Obesity: 3 weight-loss options and their risks and benefits

Aisha Langford

Obesity and its associated health problems continue to be a major public health issue facing Americans.

More than 1 in 3 American adults are obese, and about $147 billion were spent on obesity-related medical costs in 2008.

Obesity is defined as having a body mass index (BMI) of 30 or higher. BMI is the main screening tool used by healthcare providers to identify those who are obese. It’s calculated based on a person’s height and weight.

Obese people are at higher risk for developing health problems such as Type 2 diabetes, cancer, heart disease and stroke. It also raises the risk of early death.

The Affordable Care Act, also known as Obamacare, covers obesity screening and counseling with no copays or deductibles.

Currently, health insurance plans aren’t required to cover obesity treatments such as medication and weight-loss surgery, although coverage is becoming more common. Coverage varies from policy to policy.

Here are three weight-loss options that may be covered by your health insurance policy.

1. Lifestyle and behavior change supports.

Weight-loss lifestyle changes start with things such as controlling portion sizes, reading food labels and understanding your food habits, says Pam Davis, a nurse and director of a bariatric program in Tennessee.

Primary care doctors can be useful in helping patients with obesity. It’s ideal to see a doctor who is board-certified in obesity medicine, says Ted Kyle, a registered pharmacist and advocacy adviser for The Obesity Society. You can find a list of obesity medicine specialists on the American Board of Obesity Medicine’s website.

“Obesity is a very complicated issue — it’s not just about having discipline with diet and exercise,” Kyle says.

Obesity medicine doctors have special training in working with obese patients and a strong understanding of the genetic, biologic, environmental, social and behavioral factors that contribute to obesity.

For example, some patients have hormone problems that contribute to obesity like underactive thyroid. Other patients live in neighborhoods with limited gyms and safe places to exercise, making it difficult to be physically active.

Another health insurance option is sessions with a registered dietitian to learn strategies for making better food choices.

The United State Preventive Services Task Force recommends that health care providers offer or refer patients with a body mass index (BMI) of 30 or higher to receive “intensive, multicomponent behavioral interventions”. A session with a registered dietitian may be included under this recommendation.

2. Weight-loss medications.

If behavior modification and lifestyle changes don’t work for you, your doctor may want to explore prescription weight-loss medications.

Many weight-loss drugs work by suppressing your appetite and are taken in pill form — although some of the newer medications are taken by injection.

However, this may not be a great option for people with a lot of weight to lose — the average weight loss with medications is about 5 to 10 pounds over the course of one year.

3. Weight-loss surgery.

There are two principal types of weight-loss surgery: gastric bypass and sleeve gastrectomy surgery. These procedures will affect your long-term ability to fully absorb nutrients such as vitamins and minerals.

Gastric bypass

The Roux-en-Y gastric bypass — often simply called gastric bypass — is the most commonly performed surgery for weight loss in the U.S.

The procedure re-routes your digestive system by creating a small pouch with the top of your stomach, and dividing it from the rest of your stomach. The small intestine is also divided into two parts. The bottom part of the small intestine is then connected to the newly formed, smaller stomach pouch.

After the surgery, your stomach is smaller, so you eat smaller meals and feel full on less food, leading to less calorie consumption overall.

The gastric bypass can produce significant weight loss — as much as 60 to 80 percent of excess weight.

However, it’s the most complicated of the weight-loss surgeries and has a longer recovery time. Risks of the surgery include longer hospital stays and nutrition deficiencies including calcium and B12.

Sleeve gastrectomy

The laparoscopic sleeve gastrectomy — often called “the sleeve” — removes about 80 percent of the stomach. The remaining part of the stomach looks like a long tube that resembles a banana.

Like gastric bypass surgery, the sleeve works by reducing the amount of food you can consume. It impacts hormones in your gut that control hunger, feelings of fullness and blood sugars. This type of surgery isn’t reversible and it can have a number of complications.

Risks for the sleeve include gastritis (inflamed stomach lining) and leaking from the parts of the stomach that have been stapled together.

According to the American Society for Metabolic and Bariatric Surgery, qualifications for weight-loss surgery may include:

1. A BMI equal to or greater than 40, or more than 100 pounds overweight.
2. A BMI equal to or greater than 35 and at least two obesity-related problems like diabetes or heart disease.

3. Trying to lose weight on your own without success or only with short-term results.