Diet, pills, gastric balloon, or surgery — how to treat obesity?

No one is immune to becoming overweight — when excess pounds pile on of their own accord without you noticing, then losing and maintaining weight requires constant conscious effort. With new treatment methods, diets, and medications emerging constantly, the diverse world of weight loss is becoming increasingly difficult to navigate. This article aims to provide an overview of the various methods available for treating obesity.

Every weight management program  consist of two phases: the short-term weight loss phase and the lifelong weight loss maintenance phase. The short-term weight loss phase is mainly based on limiting one’s daily caloric intake, while lifelong weight management is based on physical activity, a healthier lifestyle, and sensible eating habits. Which weight loss method should be chosen depends on both the amount of excess pounds and the goal of weight loss: dissatisfaction with one’s appearance, difficulty in performing daily activities, or the desire to get relief from obesity-related diseases. In real life, of course, the reasons tend to be at least somewhat intertwined.

How much weight loss should you aim for?

It is difficult to give one definitive answer to this question, because as far as, for example, obesity-related health issues are concerned, even a 10% weight loss will yield significant health benefits. When it comes to achieving appearance or physical fitness goals, however, a 10% lower body weight may not always be enough. For taller man weighing 100 kg, a 10% weight loss would bring their body weight down to normal levels, whereas a patient of 150 kg would need to lose 60 kg to attain the same goal.

As mentioned above, today there are a wide variety of weight loss measures available, ranging from minor changes in daily eating and exercise habits to bariatric surgery. And sometimes the best results are achieved by combining different treatments.

Obesity treatments largely fall into 4 categories: lifestyle changes, medications, endoscopy (gastric balloon), and bariatric surgery.

Basic treatment for obesity: lifestyle changes

Basic treatment, in simplified terms, means more exercise and a change in diet. The traditional recommendation is to reduce your daily caloric intake to 500 kcal and exercise at least 150 minutes a week. In addition, primary care may include counseling, cognitive behavioral therapy, or participation in support groups.

According to studies, the average amount of long-term (maintained for more than 1 year) weight loss achieved with basic treatment is 3–5%, and can be up to 6% in more effective programs. For example, participants in paid programs such as the Atkins diet or Weight Watchers lose, on average, 3 kg by the end of the first year.

Despite the seemingly modest results at first glance, some patients do achieve significant and sustained weight loss even through just basic treatment. For example, in the LOOK AHEAD study, one in ten participants lost weight permanently by more than 15%. Basic treatment is also essential for other weight loss methods, such as medication or surgery – with these methods too, changes in diet and exercise habits are essential.

Anti-obesity medications

Weight loss can be achieved with a number of prescription drugs, which control digestion, absorption, appetite, or metabolism. Medication also always requires lifestyle changes.

Anti-obesity medications are indicated for individuals with a body mass index of more than 30 kg/m2 or over 27 kg/m2, for those suffering from obesity-related chronic diseases (such as type II diabetes). Patients who fail to reduce their body weight by at least 5% within 3 months of starting treatment are generally advised to discontinue the treatment, as the adverse health effects of the drugs can outweigh the potential benefits. It is also worth noting that after stopping the treatment, the patient’s body weight will go up again, i.e. the effect of the treatment will only last for as long as the drug is taken.

Naltrexone/Bupropion — a combination of a substance abuse management drug and an antidepressant that reduces appetite; the exact mechanism of action of this drug is unknown. Long-term weight loss compared to lifestyle-based treatment alone is 4.95 kg; side effects include nausea, headaches, and constipation.

Liraglutide — increases feelings of satiety, thereby reducing appetite. This drug is injected once a day and has been shown to produce an average long-term weight loss of 5.27 kg compared to lifestyle-based treatment alone.  The most common side effects are gastrointestinal in nature.

Orlistat — acts as a lipase inhibitor, preventing one third of dietary fat from being absorbed in the body. Common side effects include diarrhoea. 1-year average weight loss compared to lifestyle-based treatment alone: 2.6 kg.

Semaglutide — increases feelings of satiety, thereby reducing appetite. Semaglutide is injected once a week and has been shown to produce a 1-year average weight loss of 12.7 kg compared to lifestyle-based treatment alone.

Anti-obesity medications cost around 100–760 euros per month, or 1,200–9,000 euros per year. Treatment with prescription drugs must always be carried out under medical supervision, taking into account both the patient’s indications and contraindications.

Endoscopic treatment of obesity with a gastric balloon

The most common method for endoscopic treatment involves a balloon that is swallowed or placed into the stomach to fill part (500–700 ml) of the lumen of the stomach, thereby reducing feelings of hunger and food intake. To maintain the therapeutic effect, the balloon needs to be replaced every 6–12 months. A number of studies have been published on the short-term (6 months) efficacy of endoscopic treatment of obesity. The method has been shown to produce an average weight loss of 8–12 kg compared to lifestyle-based treatment alone. Data on long-term results is, as yet, limited, but after 1 year of treatment, patients have been shown to have lost an extra 4 kg compared to patients who only received lifestyle-based treatment.

In more than half of all patients, body weight starts to rise again after the balloon is removed and returns to its previous level within a year. Due to this, gastric balloons are not considered to be an effective long-term weight control method.

Bariatric surgery, or weight loss surgery

Compared to other methods, bariatric surgery is probably the most radical but also the most effective treatment for obesity. A number of long-term studies have shown that the body weight of patients who have undergone bariatric surgery is, on average, 30–35 kg lower compared to pre-surgery even after 10 or more years.

In addition to weight loss, surgery is also an effective method for treating many obesity-related diseases, such as type 2 diabetes or sleep apnea. This surgical procedure has a lower risk of mortality and complications than, for example, cholecystectomy (gallbladder removal surgery) and appendectomy (appendix removal surgery). Modern bariatric surgery is non-invasive and patients recover quickly. It is important to realize that surgery alone is not enough, but lifestyle change plays an important role, therefore its essential that patients would receive long-term counseling on both diet and exercise habits. Surgical treatment may be considered for individuals whose body mass index is higher than 30 kg/m2 and who suffer from obesity-related diseases.

There is no simple and definitive answer for treating obesity

In conclusion, there is, as yet, no ideal treatment for obesity, which yields both significant and sustained results, has minimal side effects, and is non-surgical and inexpensive. Weight loss journey must be holistic and always start with basic treatment. If this doesn’t give the desired result – the next steps on the treatment ladder can be considered: be it medication, a gastric balloon, or bariatric surgery.

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