Before Weight Loss Surgery: Trying Other Methods First

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Older overweight African American man outdoors smiling and walking with hand weights

About 37% of American adults are obese and nearly 8% have extreme obesity. This means millions of people are at risk for serious health problems and many of them want to do something about it. When you lose 5 to 10% of your body weight, it’s usually enough to lower your risk of obesity-related health problems. So, it’s well worth the effort.

Losing weight can be challenging and many people wonder if weight loss surgery is the solution. It can be, but medical guidelines and health insurance companies require a trial of other weight loss options first. And some people would rather avoid surgery if possible. Here is a look at weight loss surgery alternatives.

How to lose weight without surgery naturally

The basis of any kind of weight loss is eating fewer calories than you use. It’s easy to understand this energy balance concept. It can be hard to put into action. It can also be risky to try to do it on your own if you are obese. In fact, if you are obese, you need to work with a healthcare provider to safely lose weight. This could include your doctor or a registered dietitian nutritionist (RDN). Mental health providers and fitness trainers are also good resources.

Natural weight loss will focus on three core areas:

  • Behavior modification: This aspect of weight loss helps you identify and manage your thoughts, attitudes and behaviors about food and body weight. Many people aren’t even aware of how these views affect them. Until you can uncover and address them, they will continue to get in your way of losing weight. A mental health provider can help you overcome these barriers. You can learn to have realistic beliefs, reward yourself without food, and manage high-risk situations.

  • Exercise: Physical activity greatly increases your chance of successfully losing weight and keeping it off. It counteracts your body’s natural response to reducing your calorie intake. Normally, your body slows your metabolism when it doesn’t have enough fuel. Exercise kicks up your metabolism to increase the number of calories you burn. A fitness trainer can help you make small changes at first. Eventually, the goal is to make physical activity a permanent part of your life.

  • Nutrition: To lose weight safely, you need to decrease the calories you eat while maintaining nutrition. This can be very challenging if you dramatically cut your calories. An RDN will help you through the process and show how to change your eating habits instead of dieting. This includes choosing healthy portion sizes, healthy ways to prepare food, and healthy menu selections when dining out.

Medical options as an alternative to surgery

If natural weight loss is not enough, medical weight loss is another option to try before surgery. In fact, many insurance providers will want you to try medical weight loss first. Usually, they want you to try to lose weight for six to 12 months using this method before approving surgery.

Medical weight loss uses medications to help you shed the pounds. However, it alone is not a long-term answer. You still need to combine it with diet, exercise and behavior changes for the best, long-lasting results.

There are several prescription medicines your doctor can use to help you lose weight. Results vary from person to person and some people respond better to one drug over another. In general, people can lose around 10% of their body weight using medicines. Most of the weight tends to come off in the first six months.

There are risks to medical weight loss. The drugs can cause side effects. Depending on the way they work, side effects range from dizziness and sleep problems to gas, diarrhea, and leakage of oily stool. There are also some rare, but serious, side effects, such as liver damage.

Nonsurgical weight loss procedures

Nonsurgical weight loss procedures are alternatives to gastric bypass—the main type bariatric surgery. Nonsurgical procedures may be an option for people who do not qualify for surgery. This includes people whose BMI (body mass index) is not high enough for surgery. However, doctors will still want you to try to lose weight with diet, exercise, or medical therapy first. And you still need to combine these procedures with long-term lifestyle changes for lasting success.

These procedures are nonsurgical in that they do not require incisions, but they are still invasive. They use an endoscope, which is a lighted instrument with a camera on the tip. The doctor passes the endoscope through your mouth and into your stomach to perform these procedures. 

Currently, there are basic types of procedures:

  • Gastric balloon: This procedure involves placing a silicone balloon in the stomach. The balloon inflates once in place and takes up room in the stomach. This limits the amount of food you can eat and helps you feel full quickly. After six months, your doctor will remove the balloon using an endoscope.

  • Endoscopic plication: This procedure involves folding the stomach into itself and stitching the folds in place. Doctors do this through an endoscope without making any incisions. Other names for this procedure include accordion procedure and endoscopic sleeve gastroplasty. Like the gastric balloon, it limits the size of the stomach. Since it doesn’t remove any of the stomach, it may be reversible.

Both of these procedures result in weight loss of about 10 to 15% of body weight. Keeping the weight off requires a commitment to a healthy diet and regular physical activity.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Mar 14
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