Does a light ‘n easy approach deliver long-lasting weight loss?

 

Obesity is a complex issue.

So complex that the medical profession represents obesity as “a complex network of mutual influences among biological, psychosocial, and behavioural factors, which include genetic factors, gut microbiome, hypothyroidism, Cushing’s syndrome, polycystic ovary syndrome, sleep deprivation, neurological and psychopathological problems, as well as socioeconomic status and cultural influences [1].”

It’s no surprise then, that losing a significant amount of weight is neither light, nor easy.

Yet we know that the rewards are worth the effort.

For someone with obesity, weight loss of 5% is sufficient to bring about an improvement in weight-related complications, such as type 2 diabetes, reflux, high blood pressure, fatty liver disease, sleep apnea, heart disease and more.

With life-saving benefits available, many people will do whatever it takes to lose weight, especially if sounds faster or easier to achieve.

But while weight loss treatments options have expanded rapidly over recent years, are all created equal? Does fast mean good? And how do you determine which one is right for you?

Talk to a trained medical professional.

Just as you wouldn’t select treatment for another serious medical condition via telehealth or through self-selection, weight loss is no different.

Diet and nutrition, exercise, pre-existing or new medical conditions, mental health, environment – they can all contribute to weight gain, and should be considered when choosing a path to weight loss.

The first step to lose weight sustainably and safely, is to find a trained medical professional that can help understand your needs, risks associated with treatments and work with you to make the right choice for you.

Understand the weight loss options available.

It’s a reality that not every weight loss treatment will be right for you. But there is no harm in going into your consultation with an understanding of the options available, what you may be eligible for, and what outcome you are hoping to achieve.

To help guide you, the table below outlines some of the most common treatments available for comparison. While we have tried to include as much information as possible, it is important to note that almost all treatments require a commitment to a healthy lifestyle (improved eating habits and exercise) and lifelong care.

(*View full table below by swiping on mobile screens. Best viewed in landscape mode.)

Surgical Treatments

Treatment	Description	Eligibility Requirements	Outcomes
Gastric Bypass: One Anastomosis	The One Anastomosis Gastric Bypass (OAGB) is a type of gastric bypass and is also known as a single anastomosis gastric bypass, mini-bypass, or even omega-loop bypass. The One Anastomosis Gastric Bypass (OAGB) is a type of gastric bypass and is also known as a single anastomosis gastric bypass, mini-bypass, or even omega-loop bypass. Performed laparoscopically, or via keyhole, 5 small cuts to your abdomen are created. Then, a bougie, or plastic tube is inserted through the mouth to guide the creation of a small stomach pouch. The stomach pouch is then joined to the bowel, 150cms from the start of the duodenal-jejunal (DJ) flexure (a part of the small bowel). This provides the bypass.	OAGB is used as a primary surgery (for someone who has not had other weight loss surgeries previously), or as a revision operation. A Gastric Bypass is also often performed for those which existing reflux. • BMI = 30 with weight related comorbidities • BMI ≥ 35 with no comorbidities. • Age >18 • No eating disorders or untreated acute psychiatric disorders. • No alcohol or drug dependency. • Other avenues have been tried without success.	Patients can expect to lose around 65-75% of excess weight or 30-35% of Total Body Weight, with the majority occurring in the first year. Gastric Bypasses also have slightly better outcomes for those with diabetes than other treatment options. Trials have shown that at the 3-year mark, 60% of patients with type 2 diabetes (who have received a Gastric Bypass) have normal blood sugars.
Gastric Bypass: Roux-en-Y	Roux-en-Y gastric bypass is a type of weight loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. Another join is then created between the small bowel, to ensure drainage of bile as well. It works by both decreasing the volume of the gastric pouch, as well as providing hormonal changes by bypassing the duodenum and part of the jejunum. This results in a decrease in levels of hunger, as well as a feeling of fullness with a smaller amount of food. There are also changes to absorption by bypassing over 100cms of your small bowel.	A Gastric Bypass is often performed for those which existing reflux. • BMI = 30 with weight related comorbidities • BMI ≥ 35 with no comorbidities. • Age >18 • No eating disorders or untreated acute psychiatric disorders. • No alcohol or drug dependency. • Other avenues have been tried without success.	Patients can expect to lose around 65-75% of excess weight or 30-35% of Total Body Weight, with the majority occurring in the first year. Trials have shown that at the 3-year mark, 60% of patients with type 2 diabetes (who have received a Gastric Bypass) have normal blood sugars.
Sleeve Gastrectomy	Also referred to as a gastric sleeve, vertical sleeve gastrectomy or VSG. It’s the most performed weight loss procedure both in Australia and worldwide. It involves significantly decreasing the stomach size, by removing approximately 80% of the stomach over a 36F bougie (plastic tube). The procedure is performed laparoscopically or ‘keyhole’ under a general anaesthetic. During the surgery, the fundus of the stomach is removed, which is the part of the stomach rich in cells that produce Ghrelin. Ghrelin is a ‘hunger hormone’ and patients experience less hunger following a sleeve gastrectomy. It has also been known to positively impact metabolism via gut bacteria and hormones. Although the physical size of the stomach is reduced, the normal direction of the food stream through the stomach and the rest of the intestinal tract is not altered. This means that nutrients including vitamins, minerals and protein will continue to be absorbed in the small intestine normally.	• BMI = 30 with weight-related comorbidities. • BMI ≥ 35 with no comorbidities needed. • Age 18-65 • No eating disorders or untreated acute psychiatric disorders. • No alcohol or drug dependency. • Other avenues have been tried without success.	Sleeve Gastrectomy has proven highly effective at achieving durable weight loss and co-morbidity reduction over the short and intermediate terms. Patients can expect to lose around 65-75% of excess weight or 30-35% of Total Body Weight, with the majority occurring in the first year.

 

Non-surgical Treatments

Treatment	Description	Eligibility Requirements	Outcomes
Endosleeve	Also referred to as Endoscopic Sleeve Gastroplasty or ESG. Endosleeve is an alternative to more invasive bariatric surgeries and avoids stapling or removing part of the stomach. While the name suggests it is like Gastric Sleeve surgery, it is quite different. The procedure also takes less time to perform and works to aid weight loss in a different way. To perform an Endosleeve procedure, a flexible four-channel tube and small endoscope is passed through a patient’s mouth, into the oesophagus and then stomach. This is done under general anaesthesia. Using an endoscopic suturing device, internal stitches are placed inside the stomach to lessen its volume by about 40-50%. The procedure also shortens and re-shapes the stomach to help it empty into the intestines slower. This helps you to feel fuller longer.	• BMI 30-50 • Age >18 • Patient who has tried other avenues without success. • No alcohol or drug dependency • No untreated acute psychiatric disorders • No eating disorders. • Is committed to a healthy lifestyle and lifelong care. Endosleeve may not be suitable for people with conditions including large hiatus hernia, gastritis, bleeding disorders or gastric ulcer or lesions.	People who receive an Endosleeve lose approximately 15%-20% of their total body weight at 12-24-months [2].
Endoscopic Outlet Reduction	Sometimes called ‘OverStitch’, the Endoscopic Outlet Reduction procedure is used to revise gastric bypass surgery, even many years following the procedure. The procedure is performed under a general anaesthetic and avoids the need for any incisions or operations. The entire procedure may take around an hour, and postoperative pain is usually minimal. The OverStitch system is inserted by Dr Balalis through an endoscopy to place stitches at the opening between the stomach pouch and intestine to reduce the size of the outlet. Additional stitches may be placed on the wall of the pouch and when tightened reduces the size of the pouch. The procedure is used to reduce the size of the outlet as well as the stomach pouch to provide restriction for patients following gastric bypass.	Following a gastric bypass, the gastric outlet (opening between the stomach pouch and the intestine) may gradually expand with time, increasing the capacity to hold food. Endoscopic Outlet Reduction is beneficial for patients who have had previous gastric bypass surgery and are experiencing weight gain.	It is difficult to predict how patients will respond to the Endoscopic Outlet Reduction, however in a large multi-centre trial [3], the proportion of patients achieving ≥5% total body weight loss at 12 months was 67.6%. Overall, over 75% of patients experienced weight gain arrest or stabilisation at 6 and 12 months.
Weight loss Medications (non-injectables)	Weight loss medications can be used to assist in losing weight, as an adjunct to other treatment from medical and allied health professionals. Except for orlistat, which reduces absorption of ingested calories, the medications used to treat obesity primarily act via effects on appetite (reducing hunger and/or increasing satiation). It’s for this reason they can also assist with prevention of weight regain post other weight loss treatments.	• BMI > 30 • BMI >27 with comorbidities Pharmacotherapy is often best used to maintain weight loss following intensive dietary therapy (e.g. VLED), placement of intragastric balloons or even after bariatric surgery, or to prevent or reduce weight regain.	Around 4–6% over 12 months, and over 5% after 12 months’ use [4]. While data on long-term safety and effectiveness of medications for weight loss is limited, it is expected that treatment is required over the long term (as for any other chronic condition). All obesity medications are associated with improvements in cardiovascular risk factors, and some have been shown to control hyperglycaemia, inflammatory markers, glycaemic parameters, blood pressure and lipid levels.
Weight Loss Injections	Weight loss injections were originally developed as treatments for Type 2 Diabetes but have since been prescribed off-label to treat obesity. These injections mediate improved insulin secretion in response to a meal, and acts on parts of the brain including the hypothalamus, hindbrain and mesolimbic pathway to signal to the brain that the body is full, reduce hunger and promote food reward.	• BMI > 30 • BMI >27 with comorbidities Pharmacotherapy is often best used to maintain weight loss following intensive dietary therapy (e.g. VLED), placement of intragastric balloons or even after bariatric surgery, or to prevent or reduce weight regain.	When used at recommended doses for obesity management in people without type 2 diabetes, mean weight losses in clinical trials vary depending on the medication prescribed, however average weight loss is approximately 10% of Total Body Weight Loss [5].
Gastric Balloons	Gastric balloons work by reducing the space within your stomach, helping you feel full. This enables you to make healthier choices, curb hunger and build new habits over the 16 weeks the balloon remains in place. The balloon is placed during a 20-minute outpatient appointment, where the patient is guided through swallowing a capsule containing the deflated balloon. An x-ray is used to confirm correct positioning of the capsule before the balloon is filled with water. Once filled, a second x-ray is taken, ensuring the filled balloon is sitting in the right place. The balloon is placed without endoscopy, sedation, or anaesthesia, and does not require manual removal (your body naturally releases the balloon after 16 weeks).	• BMI 27-40 • Age > 18 • No prior surgery to your stomach or oesophagus. • Not currently pregnant or breastfeeding • Prepared to make permanent lifestyle changes.	Placement of an Allurion Balloon (previously called ‘Elipse’) enables an average weight loss of 10-15% of total body weight [6].
Dieting	There is a myriad of different diet types available - from macro diets (counting the intake of proteins, fats, and carbs), calorie restriction or VLED (Very Low Energy Diet), low-carb & whole food diet and more. The CSIRO diet, for example, includes a higher protein intake to reduce cravings to deliver weight loss results.	More than 2.5 million Australians over 15 years of age have tried a weight loss diet [7]. While there are no specific eligibility criteria set for those trying a diet at home (such as the Mediterranean diet), some diet programs (such as CSIRO or light ‘n easy) or working with a licensed dietician will likely utilise some eligibility criteria.	According to the CSIRO website: • Members lose 7.2% after completing the first 12 weeks, 9% after 6 months and then maintain their weight loss for the remainder of the year. • “Super star” members (those who engaged with the tools and features the most) continued to lose weight for a full year, with an average total weight loss of 22.3kg or 21.7% after 1 year. • 64% of members had lost a clinically significant amount of weight loss at 1 year, with a sustained average weight loss of 10.6kg, or 11.9% of their starting body weight. While the CSIRO diet is not considered low-calorie, it’s important to note that a recent study showed that after a low-calorie diet, only 25% of patients succeed in maintaining the result of weight loss for a long time [8].

 

Choose the path that is right for you.

The path to sustainable weight loss is not an easy route, and it is multi-faceted.

It’s important that you therefore not only choose the path that is best for you, but that you have access to the right level of support available throughout your journey.

Some questions you may consider asking yourself before you move ahead:

• Will my chosen path provide long-term results?
• Has the path been properly tested with proven results?
• What are the long-term changes I will have to make? E.g. long-term medication, vitamins etc
• Will I have support on the journey? For example, do you have access to ongoing resources or peer support? Is there someone that you can call?
• Does my chosen path take into consideration ALL of me? That is, any pre-existing health conditions, my lifestyle choices, my emotional and psychological health, my eating habits?
• If you opt for surgery, does your surgeon stay by your side for your whole journey (pre-, during and post-surgery), or are they mainly present for only the surgery itself?

 

Choosing to take control of your weight can daunting, and the truth is there is no light and easy way to achieve long-lasting results. But not only can it transform your health, it can change your life.

The team at Dr Balalis are passionate about helping people achieve their weight loss goals and diet and lifestyle management and ensuring that we find the right solution for YOU.

We’re a holistic clinic that provides patients which a range of services to suit their needs. From a range of surgical and non-surgical solutions available, to access to an interdisciplinary team of Surgeons, Endocrinologists, (Bariatric) General Practitioners, Psychologists, Dietitians, and a Habit Change Expert, all tailoring a plan to your needs.

If you are considering taking charge of your weight, we’d love to chat and see if we can help. We can’t promise it will be light or easy, but we can promise to be there for you on your journey.

To find out more about Dr Balalis and the team, or to make an appointment visit Dr George Balalis – Home.

References:

[1] Flore et al (2022). Weight Maintenance after Dietary Weight Loss: Systematic Review and Meta-Analysis on the Effectiveness of Behavioural Intensive Intervention. Available at: Weight Maintenance after Dietary Weight Loss: Systematic Review and Meta-Analysis on the Effectiveness of Behavioural Intensive Intervention (Accessed: 7 March 2024).

[2] Dayyeh et al (28 July, 2022). Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Available at: Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. (Accessed: 22 December 2022).

[3] Vargas, E.J., Bazerbachi, F., Rizk, M. et al. (2017) Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Available at: Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. (Accessed: March 7, 2024).

[4] Unknown. 2023. Medication and Surgery for the Treatment of Overweight and Obesity in Adults. [Online] Obesity Evidence Hub. Available at: Medication and Surgery for the Treatment of Overweight and Obesity in Adults. (Accessed: March 7, 2024).

[5] Unknown. 2023. Current and emerging medications for the management of obesity in adults. [Online] The Medical Journal of Australia, 218(6). Available at: urrent and emerging medications for the management of obesity in adults. [Online] The Medical Journal of Australia, 218(6) (Accessed: March 7, 2024).

[6] Obesity Surgery in 2020, volume 30

[7] Australian Bureau of Statistics. (2014). Australian Health Survey: Nutrition – First Results – Foods and Nutrients. [Online] Available at: Australian Health Survey: Nutrition – First Results – Foods and Nutrients. (Accessed: March 7, 2024).