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 GastroX, 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.
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.
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:
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 GastroX. 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.
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:
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.
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.
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)
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.