Obesity and Weight Management

Over the past decades, obesity has become a major health issue worldwide. It can have detrimental effects on many aspects of our physical, emotional and mental wellbeing.

Our body weight is the result of a complex interaction of food intake, exercise, sleep, hormones, genetics, the gut microbiome, and the environment. A multifactorial approach needs to be taken to lose weight and maintain a new healthy weight. At Gastro IQ, our team includes specialist doctors, dietitians, exercise physiologists, psychologists and surgeons. We will address all aspects of weight loss and provide an individualized plan for each person based on their individual needs and goals.

Methods of weight loss

Diet:

The Western diet contains foods that are rich in high-calorie substances such as sugars, carbohydrates, and fat. These foods give us the energy to get through our days and help us sustain our busy lives. The problem is that many of foods contain much more energy than our bodies need. Sugars and starch for example are very easily and quickly absorbed in the small bowel and are responsible for the ‘ high ’ we feel after eating these foods. This short term ‘high’ is due to raised blood sugar levels (hyper-glycemia) which triggers the body to release insulin from the pancreas. Insulin moves the blood sugar to the peripheral tissues for storage as fat. While some excess sugars are stored as glycogen in the liver, the remaining sugar are then deposited around the body as adipose tissue, better known as fat.

The key to weight loss through diet includes two important aspects:
(i) to eat foods that are slowly absorbed to avoid the insulin surge and
(ii) to eat only the number of calories our bodies need.

Modifying your diet and adhering to a healthy eating plan can be very challenging. It is important to have help from a registered dietitian to plan meals and accurately count the necessary number of calories to be in a relative caloric deficit. To make matters more  complex, our bodies automatically adjust our base metabolic rate to our caloric intake. Therefore, strategies need to be undertaken to not let our body’s metabolism decrease which includes a dedicated exercise program.

obesity

Exercise:

Most of the calories we ingest is spent maintaining our normal cellular functions. The energy we spent moving around everyday only accounts for a small amount of the calories we consume. 

There are reasons for exercising beyond the ‘minimum calorie burn ’ during exercise:

1. Increased metabolism (aka the afterburn): when you exercise your metabolism is increased and stays increased for the following days. Your body will burn more energy and if you have a dietary plan to control your energy intake, you will continue to burn fat after your work out. This is especially true when you do weights. Many weight loss programs focus on cardio, but a combination of cardio and weight training is important to sustained weight loss.

2. Cardio vascular/respiratory health: It is important to have a strong heart, lungs, legs, and arms. This is a the key component to long term survival and preventing disease. At Gastro IQ, we measure more than just weight and calculate BMI; we put all patients on our weight loss programs through impedance testing (measures the percent fat and muscle content in all parts of the body) and V02 max testing (tests strength the heart, lungs, and muscles).

3. Mental Health: A strong and healthy body is an important part of mental health. Maintaining the motivation to exercise regularly can be difficult, but in the hours and days after a workout, people often feel happier and have more energy.

Our approach: Diet and exercise are key pillars to achieving long term health and are an important component to all of our weight loss programs at Gastro IQ. While these interventions alone can result is durable weight loss, multiple large studies have shown that additional interventions are often required. One large meta-analysis of 29 studies evaluating diet and weight loss found that individuals on average were 3kg lighter at 5 year follow up (1). They concluded that diet and exercise programs alone were not enough for many participants. That’s where further interventions can play an important role.

Medications:

There are several medications registered with the Therapeutic Goods Administration (TGA) for use as weight loss aids. Whilst most people would prefer not to take a medication, they are the right choice for some people as they can enhance overall weight loss results for patients on a diet / exercise program.

These medications include:
1. Orlistat (Xenical): inhibits the pancreatic enzyme responsible for digesting fat (lipase). The dose is a 120mg tablet with each meal. In a placebo-controlled trial, the patients taking Orlistat lost 10.3Kg compared to 6.1kg with placebo. (2) Since, fat is not well absorbed, some people will experience diarrhoea.

2. Liraglutide (Saxenda): reduces blood glucose and reduces appetite. In a large randomized controlled trial, Liraglutide was shown to reduce body weight by 8.4 kg after 1 year of treatment. (3) The medication is self-administered as a daily injection under the skin. Gastrointestinal side effects are common and may require dose adjustment.

Other medications used for weight loss include Phentermine (Duromine), Topirmate (Topamax), and anti-glycemic medications such as Metformin. Decisions in regards to medications for weight loss need to be made as part on a overall weight loss program that includes diet / exercise and may involve endoscopic procedures.

Endoscopic (non-surgical) weight loss:

In Australia, there are now two effective weight loss procedures that do not involve surgery. Both procedures are performed with the gastroscope (endoscope) which is a tiny flexible camera inserted through the mouth and into the stomach. They are performed under sedation as day procedures.

1) Orbera Device (intra-gastric balloon): This is one of the most popular medical weight loss solutions in the world with over 277,000 patients having used this therapy in the last 20 years. The device works by decreasing gastric emptying (leading to slower absorption of food) and by decreasing cravings/portion size (occupies 1/3 of the stomach). A recent study of >40,000 patients who underwent this procedure, had an average weight loss of 18.4% of their body weight. (4) There are 2 Orbera balloons available which differ in the duration of therapy: 6 months or 12 months. There is an adaption phase to the balloons for the first 2 weeks and close follow up with Gastro IQ along with anti-nausea pills is needed to minimize side effects. A mandatory diet and exercise program is prescribed to maintain weight loss to help maintain the weight you have lost with the Orbera device.

2) Endoscopic Suturing Gastroplasty (ESG): This procedure is also called the ‘ endoscopic sleeve ‘ and looks to revolutionize bariatric surgery. It reduces the size of the stomach by 75% resulting in significant long-term weight loss. The main difference compared to a traditional ‘surgical sleeve’ that is the procedure is done without any abdominal incisions and without the long recovery period associated with surgery. The Apollo suturing device is attached to the end of a gastroscope and sutures are placed in a specific pattern throughout the body of the stomach. A study of 91 patients who were treated with ESG and followed for 2 years, had an average total body weight loss of 20.9%. (5)

Conclusion:

As you can see, there are many weight loss options. Everyone is different and a personalised approach is required. Weight loss is a journey, but the efforts are worth in improvement in quality of life and the health benefits.

References:

1-Long-term weight-loss maintenance: a meta-analysis of US studies James W Anderson, Elizabeth C Konz, Robert C Frederich, Constance L Wood The American Journal of Clinical Nutrition, Volume 74, Issue 5, November 2001, Pages 579–584

2-Sjostrom L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HPF, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet 1998;352:167-73

3-Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med 2015;373(1):11–22.

4-Neto MG, et al. Brazilian intragastric balloon consensus statement (BIBC): Practical guidelines based on experience of over 40,000 cases. Surgery for Obesity and Related Diseases. 2018; doi:10.1016/j.soard.2017.09.528.

5- Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients Reem Z Sharaiha 1Nikhil A Kumta 2Monica Saumoy 2Amit P Desai 2Alex M Sarkisian 2Andrea Benevenuto 2Amy Tyberg 2Rekha Kumar 3Leon Igel 3Elizabeth C Verna 4Robert Schwartz 2Christina Frissora 2Alpana Shukla 3Louis J Aronne 3Michel Kahaleh 2 Clin Gastroenterol Hepatol. 2017 Apr;15

6- Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years Palanivelu PraveenrajRachel M GomesSaravana KumarSivalingam PerumalPalanisamy SenthilnathanRamakrishnan ParthasarathiSubbiah Rajapandian, and Chinnusamy Palanivelu J Minim Access Surg. 2016 Jul-Sep; 12(3): 220–225.