Bariatric surgery continues to play a major role in obesity management despite the emergence of potent new weight-loss medications, according to two experts who spoke at an Endocrine Society science writers briefing.
“Bariatric surgery is safe, effective, and unfortunately underutilized for treating obesity and its complications,” said Jaime Almandoz, MD, medical director of the Weight Wellness Program at the University of Texas Southwestern Medical Center, Dallas.
Added Almandoz, who is triple board-certified in internal medicine, endocrinology, and obesity medicine, “Sometimes this gets presented in a linear fashion. ‘We’ll try lifestyle first and if that doesn’t work, we’ll try medications and if that doesn’t work, we’ll try surgery.’ But sometimes we might need to go straight to surgery instead of going through medications first, because it may be the most effective and evidence-based treatment for the person in the office in front of you.”
Moreover, he pointed out that currently, Medicare and many private insurers don’t cover antiobesity medications but do cover bariatric surgery.
Indeed, Srividya Kidambi, MD, professor and chief of endocrinology and molecular medicine at the Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, said there are certain types of patients for whom she might consider bariatric surgery first. One would be a person with a body mass index (BMI) greater than 40 kg/m2 or with a BMI greater than 35 kg/m2 and severe comorbidities.
Another, she said, would be young, relatively healthy people with obesity who have no comorbid conditions. “We know that if we stop the medication, the weight comes back. So, if I see a 20- to 25-year-old, am I really to commit them to lifelong therapy, or is bariatric surgery a better option in these cases? These drugs have not been around that long…so I tend to recommend bariatric surgery in some patients.”
During the recent briefing, Almandoz summarized the evidence base for the benefits of bariatric surgery beyond weight loss, which include remission of type 2 diabetes and fatty liver disease, reduction of the risks of cardiovascular disease and cancer, and increased life expectancy.
“Everyone seems to be talking about GLP-1s for facilitating weight loss and treating obesity…. What I want to do is provide a counterpoint to accessible therapies that are covered by more insurance plans and that may, in fact, have a better evidence base for treating obesity and its related complications,” he said in his introduction.
Bariatric surgery has been used for decades, and many centers of excellence perform it, with greatly reduced complication rates seen today than in the past. “It’s comparable to having a gallbladder surgery in terms of perioperative risk,” he noted.
Medicare and private insurers generally cover bariatric surgery for people with BMI greater than 40 kg/m2 or 35–39 kg/m2 and at least one weight-related comorbidity, including type 2 diabetes, obstructive sleep apnea, hypertension, atherosclerotic disease, hyperlipidemia, and fatty liver disease.
Data suggest that weight reduction of about 3% can lead to meaningful reductions in blood glucose and triglyceride levels, but weight loss of 15% or greater is associated with reductions in cardiovascular events and type 2 diabetes remission. Lifestyle modification typically produces about 5% weight loss, compared to 20% to 35% with bariatric surgery with sleeve gastrectomy or gastric bypass.
Older weight loss medications produced weight loss of 5% to 10%; only the newer medications, semaglutide 2.4 mg and tirzepatide, come close to that. Weight loss with semaglutide is about 15%, while tirzepatide can produce weight loss of up to 22%. But, there are still issues with affordability, access, and lack of coverage, Almandoz noted.
One recent randomized trial of more than 400 individuals showed that bariatric surgery was more effective than lifestyle and medical therapies for treating metabolic-associated steatohepatitis (MASH) without worsening of fibrosis.
Another showed that the surgery was associated with fewer major adverse liver outcomes among people who already had MASH. That same study showed a 70% reduction in cardiovascular events with bariatric surgery.
For patients with type 2 diabetes, numerous trials have demonstrated long-term remission and reduced A1c at 5 years and 10 years post surgery, along with reductions in microvascular and macrovascular complications.
Other data suggest that a shorter history of type 2 diabetes is among the factors predicting remission with bariatric surgery. “Oftentimes, both patients and providers will wait until the diabetes is quite advanced before they even have the conversation about weight loss or even bariatric surgery. This suggests that if we intervene earlier in the course of disease, when it is less severe and less advanced, we have a higher rate of causing remission in the diabetes,” Almandoz said.
The American Diabetes Association’s Standards of Care incorporate bariatric surgery as either “recommended” or “may be considered” to treat type 2 diabetes, depending on BMI level, for those who don’t achieve durable weight loss with nonsurgical methods, he noted.
A retrospective cohort study showed significant reductions in cardiovascular outcomes with bariatric surgery among people with baseline cardiovascular disease. “This is not just about bariatric surgery to cause weight loss. This is about the multitude of effects that happen when we treat obesity as a disease with highly effective therapies such as surgery,” he said.
Even cancer risk and cancer-related mortality were significantly reduced with bariatric surgery, another study found.
And in the long-term Swedish Obese Subjects Study, among people with obesity, bariatric surgery was associated with a 3-year increase in life expectancy compared with not undergoing surgery.
However, Almandoz also pointed out that some patients may benefit from both weight-loss medication and bariatric surgery. “Once someone has undergone pharmacotherapy, there may still be a role for bariatric procedures in helping to optimize body weight and control body weight long term. And likewise for those who have undergone bariatric surgery, there’s also a role for pharmacotherapy in terms of treating insufficient weight loss or weight recurrence after bariatric surgery…. So I think there’s clearly a role for integration of therapies.”
Almandoz serves as consultant/advisory board member for Novo Nordisk, Boehringer Ingelheim, and Eli Lilly. Kidambi is director of TOPS Center for Metabolic Research Supported by TOPS Inc and is medical editor of TOPS Magazine, for which her institution receives an honorarium.
Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She is on X (formerly Twitter) @MiriamETucker.
When it comes to losing weight, many people turn to short-term methods that do not work or are very costly. Before looking into any quick fix solutions for weight loss, consider weight loss surgery as an option; it’s a more effective way to achieve your goals. With the right amount of research and guidance from an experienced medical team, you can find a solution that works best for you.
Many people waste time and money trying ineffective methods to lose weight. These methods may include crash diets or expensive supplements that promise quick results but fail to deliver. Not only are these methods often ineffective in the long run, but they can also be costly and take up valuable time that could be better spent on healthier activities. Additionally, some of these products may even contain unhealthy ingredients or have side effects that can be harmful to your health in the long run.
Weight loss surgery offers the most effective long-term solution for those who struggle with obesity-related health issues or have had difficulty losing weight through diet and exercise alone. The Nicholson Clinic for Weight Loss Surgery provides comprehensive care for patients considering any type of weight loss surgery with experienced surgeons who specialize in bariatric surgery procedures such as gastric bypass, gastric sleeve, duodenal switch, and revision surgeries for patients who have had previous unsuccessful bariatric surgeries The clinic offers individualized care plans tailored to each patient’s unique needs including pre-operative evaluations and post-operative follow-up care with nutritionists who provide education on healthy eating habits after surgery. The Nicholson Clinic also offers support groups where patients can connect with others who have undergone similar procedures.
Weight loss surgery should not be a last resort; it should be considered prior to spending money on ineffective, short-term solutions. With proper research into available options such as gastric bypass, gastric sleeve, duodenal switch, or revision surgeries, you may find a solution that works best for you. Experienced medical teams such as those at Nicholson Clinic for Weight Loss Surgery provide comprehensive care throughout your journey towards improving your health.
About Nicholson Clinic
One of the most experienced weight loss surgeons in the country – Dr. Nick Nicholson – along with a full staff of surgeons, physician assistants, and other experienced clinicians, help patients reverse obesity with Sleeve Gastrectomy, Gastric Bypass, Duodenal Switch, Gastric Balloon, LAP-BAND removal and Revisions.
Ten years ago, Mandy had gastric sleeve surgery. After experiencing weight regain, she made the decision to have sleeve-to-bypass revision surgery with Dr. Long. She has already lost 111 pounds in 4 1/2 months. This is her story.
Life Before Surgery
Managing our weight is directly tied to how we manage our emotions around food. If you’re in a bad relationship with stress eating, we’ve got six tips to help you break the cycle.
Cool off in the summer heat with this crisp and refreshing snack. This tasty recipe also makes a great side dish for your next cookout!
La cirugía bariátrica es una forma segura y efectiva de lograr una pérdida de peso significativa y sostenida. Ha existido durante muchos años, y actualmente es la solución más efectiva y probada a largo plazo para una pérdida de peso significativa. Si está considerando la cirugía bariátrica, es posible que se pregunte si es la opción correcta para usted.
Los médicos consideran el índice de masa corporal (IMC) y otras enfermedades relacionadas con la obesidad (comorbilidades) como un criterio importante para determinar si la cirugía de pérdida de peso es una opción adecuada o no. En términos generales, la cirugía bariátrica se considera apropiada para personas con un IMC mayor de 40 o con un IMC mayor de 35 y una o más comorbilidades relacionadas con la obesidad. En ciertas circunstancias, los pacientes con un IMC más bajo, 30-34.9, también pueden ser candidatos adecuados.
La cirugía de pérdida de peso puede iniciar su camino hacia una vida más saludable, más larga y más satisfactoria. En muchos casos, los pacientes pueden experimentar los beneficios inmediatamente después de la cirugía. Ejemplos de beneficios comunes de la cirugía bariátrica son:
- Reducción del 89% en la mortalidad a 5 años
- 82% de remisión de la diabetes tipo
- 82% el asma mejoró o se resolvió
- 82% de reducción del riesgo de enfermedades cardiovasculares
- 72%-98% de alivio de la apnea del sueño
¿Cirugía de pérdida de peso o medicamentos para bajar de peso?
Es un momento emocionante en el campo de la pérdida de peso con nuevos medicamentos para perder peso disponibles para el público. Sin embargo, los medicamentos para bajar de peso pueden costar a los pacientes más de USD $ 1,000 al mes y vienen con resultados mixtos de pérdida de peso y efectos secundarios. Costos comunes asociados con estas dos opciones, respectivamente:
- USD $1,000 mensual* Medicamentos para bajar de peso – 15-17% Promedio de pérdida de peso corporal total con Wegovy
- USD $10,000 Total* Manga gástrica – 32% Pérdida promedio de peso corporal total con cirugía bariátrica
En Nicholson Clinic for Weight Loss Surgery, entendemos que decidir si la cirugía bariátrica es adecuada para usted puede ser abrumador. Al final, depende de usted decidir qué se adapta mejor a sus necesidades y condiciones, por lo que le recomendamos programar una consulta para discutir todas las opciones posibles para ayudarlo a tomar una decisión informada sobre su salud. ¡Nuestro personal está dedicado a caminar con usted en cada paso del camino y ayudarlo a lograr un éxito sostenible! ¡Contáctenos hoy!
1 Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004; 240:416–423; discussion 423–424. 2 Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232:515–529. 3 DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002; 235:640–645; discussion 645–647 4 https://eu.usatoday.com/story/news/health/2023/02/19/anti-obesity-medications-cost/11069886002/ 5 Villela R, Correa R. 2019. Semaglutide 2.4 Mg (2022): The Latest GLP-1RA Approved for Obesity. Journal of Investigative Medicine 6 Rijswijk AS, et al, 2021. What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review
Bariatric surgery is a safe and effective way to achieve significant and sustained weight loss. It has been around for many years, and is currently the most effective, proven long term solution for significant weight loss. If you’re considering bariatric surgery, you may be wondering if it’s the right choice for you.
Doctors look at Body Mass Index (BMI) and other obesity-related diseases (comorbidities) as an important criteria to determine whether weight loss surgery is a suitable option or not. Generally speaking, bariatric surgery is considered appropriate for people with a BMI greater than 40 or with a BMI greater than 35 and one or more obesity-related comorbidity. In certain circumstances, patients with a lower BMI, 30-34.9, may also be suitable candidates.
Weight loss surgery can kick-start your path to a healthier, longer, and more fulfilling life. Patients can in many cases experience the benefits immediately after surgery. Examples of common benefits from bariatric surgery are:
- 89% Reduction In 5-year Mortality
- 82% Type 2 Diabetes Remission
- 82% Asthma Improved or Resolved
- 82% Cardiovascular Diseases Risk Reduction
- 72%-98% Sleep Apnea Relief
Weight loss surgery or weight loss medication?
It is an exciting time in the weight loss field with new weight loss medication available to the public. However, weight loss medication can cost patients more than USD $1,000 a month and comes with mixed weight loss results and side effects. Common costs associated with these two options respectively:
- USD $1,000 Monthly* Weight Loss Meds – 15-17% Average total body weight loss with Wegovy
- USD $10,000 Total* Gastric Sleeve – 32% Average total body weight loss with bariatric surgery
At Nicholson Clinic for Weight Loss Surgery, we understand that deciding whether bariatric surgery is right for you can be overwhelming. In the end, it is up to you to decide what suits your needs and conditions best, so we recommend scheduling a consultation to discuss all possible options to help you make an informed decision about your health. Our staff are dedicated to walking with you each step of the way and helping you achieve sustainable success! Contact us today!
1 Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004; 240:416–423; discussion 423–424. 2 Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232:515–529. 3 DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002; 235:640–645; discussion 645–647 4 https://eu.usatoday.com/story/news/health/2023/02/19/anti-obesity-medications-cost/11069886002/ 5 Villela R, Correa R. 2019. Semaglutide 2.4 Mg (2022): The Latest GLP-1RA Approved for Obesity. Journal of Investigative Medicine 6 Rijswijk AS, et al, 2021. What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review
Cool off in the summer heat with this crisp and refreshing snack. This tasty recipe also makes a great side dish for your next cookout!
Tzatziki Greek Yogurt and Cucumber Sauce
Serving size: 1 cup, makes 8-9 servings
Ingredients:
3 cups fat-free plain Greek yogurt
3 Tbsp lemon juice
1 garlic clove, chopped
2 medium cucumbers, peeled, seeded & diced
1 Tbsp salt
1 Tbsp finely chopped dill
Salt & pepper to taste
Directions:
1. Peel cucumbers and cut in half lengthwise. Take a small spoon and scrape out and discard the seeds.
2. Dice cucumbers and put them in a colander with 1 Tbsp salt. Let stand for 30 minutes to draw out the water. Drain well and wipe dry cucumber pieces with paper towel.
3. In a food processor with a steel blade, add cucumbers, garlic, lemon juice, dill, and a few grinds of black pepper. Process until well blended.
4. Stir the mixture into the yogurt. Taste before adding any extra salt, then salt if needed.
5. Place in refrigerator for at least two hours before serving so flavors can blend. Drain off any excess water and stir before serving.
Enjoy with fresh cut veggies or warm pita bread!
Refréscate en el calor del verano con este refrigerio crujiente y refrescante. ¡Esta sabrosa receta también es una excelente guarnición para su próxima comida al aire libre!
Salsa de pepino y yogur griego Tzatziki
Tamaño de la porción: 1 taza, hace 8-9 porciones
Ingredientes:
- 3 tazas de yogur griego natural sin grasa
- 3 cucharadas de jugo de limón
- 1 diente de ajo, picado
- 2 pepinos medianos, pelados, sin semillas y cortados en cubitos
- 1 cucharada de sal
- 1 cucharada de eneldo finamente picado
- Sal y pimienta al gusto
Direcciones:
- Pela los pepinos y córtalos por la mitad a lo largo. Tome una cuchara pequeña y raspe y deseche las semillas.
- Corte los pepinos en dados y póngalos en un colador con 1 cucharada de sal. Deje reposar durante 30 minutos para extraer el agua. Escurra bien y limpie los trozos de pepino secos con una toalla de papel.
- En un procesador de alimentos con cuchilla de acero, agregue los pepinos, el ajo, el jugo de limón, el eneldo y un poco de pimienta negra molida. Procese hasta que esté bien mezclado.
- Revuelva la mezcla en el yogur. Pruebe antes de agregar sal adicional, luego sal si es necesario.
- Coloque en el refrigerador durante al menos dos horas antes de servir para que los sabores se mezclen. Escurra el exceso de agua y revuelva antes de servir.
¡Disfrútelo con vegetales recién cortados o pan de pita caliente!
Cuando la vida se vuelve estresante, ¿recurres a comer para sobrellevar la situación? Comer por estrés es una lucha común entre nuestros pacientes, e incluso hay una explicación biológica para su incapacidad para controlar su apetito cuando está estresado.
Cuando experimentamos estrés, nuestros cuerpos liberan las hormonas adrenalina y cortisol en un intento de lidiar con ese estrés. Los niveles de adrenalina vuelven rápidamente a la normalidad, pero los niveles de cortisol pueden tardar más en normalizarse después de la liberación de esta hormona. Desafortunadamente, el cortisol también es un estimulante del apetito.
¿Cuál es la relación entre el cortisol y el hambre? El cortisol estimula el metabolismo de los carbohidratos y las grasas. A su vez, la insulina se libera en el cuerpo. El aumento de los niveles de insulina estimula el hambre, que se satisface fácilmente con alimentos con alto contenido de grasa, azúcar y almidón.
Si comer (especialmente alimentos poco saludables) es su respuesta al estrés, el aumento de peso es inevitable. La buena noticia es que se puede prevenir el aumento de peso relacionado con el estrés. Estos son algunos consejos para hacer frente a su estrés de una manera saludable.
1. Ejercicio. Cuando haces ejercicio, tu cuerpo libera hormonas para “sentirte bien” llamadas endorfinas. Las endorfinas reducen los niveles de cortisol y ayudan a reducir el estrés. Dedique al menos 30 minutos al día a hacer ejercicio para ayudar a combatir el estrés. Cuando el tiempo lo permita, haga ejercicio al aire libre para tomar aire fresco y equilibrarse.
2. Elimina las tentaciones. Mantenga su refrigerador y alacenas abastecidos con alimentos saludables, como frutas, verduras, nueces y fuentes saludables de proteínas. Las galletas, las papas fritas y otros alimentos chatarra con alto contenido de grasas, calorías y azúcar solo lo tentarán en momentos de estrés.
3. Medita. Aquieta tu mente y respira profundamente. Las investigaciones muestran que respirar profundamente con el diafragma y reducir la respiración a cinco respiraciones por minuto afecta el nervio vago, que controla la frecuencia cardíaca, la función intestinal, los patrones mentales, el estado de ánimo, el asma y más.
4. Encuentra un pasatiempo. Aprovecha tus talentos. ¿Cuáles son las actividades que te equilibran y te hacen feliz? Tal vez sea pintura, jardinería, lectura o baile. Sea lo que sea, haz tiempo para disfrutar de tus pasatiempos.
5. Pasa tiempo de calidad con tus seres queridos. No hay mejor manera de relajarse y desestresarse que pasar tiempo con las personas que amas. Pase más tiempo con aquellos que llenan su taza con sentimientos positivos, en lugar de personas cuya negatividad es un drenaje para sus emociones.
6. Deténgase y piense antes de comer. Antes de comer, tómate un momento para preguntarte, ¿esta comida me hará sentir mejor? Sopesa las consecuencias positivas y negativas de lo que estás a punto de comer. Si es algo de lo que te arrepentirás, devuélvelo y elige un refrigerio más saludable, o elimina el estrés con una de las tácticas anteriores.
