Understanding medical weight loss options at Ascension St. Vincent’s

Understanding medical weight loss

While obesity affects 70 percent of Americans, it is still widely unrecognized as a medical condition. However, obesity, which is having a body mass index (BMI) over 30, is associated with more than 40 other medical conditions or diseases including high blood pressure or hypertension, diabetes, heart disease, obstructive sleep apnea, pulmonary hypertension and even some cancers.

“These diseases are associated with a 50 to 100 percent increased risk of premature death compared to lower weight individuals without disease,” said Dr. Katie Novitski, bariatric and general surgeon, Ascension St. Vincent’s. “Obesity is most certainly a medical condition, and it should be treated as one.”

What causes obesity?

Obesity is simply caused by taking in more calories than you burn through your normal daily activities and exercise. However, there are many underlying factors that play a role in its development. 

“Your body has a complex system controlling your weight and body fat levels,” explained Dr. Novitski. “This system works to establish a set point for your weight that allows you to have adequate fat stores to prevent being underweight and the risks that carries. Your set point is regulated by a series of signals to control your appetite, digestion, energy balance and metabolism.”

Everyone’s set point is different and is determined by behavioral, emotional, environmental and genetic factors. It's a dynamic system that changes over time. When you gain weight and develop obesity, your set points become too high and your body works to maintain the extra weight even though it is unhealthy. 

“Your body has multiple mechanisms to help keep your set point from going too low but not to keep it from going too high. In fact, your body may even work to resist weight loss efforts through diet and exercise,” said Dr. Novitski. “Hormones responsible for appetite, decreased feelings of fullness and decreased metabolism all increase to make further weight loss more difficult and can stay at increased levels for up to 12 months even after dieting has stopped.”

Personal weight management programs and treatments

There are many options to treat obesity including weight management programs, nutrition counseling and behavior therapy, medications and surgery. Each of these methods plays a role in treating obesity and its comorbidities. Choosing the right treatment for you is a decision for you to make in conjunction with your doctor. 

“Things to consider when choosing the right treatment include other diseases or conditions you have, any medications that you are taking, previous weight loss attempts and feelings or concerns towards treatment,” said Dr. Novitski. “Each of these things should be discussed with your doctor when talking about weight loss and evaluating what treatment is the best option for you.” 

Weight-loss management is a step-by-step process. At Ascension St. Vincent’s, we help guide and support you through every step of your journey. Our team of surgical weight-loss specialists includes a surgeon, nurse navigator, bariatric dietitian, exercise physiologist and behavioral health support. We also have an insurance coordinator that explains insurance coverage and pre-approval requirements.

Our care team helps you to understand surgical and non-surgical treatment options and lifestyle changes. 

Weight-loss management options with medication

Talking to your doctor can help determine if you would benefit from medications for weight loss. These are generally reserved for individuals with a BMI over 27 with medical conditions related to weight like diabetes, high blood pressure or high cholesterol or those with a BMI over 30 without weight-associated medical conditions. Medications for weight loss can be divided into two different categories. One type helps decrease the feelings of hunger or make you feel fuller sooner by altering the chemical signals in the brain. The second type blocks absorption of calories from the intestines. Patients taking these medications can expect to lose on average five to 11 percent of their starting weight and maintain that weight loss for up to two years. 

The choice of medication depends on multiple factors including other medical conditions for which you are being treated, desired amount of weight loss and ability to keep regularly scheduled visits to monitor the results of the medications.

“Some medications commonly used to treat high blood pressure, diabetes, psychiatric conditions and even birth control can contribute to weight gain,” said Dr. Novitski. “I discuss options to change these medications to some that cause less weight gain or even some weight loss as part of the conversation and planning with each patient.” 

Surgical weight-loss options close to home

Weight-loss surgery, also known as bariatric surgery, may also be an option for weight loss. This is reserved for individuals who have a BMI over 35 with weight related medical conditions like high blood pressure, diabetes, high cholesterol or obstructive sleep apnea or those with a BMI over 40 regardless of associated medical conditions. Bariatric surgery is very effective in causing weight loss and is associated with a weight loss of 60 to70 percent, depending on the surgery performed. Many patients who undergo surgery not only experience high rates of weight loss with associated long term maintenance of their weight loss but many also see improvements or even resolution of some of their medical conditions.

Surgical treatment options here at Ascension St. Vincent’s include:

• Gastric bypass - surgery involves reducing the size of the stomach to a thumb sized pouch which is then reattached to the intestine, bypassing most of the stomach and the first part of the intestine
• Gastric sleeve - surgery involves removal of most of the stomach leaving a narrow tube of a stomach, approximately the size of a banana
• Revisional bariatric surgery - surgery involves adjusting prior bariatric surgery patients and sometimes converting from one procedure to another

While the gastric sleeve is the most common procedure worldwide, the choice of surgery requires a discussion between you and your surgeon. Factors that may affect choice of surgery include BMI, medical conditions, patient preference and ability to establish reliable follow-up after surgery. 

“While there are many treatments for obesity and weight management, there is no quick fix. All treatments require a lifelong change in your lifestyle and eating habits,” said Dr. Novitski. “Weight management programs, behavioral therapy and nutrition counseling, weight loss medications and bariatric surgery are all tools that can aid you on your journey to weight loss. This will be a lifelong process for you but your healthcare providers here at Ascension St. Vincent’s will be with you every step of the journey.”

Start a conversation with a doctor about your weight loss. Call 205-930-2175 today. 

Weight loss results may vary depending on the individual. There is no guarantee of specific results.