Weight Loss: What Medical Interventions Are Available?

But as obesity rates continue to climb in the United States, doctors and scientists increasingly recognize that weight is influenced by more than calories consumed and calories burned. Genetics, hormones, medications, environmental exposures and other biological factors all can influence how the body gains, loses and maintains weight.

Obesity isn’t a failure of willpower. It’s a chronic disease.

This evolving understanding is changing how obesity is treated. Although there have never been so many Americans with obesity before, there also have never been so many medically assisted weight loss interventions available to them, including prescription medications, minimally invasive procedures and bariatric surgery.

About 4 out of 10 American adults are individuals with obesity, which is associated with diabetes, high blood pressure, obstructive sleep apnea and several types of cancer. If curent trends continue, By 2030 about 1 in 2 adultsin the U.S. will be individuals with obesity.

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Medical Treatments Help Manage Obesity

Obesity is a chronic disease that responds to treatment. It is not a personal shortcoming or a lack of willpower. Bariatric surgery, nonsurgical endobariatric procedures and prescription medications can help people lose and maintain weight safely and sustainably, reduce their risk of obesity-related conditions, and improve their overall health.

“If patients are taking six medications for obesity-related diseases, weight loss might reduce their blood pressure and cholesterol levels, so perhaps we can get them off some of those medications,” said Amanda Velazquez, MD, director of obesity medicine at Cedars-Sinai.

Many people need help managing their weight because counting calories and daily workouts aren’t effective for everyone. Even when they are, the weight loss may only be temporary.

“Factors that people don’t think about can contribute to weight gain,” Velazquez said. “If your mom smoked or had diabetes or gestational diabetes while you were in the womb, you have a higher likelihood of being overweight as a child and therefore as an adult. Microplastics that contain endocrine disruptor chemicals have been in products for decades, and they’ve disturbed the way our bodies can process calories.”

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Attitudes Toward Obesity Are Changing

Weight management has become a part of the collective conversation in recent years. TV commercials advertise GLP-1 medications. Celebrities talk about their experiences with medication or surgery. Friends and acquaintances post about their successes on social media.

“Previously, some doctors didn’t even discuss weight with their patients because they didn’t want to offend them,” said Kulmeet Sandhu, MD, a bariatric surgeon at Cedars-Sinai. “Now, patients bring it up, which makes it easier for doctors to say, ‘These are all of the weight loss options.’”

Bariatric Procedures for Weight Management

Bariatric surgery remains the most effective, long-term intervention for keeping weight off and improving metabolic disease, according to Sandhu.

“We’re lengthening life for patients, in a good way, so that they’re able to enjoy that time,” she said.

Bariatric surgeons commonly perform two procedures: sleeve gastrectomy and gastric bypass surgery. Both typically are performed as minimally invasive procedures through small cuts in the abdomen.

During sleeve gastrectomy, surgeons remove a portion of the stomach, which restricts the amount of food it can hold and changes the levels of hunger hormones it produces. Afterward, the stomach resembles a long, skinny sleeve connecting the esophagus to the small intestine.

“Not only do you eat less because your stomach is smaller, but you also feel less hungry because you have less of that hunger hormone,” Sandhu said.

During gastric bypass surgery, bariatric surgeons make two changes that help people lose weight: They restrict the size of the stomach, using staples to create a small pouch that can’t hold much food. They also reroute the intestines, connecting the new stomach pouch to the small intestine, so that food bypasses part of the stomach and the first section of the small intestine.

“You’re eating less because the stomach is smaller, and you don’t absorb as much of the fat and calories because we reroute the intestine,” Sandhu said. “You also don’t absorb as many vitamins and minerals, so patients have to be on vitamins for life.”

Bariatric procedures require an overnight stay in the hospital. These elective procedures are considered very safe, and the risk of complications is low.

After sleeve gastrectomy, patients typically lose 25% to 30% of their total body weight over 12 to 18 months. After gastric bypass, patients typically lose 25% to 35% of their total body weight in the same time frame.

Bariatric surgery may be right for people with a body mass index (BMI) of 40 or higher, or for people with a BMI of 35 or higher who have diabetes, hypertension or sleep apnea.

For lasting results, patients must modify what, and how, they eat.

“Because the stomach is smaller, you have to make sure your bites are smaller and chewed really well,” Sandhu said. “It helps you slow down, think about what you’re eating and realize you’re full.”

Endobariatric Procedures for Weight Management

People who don’t want to undergo surgery or take medication may be intrigued by nonsurgical endobariatric procedures such as endoscopic sleeve gastroplasty, which enables doctors to alter the stomach from within.

Doctors don’t make incisions in the abdomen during endobariatric procedures. Instead, while a patient is under sedation, the doctors access the patient’s stomach by inserting a long, flexible tube into the mouth. Once it reaches the stomach, doctors use specialized tools to reshape and reduce the size of the functioning stomach, creating a sleeve-like stomach without making cuts or removing tissue. They fold over stomach tissue and suture it shut. The procedure reduces the stomach’s volume by 70% to 80%.

“After the stomach is remodeled, patients feel full sooner and stay full longer,” said Rashmi Advani, MD, a bariatric and interventional endoscopist and assistant director of system integration for advanced endoscopy at Cedars-Sinai. “The procedure alters how food moves through the stomach and enhances the body’s natural satiety signals, helping patients achieve sustainable weight loss.”

Endoscopic sleeve gastroplasty is typically an outpatient procedure, and complications are uncommon. Patients who undergo the procedure typically lose up to 25% of their total body weight over 12 months. Many experience significant improvements to obesity-related conditions such as diabetes, high blood pressure, metabolic dysfunction-associated steatotic liver disease (formerly known as fatty liver disease) and sleep apnea.

An endobariatric procedure may be an option for people with a BMI of 30 or higher, or for people with obesity-related conditions (including diabetes) who have a BMI of 27 or higher. It may be recommended when weight-management medications aren’t effective or patients are not ideal candidates for bariatric surgery.

“We are able to offer effective treatments to patients who may not qualify for bariatric surgery or who prefer a less invasive option,” Advani said. “Many patients also seek endoscopic sleeve gastroplasty after struggling with weight regain or inadequate response to weight-loss medications. Others are looking for a pathway to reduce long-term dependence on medications.”

Endobariatric procedures are newer than bariatric procedures, and many insurance companies do not cover them yet, although Advani expects access to these therapies to expand.

“We are only beginning to realize the full potential of these procedures as part of a comprehensive, multidisciplinary approach to obesity care,” she said.

Medications for Weight Management

Some people have wondered if it would ever be possible to take a pill for sustained weight loss. Today, such a medication exists.

GLP-1 receptor agonist medications have caused a buzz in the past five years after gaining U.S. Food and Drug Administration approval to assist people with obesity in managing their weight. Semaglutide can be prescribed as a daily pill or weekly injection. Liraglutide and tirzepatide are only prescribed as weekly injections.

GLP-1 medications change the way the body manages weight.

“They do this by landing on receptors located on different organs,” Velazquez said. “Receptors are like places for a boat to dock. The medication will dock on your stomach, your intestines, your brain and your fat tissue, which helps to improve the way your body regulates weight. It also helps to re-regulate the way your body processes blood sugar.”

Once people begin taking GLP-1 medications, they’re intended to be used for life, or people may regain weight they’ve lost. Data demonstrates the long-term safety of GLP-1 medications.

“This class of medications has been prescribed since 2005 for Type 2 diabetes,” Velazquez said. “We have over 20 years of data showing these medications are safe.”

Possible side effects of GLP-1 medications include constipation, nausea, vomiting or diarrhea.

Insurance companies don’t always cover GLP-1 medications for weight loss. If out-of-pocket costs are too high, doctors may prescribe first-generation obesity medications, such as bupropion/naltrexone, phentermine/topiramate, phentermine and metformin.

People who take GLP-1 receptor agonists lose an average of 15% to 20% of their total body weight over an 18-month period. People who take first-generation obesity medications typically lose 3% to 4% of their total body weight.

Weight management drugs may be prescribed for people with a BMI of 30 or higher, or people with a BMI of 27 or higher who have a weight-related medical condition.

“This should be seen as preventive if we’re catching patients earlier in the disease process,” Velazquez said. “A higher BMI is associated with obesity-related conditions such as cancer, fatty liver, heart disease and diabetes. Early intervention can be disease prevention.”

Weight Management Treatments at Cedars-Sinai

Patients who are seeking treatment for obesity should look for a program with expert providers who can offer a customized treatment plan and who are kind and empathetic.

“Patients say that they feel very heard and validated,” Velazquez said of those treated at Cedars-Sinai. “They feel they’re in a safe space.”

The multidisciplinary team at Cedars-Sinai includes obesity medicine specialists, bariatric surgeons, endobariatric specialists, registered dietitians, social workers, clinical pharmacists and patient navigators, among others.

“We have a strong team that works to get the best outcomes for patients, and we have unbelievable relationships with our patients,” Sandhu said. “Part of the reason I went into this field is because you can build lifelong relationships with your patients.”

Some people hesitate to seek care for obesity because they want to succeed by dieting and exercising alone. But sometimes, a procedure or medication is needed to help people reach a healthier weight.

“I tell patients that it’s not cheating,” Sandhu said. “It’s just a tool to help you get to a healthy weight. You still need to put in the work.”

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