Successful weight loss often requires the use of multiple tools. From the latest in dietary education to the most recent appetite suppressant drugs, to the cutting edge of surgery, treatment options abound. It can be challenging to maneuver through the ads and fads to know what the best path for you is. Sage Bariatric Institute offers a personalized approach to weight loss, designed to help you find which tools are best for you to lose weight and to maximize your health.
Most projects in life require multiple tools. You can’t build a house with only a hammer, and you can’t cook a meal with only a bowl. Weight loss is no different. Injection drugs can be very powerful appetite suppressants, but without the proper dietary changes, they can be harmful. Bariatric surgery is the single most powerful weight loss tool available, but some patients need appetite suppressants as well to work in conjunction with it in order to get the desired weight loss. Dietary education is the foundation of success, but it frequently requires medications and or surgery to really make progress. Sometimes just one of these tools is needed, but other patients require all three.
But how do you know what tools are right for you? Which ones will work? Which ones are safe for you and your other medical conditions? At Sage Bariatric Institute, our experienced team is here to help you navigate the world of weight loss tools. We will work with you to make a plan that takes into account your individual preferences, health conditions, and situations, and we will use all of our knowledge to help find the best treatment plan for you. Additionally, we will stay with you on your journey to monitor your success and your health along the way, and to make adjustments if needed.
Sage Bariatric Institute has a combined 70 years of experience devoted solely to weight loss treatments. We have over 20,000 surgical and non-surgical patients. Our team is consistently award-winning and serve as leaders in the field. Our doctors, nurse practitioners, dietitians, and staff offer you experience, expertise, and a caring community that is with you all the way.
Weight loss is a journey. It is best accomplished with a solid, committed, experienced team who can work with you to set goals, evaluate your progress, and help guide changes that may be needed as you go. We’ve got you! Let’s go!
Bariatric Surgery
Bariatric Surgery is the gold standard treatment for patients with a Body Mass Index (BMI) of 35 or higher if they have additional obesity-related medical conditions, or 40 or higher if they do not. These procedures, including sleeve gastrectomy, gastric bypass, duodenal switch, and others, help people lose weight in several ways. After surgery, patients have significantly decreased food capacity. Their stomach is smaller and thus they can eat less food at a time. Some procedures impact the small intestine and the way food is absorbed, resulting in a lower absorption of calories. Bariatric surgery also significantly impacts hormone levels related to hunger, satiety, and fat storage.
Patients undergoing these procedures typically lose 50-80% of their excess body weight over an average of 18 months. Other benefits of bariatric surgery include:
80% resolution of Type 2 Diabetes Mellitus82% cardiovascular disease risk reduction80% resolution of Polycystic Ovarian Syndrome (PCOS)90% resolution of Obstructive Sleep Apnea57% resolution of migraine headaches40-50% reduction in 10-year mortality
The recovery time from surgery varies upon procedure and each patient, but most patients return to work in 2 weeks. Restrictions after surgery include a 30lb weight limit for 4 weeks.
Post-operatively, patients need to adhere to a healthful diet, active lifestyle, and they need to take bariatric-specific multivitamins. We see our patients 5 times in the first year, twice in the second year, and annually after that. Regular follow up with us is important for monitoring nutrition levels and to have accountability that helps you stay on track. We are always available for more frequent visits for patients who want more regular follow up.
We offer a multitude of ways to support our patients through their journey. Our medical team and dietitians are always here to guide, help, and support our surgical patients. We have a coaching program available to patients, as well as our Sage Circle community of patients who can help support each other and celebrate together.
Potential side effects after surgery can include dehydration if patients don’t drink enough water, and vitamin deficiencies if patients do not take bariatric multivitamins. Sort-term issues like small amounts of hair loss can occur during the rapid weight loss phase for some patients, but with proper nutrition resolves within 3-6 months. Gastric Bypass patients sometimes experience “dumping syndrome”, which is an intolerance to sugar that can cause nausea, sweating, lightheadedness. This can be avoided by not consuming foods that are high in sugar by themselves.
Short-term post-operative complications are uncommon in experienced hands. The safety profile of bariatric surgery in the hands of an experienced bariatric surgeon is similar to that of having a gallbladder removed.
GLP1a Injection Drugs
The treatment of overweight and obesity has been helped recently by the use of Glucagon-Like Peptide 1 receptor agonist drugs (GLP1a) such as Ozempic® (semaglutide), Wegovy® (semaglutide), Saxenda® (liraglutide), Mounjaro® (tirzepatide), and Zepbound® (tirzepatide). These drugs work by slowing the emptying of the stomach which helps you feel full longer and helps decrease the total amount of food eaten. These drugs mimic the hormone GLP1 that signals fullness to the brain, thus decreasing one’s appetite.
GLP1a drugs are good treatment options for patients with a BMI of 27-35. They usually provide a 5-12% loss of excess body weight. On average, diabetic patients experience a 1-1.5% decrease in their Hemoglobin A1c. Studies have shown a cardiovascular risk reduction of 13-26% with GLP1a drugs.
An important thing to note about these drugs is that they require continued use. There are no anatomical or physiological changes that last once the drug is stopped. The majority of patients who stop these drugs experience weight regain.
Mounjaro® and Ozempic® are approved for patients with a diagnosis of diabetes. Zepbound®, Wegovy®, and Saxenda® are approved for weight loss. For those who don’t like needles, Rybelsus is a samaglutide tablet, but it is only approved for diabetes. Injections are done in the abdomen, thigh, or arm, and we usually recommend rotating the injection site. Zepbound® and Wegovy® are weekly injections. Saxenda® is a daily injection. Some of the brands allow adjusting of the dose on the pen, such as Saxenda®, but others like Wegovy® have dose-specific injections pens that cannot be adjusted.
The cost of these drugs can be up to $1500 monthly, but some insurances do cover them. Compounded forms of these drugs are available and are currently allowed by the FDA due to the shortage of many of these drugs. Compounded versions of these drugs are NOT FDA regulated for safety or efficacy, so it is very important that if you choose a compounded drug, you get it from a vetted and reputable source. Some sources of compounded drugs use salts, which can be harmful, unsafe preservatives, and ‘watered down’ active ingredients. At Sage Bariatric, our compounded drugs are made by a pharmacist who sends their batches to an FDA-approved lab for safety testing.
Side effects of these drugs can include (but are not limited to) nausea, vomiting, diarrhea, constipation, abdominal pain, heartburn, pancreatitis, and hypoglycemia. Patients should have their kidney function monitored periodically. Patients with a personal or family history of multiple endocrine neoplasia syndrome type 2, or MEN 2 should be aware of an increased risk of medullary thyroid cancer. In rare cases, GLP1a drugs may affect mood or mental health. It’s important to speak with your healthcare provider immediately if you experience any of these.
Oral Appetite Suppression Medications
Appetite suppressant medications have been an effective part of weight management for nearly a century. These drugs act in a variety of ways and have varied side effects. We will review a few of the most commonly-used ones here.
Phentermine
Phentermine is an oral medicine that has been used in the United States since 1959. While its use with phenfluramine was halted in the 90’s due to safety concerns, phentermine itself has been shown to have a very good safety profile and is very helpful to most people for appetite control.
Qsymia®
Qsymia® is a combination of phentermine and topiramate, a drug originally used to treat epilepsy and migraine headaches. It was approved by the FDA in 2012 for weight loss because it was found that it also helps decrease appetite and can work synergistically with phentermine.
Contrave®
Contrave® is a drug that combines bupropion and naltrexone to impact hunger and cravings. Naltrexone is a drug typically used for addiction treatment, and its effect was found to help with food cravings as well as that of opioids and alcohol. Bupropion is commonly used for depression as well as smoking cessation, and the areas of the brain it impacts also are found to be helpful for appetite suppression.
Orlistat
Orlistat is a drug that impairs the intestine’s ability to absorb dietary fat, which results in absorption of fewer calories. This can be a powerful tool for people who have a tendency to eat high fat foods. It results in the fat being passed in the stool, so patients should be prepared for oily stools, flatulence, and diarrhea if they consume fat while taking this drug. Orlistat is available in an over-the-counter dosage called Alli®, or as Xenical® which is prescription strength.
Rybelsus
Rybelsus® is an oral formulation of semaglutide, which is a GLP1a receptor agonist. It is typically used in patients with diabetes, but semaglutide is a proven treatment for weight loss as well. It is effective at lowering hunger and slowing gastric emptying. The risk of hypoglycemia needs to be considered when using this medication for patients without diabetes.
Nutritional Guidance
The foundation of weight loss is diet. Food is what fuels our body and is the building block of every single cell in our body. What we eat and how we eat is paramount to the success of any program, be it surgical or non-surgical. Our registered dieticians specialize in obesity management and weight loss dietetics. They are skilled at teaching patients what they need to know to have a healthy foundation to their weight loss journey.
Exercise and Movement
While nutrition is the foundation of health, exercise and movement are key to maximizing weight loss and are critical to weight maintenance. Without exercise, one can lose muscle and bone along with fat when on a weight loss program. Exercise, particularly strength training, helps force the body to burn fat instead of muscle. Muscle mass helps with metabolism because muscle tissue burns more calories at rest than fat does. This assists with weight loss, and helps you keep the weight off long-term. Our team works closely with exercise therapists who can teach you how to exercise in a way that helps burn fat and maintain or build muscle mass to maximize weight loss and support weight maintenance.
Psychological Support
The mind is intimately connected to the gut. Our eating habits are closely connected to our psyche, and addressing this relationship can have a powerful impact on one’s success with weight loss. Sage Bariatric Institute works very closely with the Bariatric Counseling Center of San Antonio to provide support for our patients. Their team provides comprehensive counseling, therapy and education that supports our patients on their weight loss journeys. Their team consists of psychologists, dietitians, counselors and therapists who support patients trying to lose weight, regardless of if they are using surgery, medications, both or neither.
With guided support in areas of nutrition, exercise, mindset and lifestyle, weight loss drugs can have a big impact on your health and wellness. Give us a call today to schedule a consultation at (210) 651-0303 or click the Get Started button at the top of this page.
You can do this! We can help!
