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  • Writer's pictureNick Allen

Evaluating medical therapies for weight loss

As with most medical conditions, it is far better to avoid the addition of excess weight initially rather than to face the immense challenge of losing this weight after the fact. Nevertheless, our modern lifestyles have led to a state where nearly 3 out of every 4 adults in the U.S. are overweight or obese. There simply is no shortcut to weight loss — even the best medical therapies are incomparable to disciplined behavioral modifications (diet, exercise, sleep, and stress management). That being said, behavior modification is extremely difficult and there comes a time when medical treatment may be warranted. Here are some of the commonly pursued options, how they work (or don’t work), and who might want to consider them with the help of their doctor:

1. Liposuction

It’s a common misconception that liposuction (or surgical fat removal) can help with weight loss. The pure weight loss from fat removed is generally only 2-3 lbs, and there is no evidence that liposuction contributes to significant weight loss long-term. This is purely an aesthetic procedure that is best for people already near their goal weight.

2. Medications

The poster child of the non-surgical weight loss therapies is a class of drugs known as GLP-1 agonists. These medications have received a lot of publicity lately as they have proven to be very effective in terms of pure weight loss. A trial published late last year found that people taking once-weekly injections of the GLP-1 agonist semaglutide lost 15.2% of their weight on average over a two year time period. It does seem that these drugs have a role for weight loss in certain individuals, but this comes with a few significant caveats. One is that there are concerns about the type of weight lost with GLP-1 agonists. You certainly get fat loss, but there seems to be a significant loss of lean mass. This means that body fat percentage (which is what really matters for well-being and longevity) often doesn’t change much. From our perspective, it’s imperative that anyone taking these drugs focus heavily on strength training to offset any losses of muscle mass. Another reason you might want to hesitate? Even factoring in discounts, these drugs tend to come in at around $1000/month.

3. Bariatric surgery

Unlike liposuction, bariatric surgery has been shown to have a lasting impact on body weight and metabolism. Studies have shown that gastric bypass, for example, often leads to individuals losing around 75% of their excess body weight, and many are able to keep this weight off even years after surgery. In severely obese individuals, gastric bypass can quite literally add years to life expectancy. While I think this option is heavily underutilized, it also has its drawbacks. There is a real chance of complications during or after surgery, and the (intentional) malabsorption created by this procedure means that patients must take several supplements and should be closely followed by a doctor. Additionally, as with weight loss medications, cost is a major prohibitive factor. Insurance rarely covers bariatric surgery, meaning the cost to the patient can be tens of thousands of dollars.

Hopefully reviewing these options (and their prominent drawbacks) has given you the motivation to do the best you can with diet, exercise, sleep and stress management before turning to medical options for weight loss. Nevertheless, obesity is a complex disorder that is just as much a societal problem as it is an individual one. If you’re giving your all to healthy behaviors and still aren’t seeing the change you desire, GLP-1 agonists and bariatric surgery are evidence-based options to discuss with your doctor. Just ensure that, if you go down one of these paths, the medication or surgery is in addition to healthy behaviors and not in place of them.


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