What to Expect from Obesity Treatment

Dramatic weight loss stories from people taking new obesity and diabetes drugs have many patients asking their healthcare providers, “Could these be right for me?”

Dr. Alicia Shelly, an internal and obesity medicine physician at Wellstar, joined host Bruce Feinberg, DO, on 95.5 WSB’s The Weekly Check-Up to talk about it all, including:

• What to expect from obesity treatment today
• Medication options and costs
• How lifestyle coaching fits into treatment
• When bariatric surgery may be appropriate

“Obesity is a chronic disease,” said Dr. Shelly. “There are multiple reasons why people gain weight and why it's harder for them to lose weight. But know that you don’t have to do it alone.”

What to expect at your obesity appointment

Your first visit to Wellstar Center for Best Health will typically last 30 to 45 minutes, and you’ll be asked about your:

• Medical history
• Past experiences trying to lose weight
• Lifestyle, including exercise, sleep and eating habits
• Stress and mental health

“If you’re struggling with obesity, this is probably not your first time trying to lose weight,” said Dr. Shelly. “We want to understand your journey with weight loss.”

The physical exam includes measuring a body’s composition of fat, muscle and water. She explained that a healthcare professional wants to know where you carry fat. Patients with a high proportion of stomach fat or visceral fat have a greater risk of heart disease, stroke, diabetes, high blood pressure and other conditions.

Obesity medications take center stage

If you’re like many who come to Wellstar, you’ve heard about injectable medications like Wegovy and others. Similar medicines that can be taken by mouth are in clinical trials.

The drugs are called GLP-1s, which is short for glucagon-like peptide-1 receptor agonists. They act like a natural hormone that regulates appetite, slows stomach emptying and decreases insulin levels. As a result, many patients feel full longer, eat less and have better blood sugar control.

“The medications help turn off cravings and your appetite,” Dr. Shelly said. Patients also report less mental “noise” about food, such as musing after breakfast, “What am I going to eat for lunch?"

Without insurance coverage, GLP-1s can cost around $1,000 a month. If you have insurance that covers some or all of the drugs’ costs, you may need your insurance plan’s approval in advance. Wellstar nurse navigators can help you with this process.

If you can’t afford newer medications, there are additional options among older and less costly medications approved for weight loss.

Dr. Shelly noted that if cost and insurance weren’t barriers, she’d probably recommend medication for 75% of her patients. “Many people have already done a lot of diets and exercises in the past to lose weight, but the weight keeps coming back. And that’s because obesity is a chronic disease.”

Nutrition, exercise and behavioral healthcare are all part of obesity treatment

Healthy weight loss takes a combination of approaches, not just prescriptions, according to Dr. Shelly. If you are treated for obesity at Wellstar you’ll likely visit several clinicians, including:

• A registered dietitian for personalized nutrition and meal planning
• An exercise physiologist who develops routines that meet your physical condition
• A psychologist who can help you with motivation, handling cravings and other behavioral factors in weight loss

A dietitian can help you understand the effects of food choices. Dr. Shelly referenced studies showing that eating high amounts of processed food, even with low calories, can hinder weight loss. She recommends cooking at home with fresh food and avoiding vending machines and fast food.

Lack of sleep is another overlooked issue in weight management. “Studies show that when you're sleeping under five hours, your hunger hormone increases, then your weight also increases,” she said. A behavioral health specialist can help you work on improving your sleep health if needed.

Have weight loss drugs eclipsed bariatric surgery?

For years, bariatric surgery on the stomach or intestines has been used to induce weight loss.

Bariatric surgery patients can lose an average of 30 to 35% of their body weight. This is higher than the average loss of patients taking the latest medications. Insurance plans often cover surgery because of the costly and serious medical complications of obesity.

Dr. Shelly stressed that care teams work with you to create treatment plans that fit your conditions, medical histories and personal situations. Then, your care team sticks by you throughout treatment.

She also encourages you to visit your doctors and learn more about new ways to treat obesity. “At Wellstar Centers of Best Health, we’re ready and able to help you,” she said.

To hear more from Dr. Shelly, you can listen to her podcast, “Back on Track: Achieving Healthy Weight Loss.”