In the pursuit of weight loss, when diet and exercise fail to deliver results, patients are often left wondering what steps to take next. Should they immediately consider bariatric surgery or explore newer medication options like GLP-1 agonists? Natalie Larson, APRN, a nurse practitioner at the Cleveland Clinic’s Bariatric and Metabolic Institute, offers valuable insights into the complexities of obesity and the range of treatment options available, guiding individuals to the approach that best suits their needs.
Podcast Highlights
Dr. Scott Steele, President of the Main Campus Submarket at Cleveland Clinic, introduces Natalie Larson in this episode of Butts & Guts, where they discuss various weight loss options. Larson shares her journey, from growing up in Youngstown, Ohio, to becoming an expert in obesity medicine, having completed advanced training at Walsh University and a fellowship at Cleveland Clinic.
At the Bariatric and Metabolic Institute, Larson’s team focuses on creating individualized treatment plans for obesity. These plans go beyond just BMI calculations, considering factors such as a person’s lifestyle, eating habits, exercise routine, sleep patterns, and even stress levels. As treatment options for obesity evolve rapidly, the clinic offers an integrated approach to weight management that is tailored to each patient.
Treatment Pathways for Weight Loss
For many patients, bariatric surgery might be the most effective option if diet and exercise have not worked. Surgery is often pursued by individuals who have tried various methods without success, and it’s especially suitable for those with a high BMI and associated health conditions like diabetes. Surgery, such as the Roux-en-Y gastric bypass, not only aids weight loss but also helps regulate blood sugar levels, making it a dual-benefit treatment.
However, surgery is not the only approach. Pharmacotherapy is a common first step for many patients. The clinic also integrates other therapies, including nutritional counseling, to ensure a holistic approach to weight management.
Medications for Weight Loss
Newer medications like GLP-1 receptor agonists (e.g., Ozempic, Wegovy, Mounjaro, Zepbound) have shown promise in helping with weight loss. These injectable medications work by mimicking natural hormones that promote satiety and delay gastric emptying, leading to reduced hunger and longer-lasting fullness. However, weight loss is not guaranteed with medications, and patient responses vary widely. Some may need higher doses or additional medications to achieve the desired effect.
Importantly, medications help not just with weight loss but with related health issues. Conditions like hypertension, diabetes, and sleep apnea can improve as patients lose weight. Moreover, weight loss medications may enhance overall well-being by reducing cravings, improving mood, and increasing metabolism.
Criteria for Medication Use
To qualify for weight loss medications, patients typically need a BMI of 27 or greater and at least one obesity-related comorbidity (such as high blood pressure or diabetes), or a BMI of 30 or higher. The Bariatric and Metabolic Institute also offers preoperative support for patients preparing for bariatric surgery or other procedures.
Challenges and Follow-Up Care
While medications and surgery can be effective in the short term, weight regain is a possibility, as obesity is a chronic disease. For patients who stop medications or experience weight gain after surgery, ongoing follow-up and additional treatments may be necessary to maintain long-term success.
Advancements in Weight Loss Treatment
Looking ahead, new treatments like the Triple G medication, which targets a combination of hormones involved in insulin control and appetite regulation, are in development. These treatments may offer additional benefits for patients dealing with obesity-related diseases like sleep apnea or osteoarthritis.
Final Thoughts
Natalie Larson emphasizes the importance of understanding that weight loss is a personalized journey. There is no one-size-fits-all approach. Some patients may require a combination of treatments, including surgery, medication, and lifestyle changes. The goal is to offer patients a comprehensive, compassionate approach to managing obesity, acknowledging the challenges they face while helping them achieve sustainable weight loss and improve their overall health.
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