Considering bariatric surgery? Or reconsidering it now that you've done a bit of research? It's not an easy decision, and it's not for everyone. It can be quite costly, and many people can't afford it, while others simply do not meet the surgical requirements. Maybe your BMI is not high enough. The side effects - both long-term and short-term - can also be off-putting. Some types of bariatric surgery cause extremely rapid weight loss that can damage your liver. In recent years, the increased wait times for bariatric surgery is another issue that may have you looking for alternatives. Then of course, for some, there's the concern they might gain all the weight back and have gone through all of it for nothing - and they've witnessed people they know who have done exactly that. Some people, of course, are simply (and understandably) afraid to go under the knife.
Fortunately, if you and a doctor don’t feel that surgery is right for you, many other options exist for weight loss. For people with obesity who want to lose weight, there are a variety of surgical and nonsurgical procedures that can help people experience significant weight loss. But weight loss surgery isn’t for everyone - and for some people, nonsurgical weight loss procedures are a better option.
This article explores various alternatives to weight loss surgery, encompassing medical interventions, lifestyle adjustments, and innovative procedures. It aims to provide a comprehensive overview for individuals seeking effective and safer methods to achieve sustainable weight loss.
Endoscopic Bariatric and Metabolic Therapies (EBMTs)
There are new endoscopic bariatric and metabolic therapies (EBMTs) on the market now - performed using a small, flexible scope inserted through your mouth and esophagus down into your stomach. These EBMTs are same-day outpatient procedures and can reduce stomach volume - like traditional bariatric surgeries can do - but they are much less invasive with no incisions and fewer complications.
The procedures range from intragastric balloon therapy to endoscopic sleeve gastroplasty. There's also a procedure called AspireAssist where a tube device is inserted into a patient's stomach to aspirate (or drain) stomach contents after a meal. All of these new options in the emerging field of bariatric endoscopy hold promise, but there are still issues of serious concern with these procedures. Because insurance providers don't usually cover these options, bariatric endoscopy presents many of the same financial barriers as bariatric surgery, and will have some of the same nutritional and psychological issues, as well as potential short- and long-term side effects.
Read also: Better You: Healthy Eating
Intragastric Balloon
Intragastric balloons are balloon-like devices that are inserted into your stomach and expanded with liquid or air to reduce the available space inside your stomach. The Orbera® Intragastric Balloon is a minimally invasive, non-surgical weight-loss treatment option. In combination with long-term lifestyle and eating modifications, the gastric balloon can be used by people with obesity who have a BMI of 30 or greater.
During an outpatient procedure, a silicone balloon is inserted with a scope into the stomach. The intragastric balloon is then filled with saline until it’s about the size of a grapefruit. This temporary balloon implant helps limit your stomach capacity to make you feel full and reinforce portion control. After six months, the balloon is removed. The average weight loss for patients with the gastric balloon is about 10 percent of their body weight.
There are two primary types of intragastric balloons on the market:
- Liquid-filled: Once liquid-filled intragastric balloons are inserted into your stomach, they can be expanded with liquid. Orbera, which was first approved by the Food and Drug Administration (FDA) in 2015, is the most commonly used liquid-filled intragastric balloon. In one small study from 2017, researchers investigated the effectiveness of the intragastric balloon Orbera for weight loss in 35 study participants. Results of the study found that almost 55% of participants experienced at least a 10% reduction in their baseline weight after the surgery. In addition, 34% of those participants maintained their weight loss 6-12 months after the procedure.
- Air-filled: Air-filled intragastric balloons are inserted into your stomach and then expanded with air instead of liquid. Obalon, which was approved by the FDA in 2016, a year after Orbera, is the most common air-filled intragastric balloon.
Intragastric balloons are typically inserted through your esophagus in a noninvasive, nonsurgical procedure called an endoscopy. In the first few days after it is placed, the gastric balloon can cause abdominal pain, nausea, and vomiting.
AspireAssist
AspireAssist is another nonsurgical weight loss device that was first approved by the FDA in 2016 to help assist with weight loss in people with obesity. With this device, a tube running from the inside of your stomach to the outside of your stomach allows you to drain a portion of your stomach’s contents after a meal. This reduces your calorie intake by roughly 30%. Like many other nonsurgical weight loss procedures, AspireAssist is inserted directly into your stomach with the help of an endoscope.
Read also: OTC Weight Loss
Another study from 2016 explored the effectiveness of the AspireAssist with lifestyle counseling for weight loss in people with obesity. According to the study results, when used alongside lifestyle counseling, AspireAssist was effective at reducing at least 25% of baseline weight in more than 58% of study participants.
Endoscopic Sleeve Gastroplasty (ESG)
Endoscopic sleeve gastroplasty is a minimally invasive procedure, where the volume of the stomach is reduced using an endoscope and a suturing device. ESG has shown promising results, with a systematic review reporting a mean percent total body weight loss of 15.2% at one year.
Sleeve gastroplasty is an alternative to gastric sleeve surgery, in which the surgeon places sutures along the inside of your stomach to decrease the size of your stomach. A similar procedure, called gastric plication, also involves a similar approach in which your stomach is folded in on itself and stitched together to decrease your stomach size. Both procedures can be performed endoscopically and don’t involve any actual cutting of your stomach like in traditional bariatric procedures. People with a BMI greater than 30 may be candidates for endoscopic sleeve gastroplasty.
Folds are stitched into your stomach to reduce its size by about 70%. This restricts how much food and drink you can consume and makes you feel fuller faster. No part of your stomach is cut or removed. Only stitches hold the folds in place. The procedure can be undone, but scar tissue may remain. Studies report that 60% of people lost about 20% of their total body weight during the first year after surgery.
In a recent study from 2022, researchers studied the effectiveness of endoscopic sleeve gastroplasty for weight management in 91 people with obesity. Results of the multicenter study showed that the procedure was able to produce significant weight loss in study participants both after surgery and at 6 months.
Read also: Alternatives to GLP-1
What happens before ESG?
You and your healthcare provider will decide together whether you’re a good candidate for ESG. You’ll go through a health screening process, which may include some standard medical tests to make sure you can safely undergo general anesthesia. A healthcare provider will ask about your health history, diet, lifestyle and weight loss goals. They’ll counsel you about the risks and benefits of the procedure and the long-term changes you’ll have to adopt to make it successful.
What happens during the procedure?
You’ll be asleep for the procedure under general anesthesia. A gastroenterologist or an endoscopic surgeon will insert the endoscope through your mouth and down your esophagus, into your stomach. The endoscope releases gas into your stomach to expand it. The camera on the endoscope projects the inside of your stomach onto a screen. The endoscopist operates using special tools attached to the endoscope while watching the monitor. Using a suturing device, they’ll place about eight to 10 stitches between the two opposite walls of your stomach and draw them together. When these walls close, you’ll be left with a narrow, tubular section of your stomach that’s still open.
How long does endoscopic sleeve gastroplasty last?
The procedure itself takes 60 to 90 minutes. After you wake up from the anesthesia, you can go home the same day. If you have symptoms afterward, such as pain or nausea, your healthcare team will treat you for them before you go.
How painful is endoscopic sleeve gastroplasty?
Most people have mild pain as their stomach heals. Some have more pronounced pain and nausea for a few days afterward. These side effects are often manageable with over-the-counter (OTC) medications. Your doctor can give you a prescription if needed.
Will I have to follow a special diet after the procedure?
Yes, you’ll be on a strict diet during your recovery period, which lasts about a month. This is to give your stomach the chance to heal. Your provider will give you all the details.
Comprehensive Medical Weight Loss Evaluation
Some people suddenly gain weight after a change in medication and never realize that they are prescribed medications that actually cause weight gain. Thyroid conditions are often linked to changes in weight. Other patients may move less because they have a knee condition. Hormonal issues can trigger weight gain, as can sleep irregularities. Stress is notoriously connected with weight increase. A full medical weight loss evaluation can isolate real reasons why you may be experiencing problems with your weight - and then help you address those medical issues.
Medical Weight-Loss Treatments
Many people struggle to lose weight with diet modification and exercise routines alone. That’s because there are many factors that can contribute to weight gain and obesity. Genetics, hormones, illnesses and medications, behaviors and the environment around us all can affect our weight and weight loss results. If you feel like you've run out of options and your weight is impacting your well-being, medical weight-loss treatments or surgery may be your missing tool.
Weight-Loss Medications
Weight-loss medications This is an emerging field that has really gained traction in recent years. Unlike the snake oils and quackery rife in the “diet pills” industry of the past, there are weight-loss drugs that can truly be effective and safe under medical supervision.
Based on your medical and weight history, activity level, eating habits and dietary needs, prescription weight-loss medications may be an additional tool to help with weight loss. Some prescription weight-loss drugs work by making you feel fuller and controlling your appetite. Others change the way fat from your diet is absorbed into your body or improve your insulin resistance. Experts can discuss FDA-approved weight-loss medication options, including injections and oral tablets, and make recommendations based on your body mass index (BMI) and health goals. Patients on prescription weight-loss medications typically lose 10 percent of their body weight within 6 months.
Weight-management medications generally work more gradually than bariatric surgery. While the extent of weight loss may be less, these medications can be very effective for individuals with moderate obesity.
You’ve likely heard about medications like Wegovy, Ozempic, Zepbound, and Mounjarno. These classes of drugs, called GLP-1 agonists and GLP-1/GIP receptor agonists, were initially developed to treat type 2 diabetes to help control blood sugar. Since then, they have been studied and approved to treat people who are overweight or obese because they mimic a hormone that helps to decrease appetite, slow digestion, and improve the body’s response to blood sugar. Some of these medications even have indications to lower cardiovascular risk.
These medications for weight management can help individuals lose weight more effectively than lifestyle changes alone. Studies have shown that weight-management medication can reduce body weight by up to 20%. Losing even a small amount of weight can have significant health benefits, such as reducing the risk of diabetes and heart disease.
Weight-management medications also require long-term use to maintain results. Their effectiveness may decrease over time, and stopping the medication can lead to weight regain. Like bariatric surgery, employing lifestyle changes, including a healthy diet and moderate exercise, is crucial to see success. Finally, weight-management medications can often have adverse side effects, including nausea, constipation, and increased heart rate.
Nutritional Supplementation
Nutritional deficiencies can not only throw your normal hunger levels out of whack, but they can upend metabolic processes and stop your body from functioning as it should. From IV infusions to specific nutritional supplements, it's important to support your body's nutritional needs to optimize any weight loss plan.
Lifestyle Modifications
Lifestyle modifications are the cornerstone of any weight loss plan. A healthy diet, regular physical activity, and behavior changes can lead to significant weight loss and improvements in health.
Behavior Modification
Your relationship with food and your body image issues can have psychological or emotional roots. There are so many factors that can influence your relationship with food - from extreme trauma to simple bad habits. You might simply have developed a routine of eating while watching TV late at night. Breaking that pleasure connection and eating more mindfully without the distraction of TV can have a tremendous impact on the amount of food you consume. Uncovering the root causes of unhealthy eating can be one more key to unlocking weight loss.
Healthy Eating
This is not your grandmother's grapefruit diet. Emerging science is ever changing our understanding of how our body reacts to certain foods and which food choices can actually lead to substantial, sustainable weight loss. Expertise in the latest research, however, is key to creating a plan that will work. Also, learning to cook healthy menus that actually taste good and stimulate pleasure centers in the brain is an important part of transitioning to a new way of eating.
Food can be one of the best tools for improving health and weight control, but not everyone knows how to properly fuel their body-even more so if a health condition requires special diet restrictions and limitations.
Fitness
Muscle mass is one of the best predictors of aging well, and muscle not only helps you lose weight, but it helps you sustain that weight loss - but from weight training to pilates, aerobics or HIIT, not all exercise regimens are right for you. Finding a fitness plan that works for your body and your lifestyle is key. Again, recent research on exercise, fitness and weight loss can inform your choices today and lead to greater success in your future fitness regimens.
Fasting
Fasting may be an ancient religious practice, but it can also be a powerful weight loss tool. Intermittent fasting, for example, is all the rage and considered a cutting-edge weight loss technique - even though fasting has been around forever. Any fasting regimen, however, should not be undertaken without medical consultation and ongoing clinical supervision and in some cases regular lab testing.
Comprehensive Weight Management Programs
Medical weight loss programs are comprehensive, individualized plans guided by healthcare professionals. These programs can be effective and have been associated with an average weight loss of about 10% of total body weight over six months.
Nutrition Counseling
Group or individual nutrition counseling with registered dietitians can help get you on the right path. Together, you will develop a personalized plan that emphasizes nutrition, movement and coping strategies as you develop a healthy relationship with food. Meal planning can also be incorporated into dietician visits. The provider may also recommend behavioral health, therapy, exercise physiology or other complementing resources.
Meal Replacement Programs
With a meal replacement program, a physician will supervise and guide you through a 3-phase program that helps you lose weight, develop healthy eating habits and maintain your weight loss. The program begins with daily meal replacement shakes, soups and bars that contain quality nutrients to nourish the body and have fewer calories than what you’d typically consume from a standard breakfast, lunch or dinner. During this weight-loss phase, the limited food distractions help you learn to recognize hunger and fullness cues. As you improve your eating patterns, you’ll transition from supplements back to balanced meals and snacks. And when your weight-loss goal is achieved, the final phase of the program is weight maintenance. Patients on the meal replacement program for weight-loss typically lose 10 to 15 percent of their body weight.
Bariatric Surgery
For people with obesity who have struggled with less invasive weight-loss options, bariatric surgery is an effective and safe weight-loss treatment that helps support and sustain a healthy diet, lifestyle and weight. Today’s most common bariatric surgeries are the Roux en Y gastric bypass surgery and the gastric sleeve surgery, both of which are minimally invasive procedures that alter the stomach and digestive system. For people with a BMI above 35-or a BMI above 30 with other related health problems-bariatric surgery is often the most effective long-term treatment for weight loss. Gundersen patients typically lose about 72 percent of their excess weight by the end of the first year following their bariatric surgery, and many related health conditions, including diabetes, high-blood pressure, high cholesterol and sleep apnea, can be avoided, improved or completely resolved.
Bariatric surgery is best for those who have BMIs greater than 35 and need substantial and rapid weight loss, but it requires a rigorous qualification to ensure your body and mind are fit for surgery. For people who are morbidly obese in particular, bariatric surgery can truly be a lifesaver due to how significant of a toll excess weight - and co-existing weight-related conditions - can put on your body.
Bariatric surgery comes in two forms: sleeve gastrectomy - more commonly referred to as gastric sleeve - and gastric bypass. For gastric sleeve surgeries, surgeons remove a large portion of the stomach, leaving behind a much smaller “sleeve” that helps restrict food intake and decrease hunger. In gastric bypass surgeries, surgeons create a smaller stomach pouch by dividing the top of the stomach from the rest and rerouting the digestive tract to bypass the larger, original stomach. As a result, individuals lose significant portions of their body weight, often fixing other weight-related conditions in the process, like type 2 diabetes, hypertension, and sleep apnea.
There are times when people have trouble reaching their weight loss goals -- or even gain weight -- after gastric bypass, because of stretching that may occur at the connection between the stomach and small intestine, also known as gastrojejunostomy. In this case, an endoscopic gastric bypass revision may be recommended, which is performed by inserting a tube into your mouth to reach your stomach.
The Importance of Support and Commitment
Whichever procedure you choose, a robust support system, including a care team and friends and loved ones cheering you on at home, will help you achieve and sustain the weight loss you desire for a healthier life, free of diabetes, sleep apnea, and obesity’s other coexisting conditions. Patients who remain committed to the personalized weight loss plan developed by their care team and adopt a healthy diet and a regular exercise regimen have the most successful outcomes. Proper nutrition also helps patients heal faster after surgery.
Weight-Management Medications vs. Bariatric Surgery: A Comparison
Every person is different, so consulting your doctor is important when deciding if surgery or medications are best to meet your weight-loss goals and needs.
- The Commitment: Bariatric surgery is an incredibly powerful tool for weight loss, and it can help people lose between 40% and 70% of their excess weight. To achieve such significant, long-lasting outcomes, individuals must fully commit to the program's requirements, which include modifying their diet prior to surgery, exercising before and after surgery, and committing to a healthier lifestyle post-surgery. Weight management medications require lifestyle changes, including a healthy diet and regular exercise, to see results. Also, if the drug works for you, you’ll likely need to continue taking it for the rest of your life; once you stop, the weight usually comes back. With the high demand, obtaining the appropriate dosages when needed may be difficult.
- Your BMI: Bariatric surgery is generally recommended for individuals who struggle with obesity more significantly, with a body mass index (BMI) higher than 35. Weight-management medications offer promising results in individuals with a BMI of 30-35 or 27 or higher with obesity-related co-existing conditions.
Combining Therapies
For those who qualify for bariatric surgery, doctors can prescribe one of these weight-management medications to assist their weight loss prior to surgery. This combination therapy can be effective in some cases, as it provides a pre-surgery weight-loss boost. Additionally, if someone undergoes bariatric surgery and then notices their weight ticking up a bit over time, doctors can prescribe these medications as a supplemental tool to fight the weight regain.
tags: #alternatives #to #weight #loss #surgery