Assisted weight loss, a topic often talked about in hushed tones in the past, is now seemingly celebrated by individuals and across every communication medium. While the growth of weight-loss options is something to be celebrated, it’s important to develop a relationship with a trusted physician who can guide those seeking a solution to the best plan for success.

It’s been well established that diet and exercise alone will not result in any significant weight loss for 95% of individuals who are overweight or have the metabolic disease of obesity, according to Kenneth Copperwheat, DO, a Bariatric Surgeon with Piedmont Physicians Surgical Specialists and Bariatrics of Columbus. In fact, the average person with the disease of obesity will actively try to lose weight by dieting over eight times during their life.

“With the odds of success stacked so highly against them, many patients are seeking out more effective solutions,” Dr. Copperwheat says. “Thankfully, there are many different treatment options available.”

Since many patients will typically choose between medication and surgery to treat this disease, Dr. Copperwheat advises that it’s important to understand the differences between them and the differences in the expected results before choosing which is right for you.

There are many different medications available to help with weight loss.  Medications such as phentermine will typically result in up to 8% total body weight loss, he says, while newer medications such as GLP-1 Receptor Agonists (e.g. semaglutide, tirzepitide) can result in up to 15-20% total body weight loss.  

“It’s important for patients to realize that they will likely need to take these medications indefinitely in order to maintain their weight loss,” Dr. Copperwheat explains.  “Typically, medication therapy is appropriate and effective for patients with mild obesity.”

Alternatively, many patients will choose surgery for their treatment.  Depending on the type of surgery chosen, patients can typically expect to lose between 20-40% of their total body weight, he says.

“Choosing which surgery is most appropriate is a decision that you should make with your bariatric surgeon,” Dr. Copperwheat advises. “Surgical treatment is typically favored for patients with moderate to severe obesity.  In addition to treating obesity, these operations also treat the diseases that go along with obesity, such as diabetes, sleep apnea and high blood pressure.”

Presently, there is also a wide variety of surgical options available. Recommendations are tailored to individuals based on their specific goals.

Surgical options for weight loss

• Sleeve Gastrectomy (VSG): Approximately 80% of the stomach is removed, converting it into a narrow tube.
• Roux-en-Y Gastric Bypass: A small stomach pouch is created, and then the remaining stomach and first portion of the small intestine are bypassed and no longer store or digest food.
• Single-Anastomosis Duodenoileostomy (SADI): After a sleeve gastrectomy is created, the stomach is disconnected from the small intestine, and a loop of the small intestine is measured several feet from the end and reconnected to the stomach.
• Biliopancreatic Diversion with Duodenal Switch: Following the creation of a sleeve gastrectomy, the stomach is separated from the small intestine.  The stomach is then reconnected into the latter part of the small intestine.

Who is a candidate for treatment?

Medications: These are recommended for individuals with a body mass index (BMI) of 30 kg/m2 or greater, regardless of the presence, absence or severity of co-morbidities. They are also considered for individuals with metabolic disease and a BMI greater than 27 kg/m2.

Surgery: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) of 35 kg/m2 or greater, regardless of the presence, absence or severity of co-morbidities.

MBS should be considered for individuals with metabolic disease and a BMI of 30-34.9 kg/m2.

BMI thresholds should be adjusted in the Asian population such that a BMI greater than 25 kg/m2 suggests clinical obesity, and individuals with a BMI greater than 27.5 kg/m2 should be offered MBS.

“Overall, the goal of these treatments is to allow patients with the metabolic disease of obesity to enjoy a better quality of life and a longer lifespan,” Dr. Copperwheat says.

Learn more about Dr. Copperwheat and the entire Piedmont Bariatrics team.