How To Choose the Best Weight-loss Option for You

Science keeps developing new ways for people to lose weight beyond diet and exercise, but how do you choose among the three major options — bariatric surgery, endoscopic procedures and GLP-1-based medications?

It depends.

Sum Up Your Medical Challenges

Before you choose a category of weight-loss treatment, look at several factors:

• How much weight do you need to lose? You’ll benefit from any aggressive weight-loss effort if your body mass index (BMI) is 30 or higher — the ideal is under 25. If your BMI is, say, 50, though, you’ll want the options that slash the most weight.
• Is your blood sugar high? If you have Type 2 diabetes, you’ll want to slim down enough to bring your blood sugar under control. Once you’re thinner, the diabetes might disappear completely, or you might need less medication to control it.
• What other medical issues do you have? In addition to your waistline and diabetes, look at hypertension, cholesterol levels, sleep apnea and other comorbidities — medical issues — before choosing a weight-loss method.

Understand the Three Major Weight-Loss Options

The next step is to learn what each of the three major categories entail.

• Bariatric surgery involves a surgeon rerouting the way food moves through your body. There are many types. All involve anesthesia and most require a short hospital stay and a lifelong vitamin-mineral supplement regime. Weight-loss surgery, as it is also known, has been around since the 1960s. Thanks to technical and safety advances, bariatric surgery is now the gold standard for weight loss procedures. Depending on the procedure, you’re likely to lose up to 70 percent of your excess weight and keep it off if you eat healthfully and move your body regularly. As in any surgical procedure, you have a small (1 percent) risk of error, infection and anesthesia problems.
• Endoscopic surgery is a less invasive route to weight loss. It involves a surgeon manipulating your stomach, but instead of incisions through your skin, the procedure is done by snaking a tube through your mouth and throat. You’ll be asleep as the surgeon sutures an organ or inserts a removable balloon. Endoscopic procedures result in a loss of close to 50 percent of excess body weight. The bulk might return, if eating and exercise habits haven’t changed, when procedures such as the balloon are reversed.
• GLP-1-based medications are injections or pills that will reduce your appetite. Developed for people with Type 2 diabetes, these medications have also become popular with overweight and obese patients, whether their blood sugar is elevated or not. You’re likely to lose up to 30 percent of your excess weight and keep it off if you keep taking the drug. You’ll need to change your food choices and workout habits permanently if you want to end your prescription and remain thinner. Occasionally these drugs can lead to pancreatitis or slower emptying of your stomach. Animal studies indicate they might be linked to thyroid cancer.

Let Statistics Guide You

Once you understand the three options and your health challenges, your medical team can crunch numbers for you. As an example, let’s say you have a BMI of 31 plus Type 2 diabetes. GLP-1-based medications will reduce your appetite to get you to a healthy weight and control the blood sugar. Endoscopic sleeve gastroplasty will make your stomach smaller, so you’ll eat less, but won’t remove the part of the stomach that has the so-called hunger hormone, which decreases appetite. Most bariatric surgeries make your stomach smaller and curb your appetite, plus are more likely to reduce hypertension and sleep apnea issues.

With those criteria, you could do well with any of these options. However, if your BMI is 45 or 50, even if you have no other medical conditions, surgery is the only way to lose all the weight. You can, however, drop up to 25 percent of your total body weight, or 50 percent of your excess body weight, if you combine endoscopy with medication, which approaches what you’ll lose with some bariatric surgeries.

No one size fits all. None of these solutions is magic. Work with your doctors to find the best combination for you specifically, asking for details about the risk and benefits of each choice, with statistics. You should receive answers such as, “25 percent of patients at your weight and height lose this much following such-and-such treatment.”