescription medications to manage weight loss. It provides information on the prescription medications most commonly available, including common side effects and warnings.
If you are considering medications for weight loss, be aware of two things. First, unless you make significant lifestyle changes, and continue those changes, most people gain back the weight lost.
Second, prescription drugs work by making your body work in ways it wasn’t supposed to work. Your body is designed to absorb the fats you eat, for example, and when a drug changes fat absorption your body is not working the way it’s supposed to.
That alone can have long term effects and few studies have looked at what those may be. While drugs for weight loss may work for some people, another option is surgery. Is that a better option?
Weight loss surgery, known as bariatric surgery, is gaining popularity in recent years, and some hospitals now have entire units devoted to bariatric programs. People who have had successful bariatric surgery are usually quite happy with the results. However, there are some significant risks and side effects.
Weight loss surgery works in two main ways. Restriction and malabsorption. In restriction, surgery is used to physically limit the amount of food the stomach can hold, which limits the number of calories you can eat.
For malabsorption, surgery is used to shorten or bypass part of the small intestine, which reduces the amount of calories and nutrients the body absorbs.
Four common types of weight-loss surgery are:
Roux-en-Y gastric bypass involves stapling off all but a small pouch at the top of the stomach as well as re-routing a portion of the small intestine. This surgery greatly limits the amount you can comfortably eat or drink at a time, as well as limiting the amount of nutrients and calories absorbed. This is both a restriction and malabsorption procedure.
Laparoscopic adjustable gastric banding involves placing a band with an inflatable balloon around the upper portion of the stomach. This can then be adjusted through a port just under the skin. The “lap band” makes you feel full sooner but doesn’t reduce absorption. This is a restriction procedure only.
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Sleeve gastrectomy removes a portion of the stomach, with the remainder shapes like a tube, or sleeve. This is a restriction procedure, although the removal of part of the stomach means that you may produce less of the hunger hormone ghrelin.
Duodenal switch with biliopancreatic diversion is perhaps the most radical weight loss surgery, involving removing most of the stomach and bypassing most of the small intestine. This is both a restriction and a malabsorption procedure.
All these procedures have the risks of any surgery, and surgery itself is a bit more risky for overweight people than for normal weight people. Nausea and pain right after the surgery is quite common.
You can expect to be up and walking within hours of surgery, since research shows that physical movement as soon as possible after surgery improves outcomes.
Malabsorption issues are common, and you should take a high-quality multi-vitamin for the rest of your life after bariatric surgery.
With malabsorption procedures, supplemental vitamin B complex is often needed, since this vitamin is absorbed mostly in the small intestine.
Dean Ornish: Lifestyle Change
If neither of the options above sound like a good choice for you, don’t lose hope. There is another option.
Since 1984, Dr. Dean Ornish has been using an integrative program that combines a low fat diet, exercise, stress reduction, and community support to reverse heart disease.
As a side effect, if you will, people who use this powerful program also experience weight loss, diabetes reversal, stress reduction, and general improved wellness. All this without drugs, surgery, or costly medical interventions.
You can learn more here about it here and you can also look for an upcoming post dedicated to this amazing program.
Have you thought about medical weight loss solutions for yourself? Have you or someone you know tried weight loss prescription meds, surgery, or the Ornish Lifestyle program? Share your experience, tips, and advice below. Be Well!