The broad question under consideration here is whether the GLP-1 drugs in their various manifestations will cure obesity once and for all, and particularly whether they can possibly do so in the absence of continuing lifestyle intervention.
For comparison purposes, and to attempt to predict what the case will be with the new drugs, it is helpful to review the facts surrounding what was, up until recently, considered the last, best hope. Before these revolutionary new medications arrived, bariatric surgery was seen as the ultimate solution. That modality entails much preparation and extensive post-operative followup care.
Most importantly, and perhaps too often overlooked by optimists, this particular type of surgery requires a ton of consistent compliance at every stage — most essentially, the stage known as “the rest of the patient’s life.” This is where lifestyle intervention succeeds or fails.
As we have seen, the fundamentals of lifestyle medicine include appropriate nutrition, frequent physical activity, effective stress management, quality sleep, the maintenance of satisfactory social connections, and steering clear of risky substances (be they food, alcohol, drugs, or whatever.) That last part encompasses not only substances but in the case of non-substance addictions like gambling, requires the active and diligent avoidance of cues that trigger addictive behaviors.
A healthy, well-functioning person who wants to remain that way needs all these “pillars” to hold up the magnificent edifice of their recovery. A person with a problem needs to stay on top of every aspect of those conditions, every hour of every day, into infinity.
The prospect is not an encouraging one. The statistics on weight regain one year after surgery are alarming, and the harm does not stop there. The pounds continue to pile back on. Even under ideal circumstances and optimal conditions, surgery alone is not a fix.
The American Gastroenterological Association (AGA) says, “Patients, on average, return to their baseline weight within 4-5 years.” Numbers like this encouraged the AGA to review its Obesity Guidelines and conclude that good isn’t good enough. The group called current practices “usual care or minimal treatment,” and recommended that a comprehensive maintenance program become the norm.
Childhood Obesity News has talked before about preparation for bariatric surgery. The expectations include such lifestyle changes as weight loss, smoking cessation, restricted diet, counseling, and maybe even exercise. The patient will probably burn off some calories fighting with their insurer.
The overall picture is daunting. Yet even people who go through all that aggro in order to qualify for surgery, can somehow not find it within themselves to get with a program and stick with a program. Apparently, that is the only way to maintain a healthy weight.
Your responses and feedback are welcome!
Source: “Intensive Lifestyle Intervention for Obesity: Principles, Practices, and Results,” ScienceDirect.com, May 2017
Image by Hernán Piñera/CC BY-SA 2.0