Struggling with weight loss? Here's what to know about medical and surgical options
When lifestyle changes like diet and exercise are not enough to reach and maintain a healthy body weight, medication or surgical procedures are available to help treat obesity and related health conditions, like infertility, high blood pressure, and heart disease.
You have choices of different medications and bariatric procedures for weight loss. M Health Fairview is also one of just a few health systems nationwide that offer endoscopic sleeve gastroplasty, a minimally invasive procedure that reduces the size of the stomach, so people feel satisfied with less food.
Recommendations vary, but weight loss procedures and medications may be generally recommended if you have a body-mass index (BMI) above 30. Sometimes treatments are considered with a lower BMI if you also have a health condition that might be improved with weight loss, such as type 2 diabetes, high-blood pressure, heart disease, cancer, or need an organ transplant.
Ahmed Dirweesh MD, DABOM, director of bariatric endoscopy with M Health Fairview and an assistant professor at the University of Minnesota Medical School, explains the pros and cons of several weight-loss treatment options. In addition, our Surgery and Weight Management program offers tailored lifestyle recommendations for weight loss from diet and exercise experts.
Endoscopic weight-loss procedures
Endoscopic procedures are performed without surgery. Instead, a flexible tube is inserted through the mouth, allowing doctors to modify the stomach from the inside. These techniques often result in:
- Lower risk of complications
- Faster recovery times
- No incisions and no scarring
- Same-day or next-day discharge
“Endoscopic treatments are a powerful option for people with a BMI over 30, especially when other medical conditions are also present,” Dirweesh said.
Endoscopic sleeve gastroplasty is a procedure that involves putting sutures in the stomach to reduce its size by 70 to 80%. No tissue is removed, so the procedure can be easily reversed by removing the sutures. Nutrients are absorbed normally, so malnutrition isn’t a concern, Dirweesh said. It usually leads to 15 to 23% weight loss. People tend to maintain weight loss for up to 10 years. The stomach can stretch over time, but the procedure can be repeated.
The procedure is done endoscopically, which involves inserting a tool on a long flexible tube down the throat. The sutures are placed from inside the stomach, so you won’t have a scar. Another advantage is that patients recover faster than they do with other procedures, Dirweesh said. The procedure is done under anesthesia in less than two hours. You can go home the same day or the next day – and can go back to work in about three days. The procedure can also be paired with GLP-1 agonist medications for additional weight loss, Dirweesh said.
Transoral outlet reduction is a procedure for people who have regained weight after stomach-reduction procedures. A surgeon reduces the size of the stomach opening to the small intestine. That helps slow the digestion process, which helps you feel satisfied longer. It’s an endoscopic outpatient procedure, which means the incision is small and patients can go home the same day. Dirweesh said the procedure usually leads to a 10% reduction in body weight and can be done again if needed.
Gastric balloons are placed in the stomach to help fill the space for a limited amount of time. Doctors insert them through the throat then fill them with saline through a tube, so there is no surgery involved. The balloons last about six months, then are drained and removed. You can expect to lose about 10% of your excess body weight. You will need to take acid blocker medication while the balloon is in place. Some people feel discomfort.
Weight-loss surgeries
Weight-loss procedures limit how much the stomach can hold and how fast it empties. Here are some examples.
Roux-en-Y is a minimally invasive gastric bypass procedure that involves creating a small stomach pouch and bypassing part of the small intestine in the digestion process. After the procedure, the stomach can only hold about an ounce of food at a time. Studies show that people lose up to 70% of their excess body weight after the procedure.
Recovery can take several weeks. Then you will need to work with a dietitian to ensure you are getting the nutrition you need. A healthy diet and exercise are recommended because weight regain is common. Another complication is called dumping syndrome, which is diarrhea that occurs when food moves through digestive system too quickly.
Gastric sleeve surgery is a minimally invasive procedure that removes most of the stomach, leaving just a narrow stomach like a sleeve. Recovery can take about a month. You can expect to lose up to 60% of excess body weight five years after the procedure.
Like the Roux-en-Y procedure, possible complications of gastric sleeve surgery include malnutrition, acid reflux, and gallstones. The stomach can stretch over time after the surgery, which can reduce the effects of the procedure, so diet and exercise are recommended.
Weight-loss medications
GLP-1 agonist medications, like Ozempic and Wegovy, are very effective at weight loss, Dirweesh said. The medication mimics your body’s natural hormones to help manage blood sugar levels, slow stomach emptying, and keep you feeling satisfied after eating less.
Downsides of the medication include side effects, like nausea, fast heart rate, and dizziness. The medication can also be expensive and difficult to get. Most people find that they must keep taking it for life to prevent weight regain.
Weight-loss experts at M Health Fairview offer a personalized approach to weight loss. The team will help you understand your options, so you can choose the best solution based on your health, goals, and lifestyle. Learn more about weight management care and procedures at M Health Fairview locations or call 612-273-2959.
