But now more than ever, there are weight loss solutions available to the public by medical professionals who offer safer and more sustainable programs and medications, said Houston Methodist Willowbrook Hospital’s Dr. Todd Worley, who is board-certified in surgery and obesity medicine.
Some examples include new bariatric surgical techniques and drugs previously used for managing diabetes, such as Wegovy, that help patients reduce food cravings to lose weight.
The overview
Worley said perhaps insurance companies loosening restrictions on nonsurgical treatment due to the cost of surgical procedures led to the expansion of the use of medication previously used to treat Type 2 diabetes.
In addition, factors that influence the treatment recommendations are based on what type of treatment the patient might qualify for under their insurance or financial capabilities.
What’s happening?
Worley said treatment is largely dependent on a patient’s BMI, or body mass index, which is a combination of height and weight. But those guidelines that help medical professionals decide which treatments are recommended have recently changed.
“Our recent guidelines ... throughout the bariatric surgery community have [been] lowered to try and make it more accessible. And in 2022, they lowered that [threshold for pharmaceutical options] too ... to try to have it be more accessible to more people and insurances,” Worley said. “And I think now there are something like 8,000 obesity specialists throughout the country ... who [do not] do surgery.”
What the experts say
In general, for patients with a BMI between 35-40 and a life-threatening comorbidity—medical conditions such as diabetes, high blood pressure, heart problems, sleep apnea or reflux disease—or a BMI greater than 40, the following options are recommended:
- Surgical weight-loss options
- Pre- and post-surgery programs
- Individuals with a BMI of 27 with one medical issue or one weight-related medical issue
- Individuals with a BMI of 30 without any medical issues
Explained
Like all diet and weight control measures, monitoring the patient's health is key, Worley said.
“There's more awareness of the issues that can arise too, and one of the things we've seen in surgery is when people are losing weight and eating less, we really have to be very careful about constantly monitoring their blood work, their electrolytes, their vitamins [and] their minerals because ... their appetite is often less, [and] sometimes they're not absorbing everything as well,” he said.
Worley said a patient’s gastrointestinal health is impacted by consuming less food and lower hydration rates, which can lead to low levels in electrolytes and minerals, and can affect the normal function of the body.
Long term, those deficiencies can result in the loss of muscle and bone mass, leading to conditions, such as sarcopenia and osteoporosis.
“The same things happen with these medicines—people are eating less, they're not as well hydrated,” he said. “You can't just take them and think 'OK, I'll lose the weight and nothing else could happen.’ Because if you're not eating as much, that also may mean you're not as well hydrated.”
The risks
The medications also have a lengthy half life and linger in the system for up to a month after discontinuation. Worley said this can cause complications if a patient were to experience side effects to the point that they need to stop using the treatment.
In addition, Worley said some wellness practitioners and compounding pharmacies do not follow the same formula as the original medications approved for weight loss treatment, and are offering versions of the drug that are not approved by the U.S. Food and Drug Administration.
What are the options?
For some, the need to lose weight is a medical necessity. For those in need of surgical options, Houston Methodist Hospital surgeons and other bariatric surgery hospitals offer the following:
- Sleeve gastrectomy
- Gastric bypass
- Single anastomosis duodenoileostomy with sleeve, or SADI-S
- Duodenal switch with biliopancreatic diversion
- Revisional bariatric surgery
For patients who are considering medication rather than surgery, Houston Methodist Hospitals and other medical groups offer programs that include:
- Moderate weight-loss programs that focus on healthy eating habits, lifestyle changes and increased physical activity
- Medically monitored programs that focus on achieving and maintaining a healthier weight through long-term accountability, support and education measures
- Phentermine
- Qsymia
- Contrave
- Saxenda
- Wegovy
- Zepbound
- Plenity
According to the Centers for Disease Control and Prevention, 35%-40% of Texans were obese in 2023.
The CDC calculations are based on the number of Texans with a BMI of 30 or higher.
