When Diet and Exercise Aren't Enough
Sometimes no matter what you do, the weight doesn’t come off. The good news? If you’re dealing with obesity, you have more treatment options than you realize.by Lambeth Hochwald Health Writer
Kelly Carron, 49, spent years dutifully working out and trying to eat healthfully.
“I went to the gym, I did Jenny Craig and Weight Watchers, and I got nowhere,” says Carron, who works at a hospital-based weight center in Boston and had recently reached 222 pounds. “It was very frustrating because the weight would come off a little bit, and then I’d either plateau or gain again.”
Ten weeks ago, Carron opted to have gastric-sleeve surgery and is now halfway to her 80-pound weight-loss goal.
“My energy is way up, I can walk much easier, and my joint pain is so much better,” she says.
Best of all, Carron says her weight is no longer holding her back. In fact, she’s making plans to go skydiving this spring, something she’s always wanted to do.
“At work, I’ve watched so many people go through their weight-loss journey,” she says. “I’m so glad I’m on my way to where I want to be—and getting healthier every day in the process.”
If you’ve tried to lose weight on your own with very little movement on the scale, take heart: Experts are learning more and more about the genetics involved with obesity and believe we should be treating it like a disease, not an issue of your lack of control around the dinner table.
“Truth is, diet and exercise are never enough if you’re dealing with obesity,” says Angela Fitch, M.D., associate director of the MGH Weight Center in Boston. “The average person loses two to five percent, and that’s the best they can do by making lifestyle changes.”
In fact, it’s our physiology, not as much our diet and exercise regimen that drives obesity, which affects two-thirds of Americans. If you’ve been on an endless diet-and-exercise loop, read on for two other treatment options that can help:
The Prescription Weight Loss Route
What It Is:
At present, there are five FDA-approved anti-obesity medications that are believed to work either by decreasing appetite, increasing a feeling of fullness, or both. These include:
To be prescribed these medications, you must meet certain criteria, including having a BMI greater than 30, or a BMI greater than 27 plus type 2 diabetes, hypertension, or abnormal cholesterol levels.
“Nearly half of Americans qualify for treatment with anti-obesity medications,” says Ania M. Jastreboff, M.D., Ph.D., assistant professor of medicine, endocrinology, and metabolism at Yale University School of Medicine and director of the Weight Management and Obesity Prevention at the Yale Stress Center. “However less than two percent of patients are prescribed these medications.”
What to Know:
Some of these medications have GI side effects while others can prompt an increased heart rate, anxiety, dizziness and headache (though these symptoms tend to abate over time), and several aren’t covered by either Medicare, Medicaid, or private insurers.
Success Rates: Approximately 6% to 10% of patients taking anti-obesity medication lose 20% of their overall weight, Dr. Fitch says.
New Innovations: “The new thinking is that the earlier we treat obesity the better off you will be,” Dr. Fitch says. “The longer you’ve had diabetes and heart disease the more damage is done. In the future, we won’t wait until you have 100 pounds to lose to start treating your obesity with medications.”
The Surgical Treatments for Obesity
What They Are:
Otherwise known as bariatric surgery, there are three weight-loss surgery options: gastric bypass, gastric band, and gastric sleeve.
To be considered for weight loss surgery, you must have a BMI greater than 40 or a BMI greater than 35 plus such conditions as diabetes, hypertension, fatty liver disease, and/or sleep apnea.
How Gastric Bypass Works:
A portion of your stomach is stapled and part of your small intestine is bypassed to reduce your appetite and limit your ability to overeat. You’ll spend two or three days in the hospital; overall recovery time is two to five weeks. Expect to lose about 30% of your total body weight within a year, according to a recent study of 46,000 people by Kaiser Permanente published in the Annals of Internal Medicine.
How Gastric Band Works:
Also known as lap band, this same-day surgery involves the placement of a silicone band around the upper part of your stomach without reducing the overall size of your stomach. The band can be adjusted after surgery depending on your weight-loss progress. Recovery time is about two weeks. Expect to lose 14% of your total body weight the first year, according to the Kaiser Permanente study.
How Gastric Sleeve Works:
Nearly 80% of your stomach is removed in this irreversible procedure that requires a two-day hospital stay. (The narrow tube that’s left is the “sleeve,” according to Johns Hopkins Medicine.) Expect to lose 25% of your total body weight within the first year, according to the Kaiser Permanente study. You’ll be in the hospital for three to five days; overall recovery is two to three weeks. “The sleeve has become way more prevalent,” Dr. Fitch says. “That’s because the long-term outcome data at five to 10 years has shown that the sleeve and gastric bypass seem to produce the same results, and the sleeve is less complicated and has a shorter OR time.”
What to Know:
After bariatric surgery, you’ll be on a diet that moves from liquids, purees, soft foods, and then regular food. You’ll have to eat very small meals and will likely need to take supplements, including a multivitamin plus vitamin D and calcium. Your smaller stomach can make it more difficult to absorb nutrients, and you may experience pain and/or nausea if you overeat.
Success rates: On average, most bariatric surgeries prompt a 30% to 40% weight loss.
That said, new research from the Cleveland Clinic has shown that staying on anti-obesity medications after surgery can keep weight from coming back on. “In our studies, we’ve seen that when patients took medication before surgery and kept taking it afterwards, they lost more weight,” Dr. Fitch says.
New Innovations: “In the future, we’ll have precision medicine for obesity,” Dr. Jastreboff says. “You’ll have genetic testing coupled with phenotyping [which pinpoints the characteristics of your genes] along with a careful history to match what treatment will work best. For example, it might be a matter of pairing medicine plus surgery and diet changes for one person while another will need medication alone to get to a healthy weight.”
The bottom line? You don’t have face obesity alone or give up hope of managing it. You have options—so go ahead and take advantage of them.