Are weight-loss pills or bariatric surgery the answer to weight loss for obesity?
Are weight-loss pills or bariatric surgery the answer to weight loss for obesity?
It is now common knowledge that being overweight or obese increases the risk of many serious illnesses such as Type 2 diabetes, high blood pressure, heart disease, stroke, and many cancers. Obesity can also affect our ability to obtain and hold down work, our self-esteem, sense of wellbeing and mental health. It is also associated with obstructive sleep apnoea, degenerative joint disease and lower back pain.
A recent article in the Listener magazine[i] described the latest weight-loss tool – an appetite-suppressant pill made from an extract of New Zealand hops. Previous appetite suppressants – and there have been many over the decades – have been found to have serious ‘side’ effects, which indeed have not been ‘side’ at all. Whilst this latest product is ‘natural’ (a hops extract), trials have shown some mild laxative effects.
However, side effects or not, isn’t this yet another ‘quick fix’? It was observed in the article:
“We human beings are always interested in quick fixes, magic solutions, silver bullets. Nowhere is this more true than in the world of weight loss. It’s why we have a thriving multibillion-dollar industry, despite the fact that diets – almost without exception – do not succeed long-term in keeping weight off”
Another recent article[ii] discussed a US study of another new weight loss pill (an appetite-suppressant drug which did not seem to increase the risk of heart disease) hailed as a potential ‘holy grail’ in the fight against obesity, in that it could close the gap between lifestyle modification (lifestyle support and advice) and surgery. Yet the results of the study showed minimal weight loss – 4 kgs (9 lbs) in almost three and a half years – and the drug would cost a whopping $US220-290 a month!
What makes a ‘holy grail’ these days? Not a lot, it seems!
And . . . why isn’t ‘lifestyle modification’ enough?
For those who are extremely obese and therefore unable to exercise and have been unable to achieve substantial weight loss by cutting down on food alone, there is a case for more extreme medical intervention.
How effective are medical procedures for obesity? Could they be in the same ‘silver bullet’ league as weight-loss pills? A recent Cochrane study[iii] of the effects of weight loss (bariatric) surgery – gastric bypass, adjustable gastric band, sleeve gastrectomy, duodenojejunal bypass and biliopancreatic diversion with duodenal switch – for overweight or obese adults compared the different surgical interventions with non-surgical interventions for obesity (such as drugs, diet and exercise).
The conclusion was that in the short-term surgery did result in greater improvement in weight loss and associated conditions compared with non-surgical interventions. However sometimes there were complications and re-operations required, although these were poorly reported, and participants were only followed for one or two years, so the long-term effects remained unclear.[iii]
Even if the weight loss effects of medical procedures were found to be long-term, are they a realistic answer to the increase in obesity?
The World Obesity Federation’s estimates[iv] show adult obesity continuing its steady climb and that a third of the population will be overweight or obese by 2025:
- In the UK, Australia and Mexico, already over a quarter of adults are obese and rising rates show that this figure will rise to 34% by 2025 if nothing changes
- In the USA already a third of men and women are obese (34%) and by 2025 that is predicted to be 41%
- Egypt is predicted to go up from 31% to 37% of adults in the same period.
Even Asian countries, which have some of the lowest prevalence of overweight and obesity worldwide, are experiencing alarming rates of increase in recent years. There are no recent figures for Asian countries but in 2013 Malaysia had the highest obesity prevalence at 14 % in the South East Asia region, with Thailand next in line (8.8 %), while in 2015, less than 6% in Japan were obese. Vietnam and India have the lowest rates of obesity[i] in Asia Pacific (1.7 % and 1.9 % respectively). It is clear though that rates are rising, especially in children. Also, rates are somewhat skewed because Asians tend to have higher amounts of abdominal fat at lower BMIs.[v]
In South Korea the rate of obesity has risen from 26% in 1998 to 35% in 2016 – it has been recently reported that the country is to take action against a binge-eating craze on social media in an attempt to curb rising obesity rates.[vi]
In February 2018 the World Health Organization (‘WHO’) stated that worldwide obesity had nearly tripled from 1975 to 2016[vii] and that by 2016:
- More than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese[viii]
- 39% of adults aged 18 years and over were overweight, and 13% were obese
- Most of the world's population live in countries where overweight and obesity kills more people than underweight
- 41 million children under the age of 5 were overweight or obese
- Over 340 million children and adolescents aged 5-19 were overweight or obese.
WHO points out that obesity is preventable.[vii]
As noted above, 1 in 4 people in the UK are obese. Research shows that obesity is a lifelong condition and is associated with many medical problems and it is predicted that the cost of obesity may bankrupt the UK National Health Service.[iv] As Dr Michael Moseley notes, “The major ailment caused by obesity – Type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $US1.2tn a year from 2025.”[iv]
There is no way bariatric surgery and weight-loss pills alone can reverse these statistics. Although bariatric surgery is effective in reducing appetite, and studies have shown it can reverse Type 2 diabetes, there is not enough treatment available, it is very costly (to the individual and the health system) and there is a stigma attached to it, so it will only help a small number of people.
Although bariatric surgery is considered by the medical profession as the leading option for weight loss for the obese patient, it carries the risk of complications. Complications of bariatric surgery include infections and the need to revisit and correct surgical procedures, as well as abdominal complaints and pain, weight fluctuations, nutritional deficiencies (vitamins and minerals), gallstones, ulceration, small bowel obstruction, post-operative adhesions, internal hernias, band erosion or slippage, persistent nausea and vomiting and metabolic bone disease.[ix]
What can the complications of bariatric surgery look like in real life?
It can be disturbing to experience and to witness. For example, the writer is aware of some patients after bariatric surgery having to rush to the toilet after eating to vomit as they are unable to hold the amount of food they are eating in their stomach. This is obviously a traumatic experience for them.
Often for several weeks after a band operation patients can only consume liquids, which means they often consume fruit juices and even (as the writer witnessed with a friend who underwent surgery for weight loss) liquified chocolate! This shows no true change and undermines the desired effectiveness.
During the adjustment period after surgery the band may need to be loosened because patients can hardly eat anything or are sick when they do eat. Nutritional deficiencies can thus occur, with the risk of malnutrition being reported as a known side-effect.[x]
There is a reported risk of substance abuse and suicide as patients struggle to cope with the loss of comfort foods: “The problem is the surgery is an anatomic fix for a psychological problem.” says Dr Lisa Medvetz, an American bariatric surgeon and weight-loss specialist.[xi]
There has been new scientific research recently[xii] on a drug that claims to offer the same benefits as bariatric surgery. The research scientists re-created gut hormones in the lab, mixing three hormones (the hormones that have been shown to drop hunger and increase satiety after surgery) to reach the same level as after surgery, administered via a pump daily for four weeks. Obese participants experienced less hunger and more satiety (they felt full after a small meal). They lost between 2 and 8 kgs (4.5 – 17.5lbs) every week for four weeks (the maximum time the hormones were given until it has been proven to be safe).
These results appear almost miraculous, the holy grail of weight loss – a non-surgical solution to obesity! It promises that if it proves to be safe then it could be used until a healthy weight is achieved, which in turn would reduce the long-term effects of the tsunami of weight gain. However, is this really a long-term solution to the obesity epidemic? We know that the cycle of weight loss always leads to people putting the weight back on when such treatments are completed.
The experts say spending more on treating and preventing obesity will save countries many millions in the long term. Perhaps we need to ask ourselves some very real questions:
- Whether surgery, weight-loss pills or hormone treatment, the question is – why are we becoming fatter and fatter? Treatment does not stop us from wanting to eat.
- Indeed, why is being obese or overweight fast becoming ‘normal’?
- What is the true answer to our escalating obesity rates worldwide?
- What part are we playing in this escalation?
- How invested are we in food and in eating a lot?
Looking on the outside to the medical profession or the pharmacology profession to sort our obesity — so we can still gorge on food — is the ultimate ‘having your cake and eating it too’. It seems clear that neither ‘holy grail’ weight-loss pills nor bariatric surgery is the true answer to obesity because there is often no true change in the approach to our wellbeing and nutrition.
Whatever the causes of our escalating rates of obesity, such as the human body's propensity to store fat and or ‘obesogenic environments’ which are:
- places, often urban, that encourage unhealthy eating and inactivity
- TV, computers, other screens
- high-calorie food and clever food marketing
- the abundance and convenience of modern life
- reduced physical activity
- longer working hours and more desk-bound jobs
- leisure time increasingly spent indoors
. . . reversing the obesity trend will require society as a whole, and individuals, to choose differently. Medical procedures and weight-loss pills will never be enough. We need to create an environment that encourages healthier eating, eating less, moving more and learning to listen to the body and how foods truly affect it.
It will require a major shift in behaviour and thinking, not only by governments, but by all of us.
What is that shift in thinking and what part do each of us play in this? It seems few of us want to take responsibility for our true health and wellbeing, and yet each of us is ultimately responsible for our own health.
What steps could we take to be responsible?
Rather than a trend that is based on quick fixes, such as weight-loss pills, or silver bullets such as bariatric surgery or hormone treatment, we could make healthier and more sensible choices about diet and physical activity. Willpower, education, dieticians and counselling alone will not do this because we need to look at the whole picture and ask what is really going on. For example, we could ask ourselves:
- Why do we over-eat or eat foods that we know do not support our true health?
- Are there deeper issues, for example, are we trying to numb what we feel inside or numb our fear or anxiety? Are we so discontented with our life that we eat or drink as a treat or reward?
- Is food or drink the only thing that can make us feel happy or comfort us?
- Are we using food or drink as a distraction to not feel what is really going on – both within us and around us?
Why is obesity on the increase?
Why is obesity on the increase when we know more about nutrition and diet than ever before?
If we were to allow ourself the opportunity to answer these questions – to come to the answers in our own time – without expectations on ourself to get everything perfect or to fix anything – then perhaps we could allow ourselves the space to heal the underlying hurts and issues that cause us to overeat or to eat unhealthy foods. Only then will we care enough. Only then will being overweight or obese no longer be ‘normal’.