At New You, we approach the practice of weight management with an individualized approach. We know that there is no one-size-fits-all plan that will work for every person. We ask a lot of questions and gather a lot of information from our patients to help find the right path for them. There are a multitude of factors we consider like weight history, previous attempts at weight loss, medical conditions or medications that impact weight, emotional and mental health, available resources, among others.
Some patients know what they want and have a plan of action already started. Other patients may feel less sure because they lack the information that they need to make the choice that’s just right for them. Here is what you should be considering when making these important decisions.
“What’s the most important part of successful weight loss?”
Patients ask this question all the time, and the answer I always give is, “Consistency – finding what you can stick to, and stick to it!”
Any person who has tried to lose weight on their own has likely tried some diet and/or exercise plan they found online or that a friend suggested. They try it for a while, follow it religiously, and when it doesn’t work for them, they blame themselves, get frustrated and quit. This can be a repeated cycle that makes weight loss more difficult with each effort. People who try to lose weight on their own find that restricting their intake TOO much for TOO long, as many do who are desperate to lose weight, their body will respond by slowing down metabolism to conserve energy. This is what the human body is designed and programmed to do, and it’s called metabolic adaptation. This is the primary reason that a person cannot starve their body to a healthy weight. Each person should take time and effort to find that consistency and figure out their “sweet spot” for weight loss – the right balance of a lot of elements including nutrition, fluid, activity, sleep, stress, health and more.
The professional providers at New You are very experienced in assessing every aspect of each patient to develop the right plan for them. There is some trial and error in this process which requires a lot of patience, so it’s another reason that a single plan cannot exist that would meet everyone’s needs. It must be an individualized approach, and this is how we manage our patients.
“What’s the best way to lose weight – surgery or medications?”
So, the answer to this question is both simple and complex. In simple terms, the best way to lose weight is the one that’s right for you. This becomes a complex question when trying to figure out what that “sweet spot” is for you to lose weight. The best method is likely a combination of several means of reaching the end goal.
Some people have success losing weight on their own by increasing their physical activity and adjusting their nutrition. If the person doesn’t have a complicated metabolic condition, these lifestyle modifications may be enough to get results, so they wouldn’t need a medical intervention.
Other patients who DO have other medical conditions or other factors affecting their ability to lose weight will benefit from a medical intervention to get results from their efforts. This might include prescription medications, supplements, metabolic surgery, exercise plans, and in MOST cases, a person will need more than one method to successfully treat and reverse obesity.
“Is it normal for patients to use BOTH surgery and medications?’”
It is a common myth that patients MUST choose one or the other! The fact is that a majority of patients require more than one method simply because obesity is a very complex disease. It does not mean that person is weak-willed or flawed, and this is a stigma we at New You are working hard to overcome. For instance, some patients may start weight loss medications and find that they don’t lose enough weight, or they cannot tolerate the medications, so then they pursue surgery. Many surgical patients need medications after surgery to help get them to their final goal weight or to address some re-gain at some point after surgery. Some patients might need surgery but will be required to lose weight beforehand for safety reasons, so anti-obesity medications may be used prior to a surgical procedure to get the weight loss momentum going.
New You’s services include both surgical and non-surgical options, so no matter what your path, our providers are here to guide you on it. The primary goal is the same – to attain and sustain a healthy weight – so the way you get there becomes secondary.
“How do I know if I need weight loss surgery?”
Another common misconception is that weight loss surgery is a “last resort,” or a “cheat” to a healthy weight. Please remember that obesity is a disease, and it’s not ONLY about lifestyle choices. There are a lot of highly complex processes at work that are sometimes too powerful for any person to overcome on their own. Patients who pursue metabolic surgery to treat their obesity in general have exhausted other modalities and/or they have co-morbidities that require more significant and quicker weight loss than might be attained through other methods. Additionally, those patients whose obesity is significantly advanced and has persisted for a long period of time may not respond adequately to other modes of treatment.
If you are not sure, we strongly recommend a consultation to discuss your situation with our surgical staff, who are trained and highly specialized in the intricacies of the various procedures and how they might impact your specific situation.
“What surgical procedures are available?”
There are more types of weight loss surgery procedures available now than ever before, so there are more solutions to address the growing obesity epidemic. Following is an overview of each procedure.
Gastric Bypass
Procedure description: Bypass the stomach by attaching a small pouch to the small intestine.
Recovery Time (back to all your everyday activities with no restrictions): 2 – 4 weeks
Risks and Complications: Risk of dumping syndrome
Results: On average, 60-80% of excess weight is lost within the first year to year and a half
Gastric Sleeve
Procedure description: Removes a portion of the stomach, leaving a tube-shaped stomach (sleeve).
Recovery Time: 2 – 4 weeks
Risks and Complications: Lower risk of dumping syndrome
Results: Patient should expect to lose weight at a slower steadier rate. In the first 12-18 months, weight loss on average is 60% of excess weight.
SADI-S (Single Anastomosis Duodeno Ileal Bypass with Sleeve Gastrectomy)
Procedure description: Create a smaller stomach sleeve and re-route a portion of the small intestine. This combination restricts food intake and alters the absorption of calories and nutrients, resulting in significant and sustained weight loss.
Recovery Time: 1 – 4 weeks
Risks and Complications: Pre-cancerous changes and increased risk of developing esophageal cancer.
Results: On average, expect to have around 20% excess weight in first 3 months and up to nearly 100% of excess weight after two years in some studies
Duodenal Switch
Procedure description: Reducing the size of the stomach and re-routing a portion of the small intestine to limit calorie absorption, resulting in sustained and substantial weight loss.
Recovery Time: 2 – 4 weeks
Risks and Complications: Risk of dumping syndrome
Results: On average, a Duodenal Switch results in 80% loss of excess weight over a two-year period.
Orbera (intragastric balloon)
Procedure: No surgery or incision required. Deflated balloon is placed in the stomach and filled with saline. The balloon remains in place up to 6 months.
Recovery: 1 – 3 weeks
Risks and Complications: Balloon deflation and obstruction
Results: On average, expect to lose 30-50 lbs but the amount of weight loss varies with each patient.
Revision/Conversion Procedures
Unlike other bariatric surgery centers, New You is dedicated to helping patients who have previously undergone weight loss surgery but have not seen the results they hoped for. Our revisions and conversion procedures, including endoscopic revisions, help get the patient back on track to achieve their weight goals.
It is an unpleasant fact to face but it must be stated that many patients after bariatric surgery experience some regain of their weight. Nobody wants to think about weight gain at the beginning of their weight loss journey, just like someone entering marriage doesn’t want to plan for divorce. But it’s a real possibility, and it does happen frequently as people get back to their busy lives and their healthy habits begin to loosen.
“What medications are used for weight?”
Taking anti-obesity medications can be helpful for many patients for whom lifestyle modifications alone have not been sufficient in reducing weight. All of the medications prescribed for weight loss are most effective when used along with lifestyle modifications and are not meant to replace your efforts. The medications can help break the yo-yo dieting cycle and make your efforts more productive, less difficult, and less frustrating.
There is a lot of ongoing research for new anti-obesity medications, so there are new options frequently becoming available and will continue in the foreseeable future. Following is an overview of the most commonly prescribed anti-obesity prescription medications that are currently on the market.
Metformin (Glucophage)
Metformin is a diabetes medication, and it is also commonly used in prediabetes, polycystic ovarian syndrome (PCOS), and insulin resistance. It helps keep blood sugar more level and helps with the way your body processes carbohydrates. It can help with small amounts of weight loss when combined with a healthy lifestyle.
Metformin is generic, widely used, and available. It is a safe medication, but because of common side effects of diarrhea and stomach upset, about 15% of patients who try metformin are unable to tolerate it at any dose. However, most patients tolerate metformin easily after a few days of adjustment to the side effects.
GLP1 Receptor Agonists (GLP1-RA)
There are several different medications in this class:
- Wegovy (semaglutide), weekly injection, approved for weight loss
- Ozempic (semaglutide), weekly injection, approved for diabetes
- Rybelsus (semaglutide), daily pill, approved for diabetes
- Saxenda (liraglutide), daily injection, approved for weight loss
- Victoza (liraglutide), daily injection, approved for diabetes
- Trulicity (dulaglutide), weekly injection, approved for diabetes
All of the medications in this class started as diabetes medications, but they worked so well for weight in clinical studies that the manufacturers started making brands approved specifically for weight loss. These medicines slow down the speed at which your stomach empties so that you feel full sooner and are more satisfied with meals. They also help keep blood sugar levels normal and improve insulin resistance. Weight loss in trials ranged from 5% to 20% depending on the medication. Some of the brands in this class also are approved to reduce the risk factors of cardiovascular disease associated with obesity.
GIP/GLP1 Dual Agonist
The one medication in this class, tirzepitide, is marketed under two brand names – Zepbound, approved for obesity, and Mounjaro, approved for type 2 diabetes. Like the GLP1-RA class, this medicine slows down digestion, and helps keep blood sugar levels normal and improves insulin resistance. Since these are the newest brands on the market, the demand for them is very high meaning that there are some issues with consistent supply.
Phentermine (Adipex or Lomaira), or Phendimetrazine (Bontril)
Phentermine is an appetite suppressant medication. It decreases appetite and increases energy and focus. It can be helpful in patients with low metabolism as well. The FDA approval for phentermine is for short-term use, however large studies recently have shown that it is safe and effective when used long term. Average weight loss is around 5%. Lomaira is a brand name with a lower dose of phentermine that can be taken 2-3 times a day. Adipex is a brand with a higher dose usually taken in the morning. Phendimetrazine (Bontril) is in the same class of medications, works similarly but can be somewhat stronger and last longer than phentermine.
Topiramate (Topamax)
Topiramate is a medicine that was initially used for seizures and for preventing migraine headaches. It has been shown to be helpful in binge eating, cravings, and night eating. It has good evidence in helping with weight loss after bariatric surgery procedures. It has not been studied for weight loss by itself but is approved for use in weight loss in the form of Qsymia (see below).
Qsymia (topiramate/phentermine)
Qsymia is a brand name medication that combines variable doses of phentermine and topiramate in a once-daily formulation. There are patient affordability programs available through the manufacturer’s contracted mail order pharmacy.
Bupropion (Wellbutrin)
Bupropion is a medicine used for depression and smoking cessation. It can help with appetite regulation, energy, mood, focus, and stress eating. It has not been studied for weight loss by itself but is approved for use in weight loss in the form of Contrave (see below).
Naltrexone
Naltrexone has traditionally been used in alcohol and drug addiction and targets impulsivity in the brain. It helps with weight loss by reducing food cravings, limiting impulsive eating, and increasing fullness. It has not been studied for weight loss by itself but is approved for weight loss in the form of Contrave (see below).
Contrave (bupropion/naltrexone)
This medication combines bupropion and naltrexone and is helpful for binge eating and food addiction. Weight loss with Contrave averages 5-8% when studied in combination. The manufacturer of Contrave has an affordability program in place for cost savings if the medication is not covered by the patient’s insurance plan.
Vyvanse (lisdexamfetamine)
Vyvanse is a medication that is approved for use in Moderate or Severe Binge Eating Disorder (BED), and in Attention Deficit Hyperactivity Disorder (ADHD). It can help with weight by decreasing frequency and severity of binging episodes in BED. There have been some supply constraints related to this medication, so some patients have experienced disruptions in treatment because of the shortages.
“What about compounded weight loss medications?”
The GLP1-RA and GIP/GLP1 dual agonist medication classes are the newest anti-obesity medications on the market, and there has been overwhelming popularity because the medications are so effective. Because of the high demand, there are widespread, intermittent shortages of the FDA-approved medications occurring worldwide. The shortages have prompted a surge of compounded medications touting similar results. While the practice of compounding may have initially started to help patients affected by the shortages, the practice has now become predatory towards people living with obesity who are desperate for a solution. Compounded medications that are marketed for weight loss do not have any accepted research to back any claims of effectiveness, so patients may be paying hundreds and sometimes thousands of dollars for inconsistent results and possibly dangerous outcomes. The providers at New You do not recommend or prescribe any compounded weight loss medications, because it’s not safe and it’s taking resources away that could be utilized for proven effective treatments.
“Will my insurance plan cover anti-obesity medications? Are they expensive?”
This is variable depending on the individual medications and the individual insurance plan.
Some anti-obesity medications are manufactured specifically for the treatment of excess weight. However, others are commonly prescribed for “off-label” use. This means that while a particular medication may aid weight loss, it is not specifically approved by the FDA for that purpose. For this reason, many health insurers don’t approve coverage for off-label use. This does not mean that it’s wrong for your provider to prescribe it, but an insurance company may still deny coverage for cost control reasons. Some medications are affordable enough that patients can pay out of pocket for them. If you have further questions about covered benefits, we strongly encourage you to contact your plan administrator for more information specific to your needs.
At New You, we always remind our patients at each visit that you should never hesitate to ask for help with weight loss, no matter what help you have already had. Just like other chronic diseases, obesity requires lifelong management. Don’t be afraid to ask for the help you need, when you need it, at whatever stage of your journey you are.