Lifestyle, Medication, and Surgery: Managing Obesity with Modern Tools.

The struggle to lose weight and keep it off can lead to frustration and self-doubt. Too often, weight management conversations overemphasize “trying harder.” If you don’t get results, this approach suggests, it’s because you’ve failed.

This method couldn’t be more flawed. Obesity is not a lack of willpower. It is a complex, chronic disease that requires specialized, long-term management, just like high blood pressure or diabetes.

Make no mistake, obesity is a serious national health crisis:
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• More than 2 in 5 U.S. adults have obesity

• U.S. healthcare costs tied to this epidemic total nearly $173 billion a year

• Obesity dramatically increases the risk of other serious conditions such as heart disease, type 2 diabetes, stroke, and some cancers.

We have more powerful tools than ever before to treat obesity. Clinical trials show some anti-obesity medications (AOMs) can help patients lose as much as 21% of their body weight. Yet we find that in the real world, patients usually achieve about half of that total—there are challenges associated with trying to manage long-term weight management on one’s own. 

In the long term, our patients’ health is almost always achieved through a comprehensive strategy. We work together to manage obesity with lifestyle changes, new AOMs, and metabolic surgery.

Connection between hormones and obesity treatments.

Anti-obesity medications

The rise of AOMs such as GLP-1 RA (such as semaglutide) and dual agonists (like tirzepatide) has cemented our understanding of obesity as a disease driven by hormone dysregulation. 

These medications mimic the natural hormones in the gut that regulate metabolism, signal when you’ve eaten enough, and stabilize blood sugar. AOMs help enable significant weight loss by restoring hormone balance. 

The success of these medications confirms a vital truth: hormone dysregulation, not a lack of willpower, is what causes obesity. 

Metabolic surgery

For many years, surgeons thought that metabolic procedures like gastric bypass and sleeve gastrectomy worked by simply reducing the size of the stomach (restriction) or changing the body’s ability to absorb calories (malabsorption).

Our understanding has evolved. We now know that surgically altering the digestive tract can create profound and lasting change. Many patients with long-standing diabetes could see their blood sugar issues disappear almost immediately after surgery, often before any major weight loss happened. This is because surgery impacts multiple gut hormones, enhancing insulin sensitivity, and boosting the body’s natural insulin production. 

While medications work on one or two hormones, surgery impacts several. This creates more change that lasts longer. This durable hormone reset is central to long-term health and obesity management. 

Treatment for obesity isn’t about choosing one tool or the other. We often prescribe medications before or after surgery to help patients achieve their long-term health goals.

Related reading: Bariatric Surgery Is Effective Obesity Treatment: Now for Even More People.

Evidence-backed considerations for obesity treatment.

Research has demonstrated that to maintain the health and weight loss benefits of AOMs, patients must remain on medications throughout their life. An extension of a major study, the  STEP 1 Trial, found that after one year, patients who stopped taking AOMs regained two-thirds of the weight they’d lost. They saw most of their cardiometabolic improvements vanish, too.

New studies have compared benefits of AOMs to metabolic surgery. A large study recently published in Nature Medicine compared the outcomes of thousands of patients with obesity and diabetes who had metabolic surgery to a group of similar people who took GLP-1 RA medications. 

After about six years of follow-up, the results were clear: Metabolic surgery provides greater and more lasting defense against dangerous complications from obesity, including death, heart attack and stroke, sever kidney disease, and diabetes-related eye damage. 

Related reading: Science vs. Stigma: Research Examines New Drug’s Effects on Weight Loss.

Prioritizing metabolic surgery options.

Only about 1% of patients who qualify for metabolic surgery get the procedure; that means millions of people are missing out on its benefits. 

If you’re struggling to achieve a healthier weight, talk with a metabolic surgeon, especially if:
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• You’re already taking a weight loss medication but your chronic conditions are getting worse. If your A1C level is rising or your kidney function or vision are worsening, surgery may help to rebalance your hormones.

• If you have a body mass index (BMI) in the 40s or above or if you have more than one obesity-related condition, surgery can help.

MedStar Health offers a range of metabolic surgery options, including:
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• Duodenal switch: A complex surgery that combines sleeve gastrectomy (removing a portion of the stomach) with intestinal bypass. 

• Endoscopic sleeve gastroplasty: A newer, incision-free, less-invasive option. We use an endoscopic device to access the stomach through the mouth, reducing its size to restrict intake and adjust hormones.

• Roux-en-Y gastric bypass: This procedure rearranges the small intestine to change the way food is absorbed and maximizing hormonal reset.

• Single anastomosis duodeno-ileal bypass with sleeve gastrectomy: A hybrid surgery that reduces the size of the stomach and bypasses much of the small intestine.

• Sleeve gastrectomy: The most common metabolic surgery procedure, in which surgeons remove a portion of the stomach to create a smaller, tube-like sleeve that reduces food intake and impacts appetite hormones.

For many patients, cost is a real barrier. Brand-name AOMs can cost more than $1,000 a month, creating a massive lifetime commitment if insurance doesn’t pick up the tab. While metabolic surgery has a high up-front cost, most procedures are covered by most insurance plans. For many patients, surgery presents a more realistic financial option. 

Related reading: Obesity Is a Chronic Disease: How Long-term Care Supports Healthy Weight Management.

Your long-term health partner.

Obesity is a chronic disease. It’s not a result of personal failings or a lack of willpower—it is difficult and we’re here to help you. 

At MedStar Health, we know the best approach to care is holistic and multidisciplinary. We work together to care for our whole patient, not just their disease. We tailor our care to each patient. 

Together, we’ll craft a plan that could involve lifestyle modifications, medications, surgery, or a combination. You’ll have a team of surgeons, dietitians, and behavioral health experts working together to support you throughout your journey, now and long into the future.