By Laura Freeman

Now that injectable medications as well as surgical options are available for patients taking on the challenge of reversing severe obesity, providers have to consider which choice is right for each patient. What should physicians consider in making recommendations? The best choice varies by patient, their individual health factors and their personal circumstances.

“While GLP-1 injections finally offer a medical approach to treating morbid obesity, they aren’t without side effects. They can be expensive, especially without insurance, and results only seem to last as long as injections continue. For patients who need to achieve major weight loss long-term, some form of weight loss surgery may need to be considered,” Jay C. Long, MD, FACS said.

Morbid obesity is a risk factor for many diseases that affect longevity, quality of life and overall health. This includes diabetes, heart disease, and there are correlations with some forms of cancer. In addition to arthritis and mobility issues, there are the psychological and economic effects of social stigma and career-limiting prejudice.

However, the more we learn about the mechanisms of obesity, the more we understand that people don’t necessarily fail at weight loss for lack of trying. Many severely overweight people have been dieting most of their lives. The factors keeping them obese tend to be complex and varied. For lasting success, most will need help.

In past years, more than 270,000 bariatric surgery procedures have been done annually in the United States. Recently, around six percent of adults in the U. S. are reported to be currently using GLP-1 injections, and 12 percent have used them.

“For patients with a BMI over 40, and under new guidelines the consensus is over 30 to 35, surgical weight loss could be an effective approach,” Long said. “Now we can do minimally invasive laparoscopic surgery in an outpatient setting. Single Anastomosis Duodeno-Ileal Bypass bypass (SADI) with a sleeve gastrectomy may be all that is necessary.

“In some cases, a more extensive procedure is indicated. For example, a patient with severe reflux problems would probably do better with a gastric bypass. We also see some patients who need revision surgery if the stomach pouch becomes stretched over time. These patients may need distalization to move the connection downstream, reducing the amount of absorption surface the food passes through.”

After surgery, patients tend to be satisfied with less food, leading to weight loss. Fewer calories are absorbed, and there can be a shift in metabolism that can have a helpful effect on losing weight. Since a primary objective achieved by surgery is reducing absorption of calories, reduced absorption of nutrients should also be addressed with a planned program supplementing vitamins and minerals as needed.

“Some form of weight loss surgery is possible for most patients,” Long said. “I’ve done procedures for patients well into their senior years. I usually prefer that patients be over 18, since the bodies of younger patients are still growing. There may occasionally be a few cases where earlier intervention could be indicated.”

Sometimes people may prefer not to have surgery or they could have other conditions or circumstances that might make surgery difficult. That’s when the help they need may be in the form of GLP-1 injections.

“I’m going to be offering GLP-1s to give my patients a full range of options. I’ll start with the one that research is showing offers the greatest potential for weight loss. If patients experience side effects, we can switch to another.” Long said. “In the next couple of years, we’re expecting even better medications to become available.

“The injections help to slow emptying of the stomach and reduce appetite. Some patients may experience side effects such as diarrhea, constipation or bloating, though these may ease as they become accustomed to the medication.

“For all my patients, whether surgical or medical, I suggest building good habits in both eating and activity so they achieve the best results for their efforts and hold on to that success as long as possible.”

Lap-band certified, Long is fellowship-trained in minimally invasive and bariatric surgery and practices with Birmingham Minimally Invasive Surgery PC on Medical Park Drive near UAB St. Vincent’s East.