Dear Jenn,

I have battled with weight ever since adolescence. When I stopped growing, I started gaining weight. When I got married, I was the thinnest I had been in years but worked hard to get there. During and after having three children my weight just kept going up. I ignored it. Recently, at a doctor’s appointment, my blood pressure and blood sugar were elevated. My physician recommended weight loss and put me on medications to help control my new diagnoses. I have about 65 pounds to lose and it seems like an awesome amount to take off. I was thinking of the possibility of having bariatric surgery. A friend of mine had great success with a bariatric procedure and raves about it. From my understanding, with bariatric surgery, blood sugar stabilizes immediately, and the results are permanent. My thought is that I’m scared to have the surgery and therefore hesitant. Another thought is to start weight loss medication but again, I’m concerned about long-term repercussions and side effects. So here I am, writing to you about my conundrum. What’s your opinion? I feel overwhelmed.

Sincerely,

Perplexed about weight loss options

Dear Perplexed about weight loss options,

Having two new medical diagnoses can be stressful. Over the years, you ignored weight gain, your health and well-being. Having children, family responsibilities and even working can make it difficult to focus on ourselves. You had a scary wake-up call at your doctor’s appointment. Sixty-five pounds is a considerable amount of weight to lose but can be done … let’s explore.

General Information

In terms of deciding to have bariatric surgery or take weight loss medication, note that both are tools to help weight loss but are not cures for obesity. That’s important for you to understand going forward with any decision.

Obesity is a chronic disease that requires on-going effort and permanent lifestyle changes.

Bariatric Surgery: Pros and Cons

Many patients I treat have had bariatric surgical procedures but failed to keep the weight off in the long run. Bariatric surgery cuts down on your appetite for various reasons. For example, in laparoscopic sleeve gastrectomy the stomach is reduced in size. Reducing the size of the stomach reduces the amount of food that can be consumed at one time. Also, with the reduction of the gut, levels of the stomach hormone ghrelin. “the hunger hormone,” is also reduced and that discourages appetite.

On the other hand, the hormone GLP1 (glucagon-like peptide 1), is enhanced after gastric bypass surgery. This hormone reduces appetite and regulates glucose metabolism. That is a good recipe for reducing blood glucose and weight. Leptin, a hormone derived from the adipose tissue (fat tissues) and the small intestine, regulates energy and suppresses hunger. This reduces the amount of fat in adipocytes (fat cells). There are studies claiming Leptin increases after bariatric surgery, although certain individuals are “Leptin-resistant.”

So, why the bariatric failure? Because after bariatric surgery and recovery, the person did not follow the new and “forever” bariatric diet. There are dietary protocols that must be followed for success with bariatric surgery. Also, there are life-altering behaviors that must be made, such as regular exercise. Eating high-calorie nutrient-deficient food selections will lead to weight gain, deficiencies, and poor quality health. Bariatric surgery is only a tool.

Weight Loss Medication: Pros and Cons

Dr. Jeffrey Berman and I practice together treating people who need to lose weight due to serious health problems as well as to improve overall wellness and appearance. Some individuals who come to me for weight loss assistance do not wish to use medications. They do well if they remain committed to the principles and practices we recommend. Others seek medication assisted treatment. The weight loss medications that we recommend reduce appetite. They do not alter your metabolism or cure you of obesity. Weight loss medication is a tool to lose some weight rapidly and jump start the longer-term weight loss process.

In our practice, Nutrition Transformations, when a client is placed on weight loss medication, use of medication is the easy part of the process, as it reduces hunger. However, more importantly, the ability to have long-term success is determined by the ongoing lifestyle adjustments and dietary habits that must be followed each day. If you want to reach a desirable body weight range and have a normal BMI (body mass index), you must be willing to work with me. I will help you learn to live and eat well for good health, well-being, and weight control. There are no shortcuts or quick fixes for this problem.

So why the weight loss medication failure? There are reasons for failure on weight loss medication. First, if a person is not losing weight on a particular medication another medication might be more effective. Second, the dosage of weight loss medications often need to be adjusted. Third, plateaus can occur in any weight loss effort; but to break the plateau involves more than medication. Lastly, losing weight with medication alone will not produce long-lasting results.

Note: Long-term effects of weight loss medications are being studied. The medications currently available are FDA approved. Studies have shown positive effects on blood sugar regulation, HgbA1C (how well blood sugar is being controlled) and weight loss.

Unless behaviors that resulted in weight and health problems are not permanently changed, there will be no success. Working with a certified dietician can help you learn many things, such as how to make healthy food choices, understand portion control, and become calorie aware. You will also learn how to prepare non-fattening meals and the importance of regular exercise and its effect on metabolism.

“Perplexed about weight loss options”: Whatever route you decide to take regarding weight loss, remember that the behaviors that got you 65 pounds overweight with elevated blood sugar and blood pressure need to be adjusted. Surgery and medications can help, but you need to learn to take better care of yourself. By the way, taking diabetes and blood pressure medications works best when it is coordinated with diet and exercise … I wish you the best of luck!

For further information, visit www.nu-transform.com  or call (718) 644-1387.

By Jennifer B. Chapler, MS RD CDN