Comparison of lifestyle changes, pharmacological treatment, and bariatric surgery in the treatment of obesity
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Abstract
Currently, 42.5% of Americans and 15% of people globally are classified as obese with a Body Mass Index over 30 kg/m2. Our knowledge of what leads to obesity is limited, however, various factors on an individual and societal level contribute to the disease. Effective treatments are needed as obesity is correlated with other diseases, like type 2 diabetes, cardiovascular diseases, respiratory disorders, and cancer, and its prevalence is projected to increase. Currently, there are three options available for weight loss, a) Lifestyle changes b) pharmacologic intervention, and c) bariatric surgery.Lifestyle changes involving diet and exercise have been the first-line treatment for obesity for years. Maintaining a calorie deficit and a well-balanced diet, like the Mediterranean diet or the Dietary Approaches to Avoid Hypertension (DASH) diet, is an essential part of this treatment. However, this treatment is the least effective. For patients with a higher BMI, one of the other treatments may be preferable.
Pharmacological treatment is quickly becoming the prominent treatment of obesity. Attempts were made throughout the 20th century to develop an effective drug to treat obesity. However, each one had side effects that made the medications more harmful than beneficial. Recently, the Type II diabetes medications, semaglutide and tirzepatide, which act as GLP-1 and GIP receptor agonists, have been found to promote weight loss by increasing satiety levels. These medications are a middle ground in available treatments with better weight-loss effects and limited side effects. However, these medications do have drawbacks because of their side effects and the highest lifetime cost of three treatments.
Bariatric surgery may be an effective treatment for patients with a higher BMI. These surgeries involve the modification of the gastrointestinal system to promote weight loss by changing the GI hormonal makeup, neural pathways, and bile acid composition. Of the three treatments, bariatric surgery causes the greatest reduction in weight and does not require a significant treatment regimen. However, these surgeries are not reversible and have the most significant side effects.
In conclusion, GLP-1 and GIP receptor agonists are currently the treatment of preference. But, by having multiple treatments, the plan can be individualized for a patient’s needs.
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2024