Is weight loss medication or surgery an option for you?

January 10, 2024

Providence Swedish Weight Loss Services

[5 MIN READ]

When diet and exercise don’t help you with long-term weight loss, you may find a solution with a medical weight-loss treatment.
Providence offers patients weight-loss medication, as well as gastric bypass and sleeve gastrectomy procedures.
Medical weight loss can help decrease depression and anxiety, and improve many other aspects of health.

Obesity continues to be a major problem across the United States. In Washington state alone, around 25%-30% of people consider themselves obese, which puts them at increased risk for coronary heart disease, stroke, Type 2 diabetes, many types of cancer and other health concerns.

If you are struggling with your body weight, you may feel frustrated or like you’ve failed in some way. “We tell patients this is not a character or moral failing,” said Anirban Gupta, M.D., medical director for bariatric surgery at Providence Swedish.

There’s no need for shame or blame. The odds are already stacked against you, with technology delivering your work and food via apps, making it easier to eat more and move less. “It’s harder to stay healthy,” Dr. Gupta said — and doing so involves serious effort.

Dr. Gupta said many patients who come to him for help already have significant weight-related medical problems such as sleep apnea, diabetes, high blood pressure, nonalcoholic fatty liver disease, arthritis or acid reflux. Some of them need to lose weight before qualifying for an organ transplant or joint replacement surgery.

It’s important for providers to consider a wide variety of options to help their patients. “Weight loss requires a multifaceted approach, not a single solution,” Dr. Gupta said.

The individual approach

Medical weight-loss treatment has changed significantly over the past few years. For example, drug companies have released a new class of more effective anti-obesity medication, said Enrica Basilico, M.D., medical director at Providence Swedish Weight Loss Services.

In the past, medication might have helped a person lose 10% of their total weight — for example, someone who is 200 pounds might lose 20 pounds. Today, the average medication-related loss is around 15%. But some people can lose up to 20% to 30% if the medication is part of a complete strategy.

At Providence Swedish Weight Loss Services, an intake clinician collects your medical, social and weight history, including what you have tried so far to lose or stabilize weight. Providers work with you to create an individual, evidence-based treatment plan that could include a new eating plan, weight-loss drugs or bariatric surgery.

For nutrition and physical activity, the weight loss center offers resources and interactive classes based on nutrition basics, meal planning and convenience. “We all have busy jobs and lives and might not be three-star chefs, but we can help people find convenient and healthy foods,” Dr. Basilico said.

Patients who maintain their weight loss journey best do so by monitoring their health and following up with their providers or the clinic. Some patients may be a better fit for bariatric surgery, said Dr. Gupta — particularly those with a body mass index (BMI) of at least 40, or a BMI of 35 and significant weight-related medical problems. At around 12 months after surgery, he said, most patients have lost 25% to 37% of their total weight.

Bariatric and metabolic surgery can be performed with a sleeve gastrectomy, which reduces stomach size and decreases hunger, or a gastric bypass, which creates a small pouch to restrict food intake.

“We use evidence and shared decision-making to match the right patient to the right procedure,” Dr. Gupta said. For example, someone experiencing significant acid reflux may be a better candidate for gastric bypass, as the sleeve can make reflux worse.

When determining if a surgical approach is the right choice, a multidisciplinary team considers whether the patient is ready on a psychological level. “This is not a quick fix,” Dr. Gupta warned — and is the best fit for highly motivated patients ready for a transformative change.

Successful, safe bariatric surgery requires that a person follows instructions regarding vitamins, diets and follow-up care. “Major lifestyle changes have to be made first,” Dr. Gupta said.

Medical weight loss and bariatric surgery can even be combined to increase weight loss after surgery or help patients maintain a healthy lifestyle. For example, bariatric surgery can improve health and longevity for some patients — but their weight might put them at greater risks for surgery complications. “Medication can become a bridge to surgery, by decreasing weight pre-operation,” Dr. Gupta said.

How medical weight loss can help

Both surgery and medications seem to lessen the secretion of the hunger hormone ghrelin, leading to double-digit weight loss percentages. “Habits and interventions related to diet, exercise, sleep and mental health can be stacked for optimal success,” Dr. Gupta said. For example, patients can meet with a dietitian and psychologist to address underlying issues. This holistic approach can be life-changing.

The results are impressive. “Studies show that depression and anxiety significantly decrease in this patient population post-metabolic surgery,” Dr. Gupta said. “The quality of life improves, along with other health metrics and mortality, and other medical conditions improve.” Some patients can stop taking daily medications.

For Dr. Basilico, the reward of patient joy is a worthwhile endeavor. “Often, people say they’re motivated to lose weight by wanting to get on the floor with grandkids to play or participate in activities they used to enjoy, but are now restricted by mobility or joint pain,” she said. “I love to see people feeling healthier, becoming more active, where managing their weight isn’t in the forefront of their mind.”

Contributing caregivers

Anirban Gupta, M.D., medical director for bariatric surgery at Providence Swedish

Enrica Basilico, M.D., medical director at Providence Swedish Weight Loss Services

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