Weight Loss: Medical and Surgical Treatments
Diet and exercise are often the mainstays of weight loss treatment, but they don't work for everybody. For people who want weight loss options that go beyond lifestyle adjustments, there are several treatments available.
New, effective medications are now approved for longer-term use. Many of these medications are now covered by some insurance plans or are very affordable. Our experienced team can help you find the best medication and help you put together a plan to achieve success.
- Contrave – combination of Bupropion to suppress appetite and Naltrexone to reduce cravings
- Qsymia – combination of appetite suppressant (Phentermine) and topiramate
- Belviq – works on serotonin 2c in brain to make you feel full
- Phentermine – appetite suppressant
- Xenical – prevents up to 1/3 of fat you eat from being absorbed
- Diethylproprion – appetite suppressant
- Saxenda – acts like a hormone tat makes you feel full
The Orbera™ gastric balloon has been used around the world since 1999 and has helped over 200,000 people lose much of their extra weight without the need for surgery. Gastric balloons are now FDA approved in the United States and this incision-less, non-surgical procedure is now being offered at our comprehensive obesity management center.
By taking up space in the stomach and making it work harder to empty food, you can feel full faster and stay full longer.
The gastric balloon is placed in a simple, outpatient procedure that takes less than an hour and does not require general anesthesia. Patients lose about 15% of starting weight, over 30lb on average (5+ BMI points) over a period of 6 months.
The Orbera gastric balloon may stay in place for up to 6 months and is then removed (risk for balloon rupture, which can lead to intestinal obstruction, increases after that time). After adapting to the gastric balloon, over 96% of patients tolerate it well and the weight loss success rate is over 98%. About half of patients keep weight off for at least a year.
Since the gastric balloon must be removed after 6 months, this method is considered part of a broader plan for long-term weight management. Our comprehensive program can help you achieve and maintain significant weight loss using a multidisciplinary, comprehensive approach.
Endoscopic Stomach Plication
A non-surgical endoscopic suturing device allows surgeons to stitch the stomach from within, using an endoscopic approach through the mouth. Stitches are placed to pull together the walls of the stomach, making it smaller overall. By reducing the size of the stomach, you will be able to eat less but still feel full.
The procedure requires general anesthesia but no incisions. A standard endoscope with the stitching device attached goes through the mouth and down into the stomach. Marks are made where stitches will be placed to shrink the stomach. Next, stitches will be placed in a way that prevents most of the stomach from expanding. Patients usually go home the same day and recover quickly.
Benefits of stomach plication: Similar to the balloon procedure, patients lose about 15% of starting weight, over 30lb on average (5+ BMI points) over a period of 3-6 months. Weight loss may continue longer than with the balloon because the stitches do not have to be removed.
Risks of stomach plication: Stitches may get pulled out over time.
Minimally Invasive Surgery
Although choosing to undergo surgery is a major decision, these operations have proven to be the best long-term treatments for significant weight loss. Some of these operations have been used for over 30 years and have been shown to treat and prevent disease as well as prolong life. The minimally invasive or laparoscopic approach uses tiny incisions that lead to less pain and quicker recovery than traditional surgery. Patients who qualify can usually get insurance coverage. Below is a short description of the most commonly performed operations in order of popularity.
During sleeve gastrectomy, the size of the stomach is surgically reduced by removing the portion that stretches when you eat. This part of the stomach produces a powerful hunger hormone called ghrelin, so removal of this portion causes ghrelin levels to fall and usually causes hunger to be greatly reduced. A smaller tube or "sleeve" of stomach remains, and patients feel full much more quickly. Most patients lose more than half of their extra weight or 30% of starting weight.
Because sleeve gastrectomy does not involve intestinal bypass, it does not cause nutritional malabsorption that gastric bypass operations do. Due to its excellent weight loss outcomes, safety and simplicity, sleeve gastrectomy has become the most popular weight loss operation.
During gastric bypass surgery, a small pouch is made from the top of the stomach. This small pouch is connected directly to the intestine. As a result, patients aren’t as hungry and feel full quickly. This is in part because the pouch can hold just a few ounces of food and also because the intestine quickly sends hormone signals of fullness since food enters the intestine so soon after it is eaten.
Benefits of gastric bypass: Over 95% patients lose more than half of their excess weight or 35% of starting weight, making this one of the most effective types of weight loss surgery. Gastric bypass also has a powerful effect on controlling Type 2 Diabetes.
Risks of gastric bypass: Patients are less able to absorb some vitamins and minerals, and therefore must take vitamin and mineral supplements for the rest of their lives.
Laparoscopic Gastric Banding
Laparoscopic gastric banding is the only option that is adjustable and removable. It involves the placement of an adjustable silicone band around the upper part of the stomach. A port for injecting fluid is placed under the skin; injecting saline into the band causes it to tighten around the stomach. When the band is tightened, food passes much more slowly so pressure builds up quickly. Though considered the safest weight loss operation, banding has less predictable results and the least average weight loss, at about 15% of starting weight. This and a high rate of needing future surgery have made banding less popular than other options. Neither the stomach nor the intestine is cut so vitamins and minerals are absorbed normally.
Duodenal switch entails a sleeve gastrectomy combined with intestinal bypass. This very powerful combination has the best success in weight loss overall, leading to an average loss of 80% of excess weight loss or 40% of starting weight. Though this operation gets patients closest to ideal weight, it causes more vitamin and mineral malapsorption than the other operations and requires lifelong supplements of vitamins A, D, B12, as well as iron and calcium. For the heaviest patients, this two-part operation is sometimes done in stages 9-12 months apart.