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Counting calories. Slimming down. Watching weight. No matter what you call your personal journey, society has lots of names and options for achieving your weight-loss goals—and some that are no help at all.
With so many products and services available today that claim a quick weight-loss fix, it’s important to understand that obesity is recognized by the American Medical Association as a chronic disease. Your body mass index (BMI) is a calculation using your weight and height. A BMI of 30 or higher indicates obesity.
This diagnosis can mean different things:
- Obesity is more than a simple result of lifestyle choices. It’s a medical condition sometimes tied to metabolic changes that can benefit from treatment.
- Obesity is a lifelong condition to keep an eye on. Losing weight today doesn’t mean you’re not at risk for gaining it back tomorrow. In fact, fewer than 5% of people who achieve their weight-loss goal with lifestyle changes only maintain it.
Talking with your doctor is a great first step to learn the best ways to help manage your weight. While you prepare for that conversation, here are four weight-loss tools to think about.
1. Diet and exercise.
A mindful diet of nutritious foods and appropriate exercise go together to play a crucial role in helping you lose weight and maintain your goal weight when you get there.
There are different healthy-eating lifestyles to consider, such as:
- Heart-healthy choices like the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets
- Intermittent fasting
- Sugar-conscious options like low carb and keto
Your primary care provider can help you decide if these options might be right for you.
As a bariatric surgeon, I tend to encourage patients in our bariatric program at MedStar Washington Hospital Center to focus on portion size and moderation and less on restrictive diets. We discuss the value of paying close attention to nutrition labels to avoid trans fats and high sugar foods.
I also caution against too many liquid calories like diet shakes and nutritional smoothies—these can sometimes contain up to three times the amount of nutrients that would have been consumed in solid food.
The right portions of healthy fats, and low sugar, high protein foods like leafy green vegetables and lean meats can help avoid the frustrating yo-yo dieting effect that some restrictive plans can cause.
When it comes to exercise, recommendations vary. The Centers for Disease Control and Prevention suggests moderate-intense activity at least 30 minutes per day, five days per week. The Journal of Applied Physiology suggests 60 or more minutes of moderate-intense activity per day to maintain weight, a challenging commitment for people with time-consuming work or family responsibilities.
I usually recommend my bariatric surgery patients strive for 60 minutes of activity three days per week to start. It’s an easier exercise target to hit for a busy lifestyle and for obese patients with activity-limiting conditions like painful arthritis or respiratory illnesses.
Zapped energy, breathing problems, and aching joints caused by carrying extra pounds can make it difficult to achieve the level of activity needed to lose weight, trapping patients with obesity in a cycle of trying and failing, starting and stopping.
In those cases, diet and exercise alone might not be enough to break out of obesity.
Related reading: Is Your Diet SAD? See How Going Mediterranean Supports Heart Health.
2. Weight-loss medications.
Drug store products like gummies, liquids, and patches that advertise a special formula for weight loss without a prescription sound too good to be true because they are.
Think of it this way: Obesity isn’t usually caused by one thing alone, so one key ingredient probably isn’t going to be a miracle fix. None of the over-the-counter products are going to work like you might hope. You’ll probably end up wasting money on a gimmick.
Weight-loss medications that do work are evidence-backed, and doctor-prescribed. For example, GLP-1 receptor agonists injections, such as Ozempic® or Wegovy® help people lose weight by regulating blood sugars and appetite.
For people with a BMI in the overweight range of 25 to 30 with other conditions such as high cholesterol or diabetes, GLP-1 medication management may help stop obesity before it starts. On average, some people experience as much as 10% weight loss in six months with help from GLP-1 injections, making this a good option to explore for those who aren’t interested in surgery or for those with a BMI of 30+ who fall into a bariatric surgery qualification gap.
There are some downsides to consider, though:
- GLP-1 treatments are relatively new, so there isn’t data yet on long-term effects or how well weight loss is maintained post-medication.
- Some people can experience side effects like diarrhea or nausea—prescription weight loss might not be right for everyone.
- GLP-1 injections are often expensive, the American Pharmacists Association says sometimes they can cost as much as $1,200 per month for one dose with limited insurance coverage.
If you decide GLP-1 medication is the way to go after talking with your doctor, be sure to keep your diet and exercise routine on point along the way.
Related Reading: How GLP-1 RA Medications Can Help Manage Diabetes and Weight Loss.
3. Bariatric surgery.
For some people with a BMI of 40+ or a BMI of 35+ with medical challenges related to obesity, such as sleep apnea, high blood pressure, and diabetes, bariatric surgery may be a successful choice for managing obesity and its chronic health conditions.
Unlike a diet plan or medication, committing to any type of bariatric surgery—whether a lap-band, sleeve or gastric bypass—means altering the stomach and being ready for positive, and permanent, changes.
That level of commitment can feel a bit overwhelming sometimes. You’ll want to be sure you talk to your doctor about any concerns and remember that undergoing any kind of surgical procedure always comes with the possibility of risks.
It’s also important to understand that bariatric surgical processes and procedures have advanced tremendously, especially during the last 20 years.
- Bariatric surgeons must undergo an extra year of surgical training for this specialty.
- Bariatric surgery is often as safe or safer than a knee replacement or gallbladder surgery per the American Society for Metabolic and Bariatric Surgery.
- Most insurance will cover bariatric surgery for those who qualify.
- Reputable programs should be accredited, follow quality guidelines, and adhere to regulations that boost patient safety.
For those who are comfortable with the idea of surgery, it might seem as though bariatric procedures are an easy fix for obesity. However, patients put in a lot of work both before and after their procedure, from lab tests to learning a new way of eating and exercising.
Every bariatric program has a safety profile with a BMI limitation, meaning people with severe obesity can’t safely undergo surgery until they’re able to lower their BMI. This is when diet, exercise, and weight-loss medication may join forces to help a person lose weight.
The safety profile for our bariatric program at MedStar Washington Hospital Center includes a BMI of 80+. We put a multi-modal plan in place for those patients using a combination of diet, exercise and weight-loss medication management to help lower their BMI to the safe zone for surgery. Then, we implement strategies to continue treating their obesity after surgery as they continue to work toward their goal.
At the end of the day, bariatric surgery is a tool to help people live healthier, longer lives. And it’s possible that access to this treatment may soon be available for more people.
The American Society for Metabolic and Bariatric Surgery recently proposed new BMI guidelines that would help patients qualify for surgery sooner. That means more people would have the potential to avoid severe obesity and reverse chronic conditions like diabetes. Advocates are championing these new recommendations for Medicare approval, and physicians like me are hopeful they’ll be in place sooner rather than later.
Related reading: 5 Reasons to Consider Bariatric Weight Loss Surgery.
4. Endoscopic weight-loss procedures.
Non-surgical endoscopic procedures are on the horizon. They’re not covered by insurance today and are still being studied. In the future, they may offer less invasive opportunities to lower BMI or become another tool to help bridge any gaps in treatment. Examples of these procedures include:
- Gastric balloon: This procedure implants a temporary balloon inside the stomach to simulate the feeling of fullness, giving the patient time to implement diet and exercise changes.
- Sleeve gastroplasty: This procedure uses stitching to reduce the stomach’s volume, limiting how much it can hold and how long it takes to empty.
Our experts can help.
No matter which weight-loss tools you and your doctor decide would be the right ones, a healthy diet and exercise lifestyle are sure to be part of it. Obesity is a chronic disease with the potential to sneak back into your life without careful management. Our experts are here to support you on your journey to a healthy weight.