Medications and Surgical Options for Weight Loss

By Eduardo Grunvald, MD

Few people can argue that losing weight is difficult, and keeping the weight off is even harder. For those folks suffering from “diabesity” – both type 2 diabetes and obesity – maintaining a “healthy” weight seems like a never-ending battle. So why is it so easy to gain weight, yet so difficult to lose it?

Mother nature has designed our bodies to resist weight loss, a trait that was a survival advantage during our ancestral days when we didn’t have access to food everywhere. But we now live in a modern environment that provides effortless access to tasty, high calorie food almost 24 hours a day. Deep in the center of our brains sits a bundle of nerve cells that turns appetite on and off, in response to the supply of nutrients and fat stored in our bodies. This is the part that makes us more hungry and slows down our metabolism when we try to lose weight. Additionally, there are a group of structures in the brain that make up the limbic system, responsible for our reward driven behavior – the reason why we want that piece of chocolate cake even though we may have eaten more than enough at a given meal.

When we try to lose weight our bodies resist by driving us to consume more calories and burn less of them, thereby restoring our lost body mass – a concept we term the Set Point Theory. This explains the eternal “yo-yo” effect. We all know people who have lost a significant amount of weight and have kept it off, but the scientific evidence suggests that most are not successful long-term. We now think this observation is more from our biological systems rather than “lack of willpower or discipline”. The brain systems previously mentioned are the targets of medications and surgery for weight loss.

For those with weight problems and serious health concerns as a result, perhaps medical treatment, in the form of medications and/or surgery, may be an option. Over the past five years, four new medications have appeared on the market: Qsymia™, Belviq™, Contrave™, and Saxenda™. Medications affect appetite, but a better way to think about that effect is that they help the brain sustain a lower weight by resisting the biological urges to consume more calories, hence maintaining a lower “set point”.

The two most common types of bariatric surgery – the sleeve gastrectomy and gastric bypass – are also called “metabolic surgeries” because clinical studies have shown their excellent effects on improving type 2 diabetes, and in many cases even leading to remission of the disease. A gastric bypass is the creation of a small stomach pouch and rerouting parts of the small intestine so that ingested food bypasses most of the stomach and a long stretch of the small intestine. A sleeve gastrectomy is technically a simpler procedure where approximately 80% of the stomach is removed. Contrary to popular notions, these surgeries work by changing various metabolic processes in the body that lead to a lower weight and improved blood sugar control.

Of course, all of these options are meant to be used in combination, not in place of, a structured lifestyle modification program for optimal results.

If your efforts at permanent weight loss have failed, especially if your weight is affecting your diabetes, you may want to consider seeing a specialist who can explain options in further detail, just as you would for any other chronic condition.

For more information on weight management from a reputable source, and a directory for finding board certified weight loss providers, visit

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