Are advanced weight management options right for you

So who should consider advanced weight loss options? Anyone whose weight is excessive enough to be a health problem.

What should you do if you have tried everything to lose weight and still have excess pounds (or kilograms) that you need or want to lose?

Consult your physician

If you haven’t already, talk to your doctor. Your doctor can evaluate your weight in the context of your total health. Perhaps you have medical conditions or medications that promote weight gain or make weight loss more difficult. You may need to address those before any weight loss plan will be successful.

Beyond that, you and your doctor might then consider weight loss medications. In general, they can be helpful in the short run which may get you started with sustained weight loss, but in general none of them have proven as successful and doctors and patients would like. This post describes what’s available now.

Collage of Various Types and Colors of Medication

How to lose weight when nothing else has worked.

In helping people lose weight, there is a significant gap that needs to be closed. When diet/exercise fails, we need something less invasive  before resorting to surgery with its significant risks and complications. One option is prescription medication.

This information is current as of the publication date; it is general medical information that helps a doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

Options beyond lifestyle alone

someone standing on a scale
New weight loss options are good news.

So who should consider advanced weight loss options? Anyone whose weight is excessive enough to be a health problem. In general this is considered to be those with

  • a BMI, body mass index, of 40 or greater.
  • a BMI of 30- 35 and certain medical conditions especially type 2 diabetes, heart disease, and sleep apnea

Calculate your BMI here.

Benefits of weight loss

Although these can be true even for people with lower BMI , when those with BMI 30+ lose weight, they can experience

  • improved blood glucose control in diabetics
  • lower cholesterol
  • lower blood pressure
  • less sleep apnea
  • less urinary incontinence
  • less back and joint pain
  • lower risk of many types of cancer
  • less gastroesophageal reflux-heartburn

Weight-loss Devices

The FDA regulates four devices intended for weight loss in certain adult patients age 18 and older.

Gastric Band –

bands are placed around the top portion of the stomach leaving only a small portion available for food.

Lap-Band Adjustable Gastric Banding System

Electrical Stimulation Systems –

electrical stimulator is placed in the abdomen to block nerve activity between the brain and stomach.

The Maestro Rechargeable System is implanted under the skin; an intermittent pulse generator delivers an electrical signal to the vagus nerve in the abdomen. The vagus nerve controls stomach action; when slowed down, one feels full sooner and theoretically will eat less. However, the company has not marketed it since 2018.

Gastric Balloon Systems

inflatable balloons are placed in the stomach to take up space and delay gastric emptying

The ReShape Integrated Dual Balloon System was approved by the U.S. Food and Drug Administration in July 2015. Apollo Endosurgery purchased it in 2018 and replaced it with their existing product the Orbera Gastric Balloon.

The company claims patients with Orbera experience three times more weight loss than diet & exercise alone and are provided with the right tools and resources to successfully learn to keep it off.

The device is placed into the stomach by going through the mouth and down through the esophagus with a tube called an endoscope. It takes about 30 minutes and requires on a mild sedative, not general anesthesia. Once in the stomach the “balloons” are inflated; by taking up space in the stomach it can trigger a feeling of fullness.

Gastric Emptying Systems

a tube is inserted between the stomach and outside of abdomen to drain food after eating

This device is called AspireAssist. This is a tube inserted into the stomach, from which a portion of the stomach contents can be “aspirated” (sucked out) after eating. The company claims patients lost 3 times more weight than those who received only diet and exercise counseling. The most successful patients lost over 100 pounds in the first year.

People lose weight with these devices largely due to the intensive counseling and support they received along with use of the device.

I encourage you to follow the links to learn more about each device.

 

tape-403591_1280
Obesity is defined using BMI, body mass index, but waist circumference is also important and may be more accurate.

Bariatric surgery

Two procedures comprise the majority of operations done to help people lose significant amounts of weight.

Sleeve Gastrectomy

In this procedure, a surgeon trained in bariatric procedures removes a large portion of the stomach.

The new, smaller stomach is about the size of a banana. It limits the amount of food you can eat by making you feel full after eating small amounts of food.

Gastric bypass

There are 2 steps during gastric bypass surgery:

In the first step the surgeon uses staples to divide the stomach into a small upper section and a larger bottom section. The top section, about the size of a walnut (called the pouch)will receive the food one eats. It holds only about 1 ounce (oz) or 28 grams (g) of food, causing one to eat much less.

The second step is the bypass. The surgeon connects a small part of the small intestine (the jejunum) to a small hole in your pouch. The food will now travel from the pouch into this new opening and into the small intestine. As a result, the body will absorb fewer calories.

Thus weight loss occurs from eating less and absorbing less food.

A success story

After gaining weight with her pregnancies, one woman , J.T. ,successfully lost weight with gastric bypass surgery.

I gained over 100 lb after my pregnancies. When my family doctor diagnosed me as borderline diabetic with high cholesterol, I panicked. Discouraged after failing numerous diets, I felt hopeful when I read about gastric bypass.

Learn about the lifestyle changes she made at this article from American Family Physician journal

 

Review these other posts about weight management
Obesity and BMI defined
How we should view excess weight 
How effective are weight management programs? 
A success story; how a doctor helped her patient lose weight
When diet alone doesn’t work
and, one of my all time most read posts

How my friend lost weight and inspired others with her example

exploring the HEART of achieving a healthy weight

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A 5 year love affair-with healthy eating

I still enjoy food.  Very much.  Maybe even more than before because now I appreciate my food as fuel to live a healthy and active and even beautiful (in the eyes of the beholder) life!  I still enjoy the tastes, even more so because I choose only the best.  My plate is colorful with roasted veggies and fresh fruits and salad greens.  I enjoy grilled lean chicken, steak and seafood.  My carbs are high fiber, full of flavor and texture.  I no longer long for the processed foods full of white flour, sugar and fat.

 

One of my all time most viewed posts is a story about my friend Pam and her weight loss journey using the Weight Watchers program.  After successfully reaching and maintaining her weight goal, she started coaching others who have been equally successful. Recently, she was honored for 5 years as a coach.

a smiling woman holding flowers
Pam’s clients showed appreciation for  her for 5 years of service.

 

 

Many of us would like to weight less than we do, but some people struggle with severe excess weight that threatens their health and keeps them from enjoying life as they would like. These are usually people whose BMI, body mass index, is 30 or more. For people with diabetes, heart disease, liver disease, and osteoarthritis, even lower BMI can put them at excess disease risk.

Body mass index chart
A BMI of 30 or more represents obesity. BMI Chart created by Vertex42.com. Used with permission.

 

 

The United States Preventive Services Task Force, USPSTF,  recently reviewed weight loss methods and made a recommendation to physicians about how to help patients with weight.

The Task force encourages  doctors to refer patients for  “intensive, multicomponent behavioral interventions” to successfully lose weight. 

What exactly does “intensive, multicomponent” mean? 

 

 

A Patient Page in JAMA explains it this way- Interventions that are

  • done in a group or individual setting, provided in person or virtually, and use print or online materials
  • occurs over 1 to 2 years and with 1 to 4 sessions per month
  • includes counseling about nutrition and exercise as well as education about how to self-monitor both of these components.
  • includes help to identify barriers to weight loss, and  help with problem solving related to challenges
  • support from other people who are also working on weight loss
  • education  focused not only on weight loss but also on weight maintenance after interventions are completed.

 

 

Here is a link to the page-

Behavioral Interventions for Weight Loss

 

 

a lady in bare feet standing on a scalefeet in sports shoes

 

 

 

 

 

 

 

I haven’t used Weight Watchers but from what I understand about it, this is the type of program they offer. I’m not necessarily promoting WW, as they are called now, but if you want to lose weight I suggest looking for a program that includes these features. It certainly has worked for Pam and those she coaches.

“If we want to be people’s partners in what healthy means to the, it has to be about more than just weight. It has to be a total approach to how they can live their healthiest, best lives.”

Mindy Grossman, CEO of WW, quote taken from TIME magazine, October 15, 2018

 

 

And here is my story about Pam and her break-up with junk food.

How I “broke up” with junk food

and fell in love with healthy eating.

Meet my friend Pam. My husband and I met Pam and her husband in a ballroom dance class. I was immediately captivated by her radiant smile and Southern charm. Since then I have learned more about her and watched an amazing transformation in her life.

Pam and I attending a wedding at the dance studio
Pam and I  at the dance studio

 

 

Pam graduated summa cum laude with a Bachelor of Arts from Mississippi State University in 1980. With a major in Communications, she started her career as a writer and Account Executive for advertising and public relations agencies in Mississippi and in Oklahoma where she moved after marrying.  She was the Marketing Director for a large medical clinic for several years. Since 1995, she has enjoyed being a stay-at-home mom with involvement in PTA, church and community. In 2012, she was named Volunteer of the Year by her community public school system.

But despite such a charmed life, there was a struggle, one that Pam shares with many people. In this blog I have discussed the physical and emotional consequences of excess weightyou will be encouraged by Pam’s success story which she so generously shares with me and you.

“Breaking up is hard to do. ” By Pam Whitson

“I was happily married to the love of my life and should have been having the time of my life.   Sadly, my self-confidence and my happiness had been stolen, and I was the thief.

For over two decades, I robbed myself of peak energy, vitality, health and beauty by totally disregarding my intake of food.  Oh, don’t get me wrong, I thought about what I should do.  I spent money on self-help tapes, gym memberships and weight loss programs from the practical to the extreme.  I whined and wished about it constantly.  And it didn’t help knowing that I was not alone; almost half of adults are overweight or obese.

And I had occasional moments of success.  Like the time I was within four pounds of leaving the “obese” category. (Obese is a BMI, body mass index, of 30 or higher)  After months of hard work, I ran to Glamour Shots for the mid-1990s version of a sequin and big hair make-over.  On the way home from my triumphant photo session, I stopped by my favorite barbecue place and started eating my way right back to where I was before.  I gained all the weight I had lost back and more.

I joked my way through feelings of depression, because  I had an unhealthy relationship with food.    I thought about it way too much.  I ran to it for instant gratification.  I was too in love with the tastes, the textures, the sheer delight of food.  Even now, I love to grocery shop.  One of my favorite places on the planet is the cereal aisle of the grocery store.

cereal boxes in a store
“One of my favorite places on the planet is the cereal aisle of the grocery store.”

 

 

Finally, at age 53, after twenty years of carrying way too much weight for my 5’7 ½” (1.7 meters) (yes, the half inch counts!) frame, I was ready for a change.  Really ready.  Change isn’t easy.  Change hurts.  I walked into Weight Watchers and pretended it was my first time ever.  I read everything.  I listened and participated.  I went to every meeting.  I hung around afterwards and pestered my leader for every little nugget of information I could cling to.

Pam before weight loss
Pam and her daughter

 

 

I rejoined Weight Watchers in July, 2012, with 20 pounds (9 kg) still off from a previous Weight Watcher effort. I lost 40 pounds (18 kg) in 4 1/2 months to be at goal before Thanksgiving! I learned to maintain this loss during the required six week maintenance period with Weight Watchers and became an official Lifetime Member before the year’s end of 2012. This meant a lot to me because my birthday is New Year’s Day. How wonderful to start the year at a healthy weight!

At Weight Watchers I learned I could change.  I could change what I put in my grocery basket.  I could change what I ordered in restaurants.  I could change how much I moved.

I could change my relationship with food for good.

I still enjoy food.  Very much.  Maybe even more than before because now I appreciate my food as fuel to live a healthy and active and even beautiful (in the eyes of the beholder) life!  I still enjoy the tastes, even more so because I choose only the best.  My plate is colorful with roasted veggies and fresh fruits and salad greens.  I enjoy grilled lean chicken, steak and seafood.  My carbs are high fiber, full of flavor and texture.  I no longer long for the processed foods full of white flour, sugar and fat.

By pairing healthy eating with increased physical activity, I changed my weight dropped from 226 lbs (102 kg) to 150 lbs (68 kg).  Now 70 pounds (31 kg) lighter and at a healthy BMI of 23, I feel so much happier and healthier.

But once I started eating better, even before I was near my goal weight, my self-esteem and confidence were instantly restored.  Just knowing that I had a plan gave me optimism and excitement.  I’ve been at goal for almost three years and I wouldn’t trade it for the world (or even a crisp cookie). And I now stay about 10 pounds (4.5 kg) below goal as a safety net.

Pam on a well deserved vacation
Pam on a well deserved vacation

 

 

In addition to my daily walks, I enjoy ballroom dancing, Jazzercise, swimming and an occasional bike ride.  I wear a Fitbit and accomplish 15,000 steps a day.

I’ve been a Weight Watcher leader for two and a half years and just LOVE it! I never imagined I would do this; you might as well as told me I would become an astronaut. While helping me stay at a healthy weight, I enjoy the privilege of making new friends and helping other people be their most confident and healthy selves.

Just for fun, I’ve started a Park Walking group that explores different parks in our city every two weeks. We took a summer break (Oklahoma gets real hot in the summer) but will be back on the trails in September. Along with my awesome Weight Watcher members, I’m enjoying a new healthy relationship with food for good. ”

Pam leading a Weight Watchers meeting
Pam is now a WW coach

 

 

Weight Watchers may not be the answer for everyone, but Pam’s idea of changing our relationship with food should be a part of any weight management plan.  Our eating habits affect our health in other ways, so even if you are not overweight, using food appropriately is important.

Physical activity  has health benefits beyond weight loss. I joined Pam’s walking group and find it a fun way to exercise and make new friends. (My favorite walking shoe is Go Walk by Skechers.)  In addition to social dancing with our husbands, Pam and I were in a ladies dance team. We performed a Western theme dance routine to the song “These Boots are Made for Walking” . That’s so appropriate for someone who walked her way from a BMI of 35 down to 25. If she can do it, so can you.

( This post contains affiliate product links; purchase through these links pays a commission to this blog; thank you)

 

Our son introduced my husband and I to Hello Fresh delivery meal kits and we’ve enjoyed the convenience, taste, variety, and quality. The meals feature lots of fresh vegetables with vegan  and “fit” choices. We think we are eating healthier and ever with less work. Here is a link through which you can get $40 off your first order.

HELLO FRESH OFFER 

 

Thanks for letting me introduce you to my friend Pam. We would love to hear your weight management stories. Please share in the comments or send me a message if you want it kept anonymous. Remember, support from others is an important step toward success.

Dr. Aletha