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Weight Loss Surgery More Effective Than Diet

But Risks of Obesity Surgery Are Serious and Real

A Role for Weight Loss Drugs continued...

Most people think weight loss drugs are little magic bullets that make fat melt away. Sadly, that's not the case. Like surgery, the drugs work only for patients who follow strict diet and exercise programs, says guidelines author Vincenza Snow, MD, director of clinical programs for the American College of Physicians.

"People need to know they'll have to continue diet and exercise even if they undergo weight loss treatment," Snow tells WebMD. "People need to be aware of the very modest effects of all weight loss drugs. Even so, these small amounts of weight loss can produce good physiological effects. You may not get the figure you want, but those are good things to happen. We want to make sure doctors and patients are very clear about the modest efficacy -- and that there is no long-term data on efficacy or safety."

In other words, Snow says, there's no way -- yet -- to know for sure whether the gains a person gets from weight loss drugs will last over time. And there's no way -- yet -- to know the long-term effects of these drugs.

"We have no evidence one way or the other to say what will happen if you do continue to take obesity drugs for more than one or two years -- we don't know, it is a total black box," Snow says. "These are not cheap drugs. It would be pretty sad if patients were taking these drugs over the long term, spending money, not getting any weight loss, and getting side effects we don't know about yet."

Based on this data, the American College of Physicians has issued new obesity treatment guidelines. The guidelines call for doctors to discuss weight loss surgery with all patients who have a BMI of 40 or more and who suffer from weight-related health problems,weight-related health problems, such as high blood pressure, diabetes, or sleep apnea.

The guidelines strongly suggest that patients first try a doctor-supervised effort to lose weight with diet and exercise, Snow says. Unfortunately, they don't specify how long a person should try this before moving on to surgery.

"We grappled with this question of when to tell a patient that diet and exercise has failed," Snow tells WebMD. "That is where doctor judgment and patient discussion comes in. When do you decide? At three months, six months, nine months? We thought at least three to six months would be a reasonable time, but we could not find an evidence-based figure to put in the guidelines."

Here are the new weight loss treatment guidelines in a nutshell:

  • If you're overweight -- a BMI of 25 to 25.9 -- you need to lose weight. Diet and exercise arerecommended.
  • If you're obese -- a BMI of 30 to 39.9 -- your health depends on losing weight. The new guidelines apply to people with a BMI of 30 or more.
  • A doctor-supervised weight loss program may be all you need.
  • If your weight loss program isn't getting results, you and your doctor may wish to discuss weight loss drugs. The important facts about these drugs are that after six to 12 months, you stand to lose up to 11 extra pounds. This may be enough for important health effects.
  • If your BMI is 40 or more -- and if you have complications such as high blood pressure, diabetes, or sleep apnea -- you should discuss weight loss surgery with your doctor. This does not mean that surgery is an automatic choice for all patients in this category. Weight loss surgery carries considerable risk, including risk of death.
  • Regardless of the weight loss treatment chosen, diet and exercise remain essential

"What is nice is this is the first time we have put together a summary of the surgical versus the nonsurgical treatments for weight loss," Maggard says. "It shows you what you can expect if you try to do drugs plus diet treatments versus surgery. It is a very nice comparison to see what the amount of weight loss to be achieved is likely to be from these treatments. And it helps doctors and patients understand what some of the risks are with surgery."

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