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What Is Total Obesity Care and Why Do We Need It? – Monica Anz-Cavazos, MD

The disease of Obesity is an epidemic that affects 42% of Americans. It is the second leading cause of preventable death in the United States. An estimated 500,000 deaths occur every year from obesity ᶦ – that is 1300 deaths every day. Not only does Obesity cause premature death for many Americans, it leads to illness and lasting disability for many more.  the negative health impact of Obesity is especially distressing because it affects people in the prime of life.  At Sage Bariatric Institute, we are committed to making an impact on this disease and its life-threatening effects with total obesity care.

What is the best treatment for obesity?

There are effective treatment options available to assist people in reaching a healthy weight. Bariatric surgery is the most powerful treatment for people with severe obesity.  Appetite suppressant medications or injection drugs such as Ozempic ® and Mounjaro® can be effective as well.  Food coaching programs and lifestyle support are abundant.  Our computers and televisions inundate us with ads for weight loss tactics and programs, and weight loss centers have popped up on nearly every street corner. So why are we still struggling so much with Obesity if there are so many treatment options?

Obesity is not a simple fix.

The problem is that obesity does not have a simple fix.  Our weight is impacted by a multitude of factors, including medical conditions, lifestyle, environment, psychology, hormones, food choices, activity level, and genetics. There are multiple interlocking control systems that connect our brain, our gut, our fat cells and other organs to control our weight. These control systems control our hunger and appetite, activity tolerance, and how our bodies process the food that we eat. In order to have a lasting impact on obesity, we have to impact most, if not all, of these factors.

Bariatric surgery and anti-obesity medications are powerful tools to help manage this disease, but alone they are not enough because they do not address all of the factors involved.  If you just eat less, but don’t change the foods you eat or increase movement, your weight loss will be short-lived.  If you make your stomach smaller but don’t address hunger hormone levels, you may face weight regain. Even the most powerful surgery or injection may fail if not combined with other elements of obesity management.

It’s a little like fixing a car that isn’t running right.  Most of the time, several tools are required to repair a car.  One can’t just choose a wrench to do the job, nor just the screwdriver. One needs several tools.  And often one needs several people… maybe an electrician to fix the electrical system, and the mechanic to replace the spark plug.  Additionally, you have to make sure you are using the correct oil for the engine, and you need to make sure there is good gas in the car. Only with all of the proper people and tools can you get the car running quickly and efficiently again.

So what is the most effective treatment for obesity?

At Sage Bariatric Institute, we approach obesity management with a full toolbox. Some patients need to start with bariatric surgery, while others need to begin with appetite suppressant medications.  Some need dietary education and metabolic physical therapy, while others need the help of a bariatric counseling center. And like the car example above, most patients need several of these tools, and some even need all of them.  Most importantly, patients need a team of people equipped to provide whatever tools they need, and to continually assess how well they are working.

Obesity is a lifelong condition; there is no one-time definitive cure.  Not only are multiple tools often needed, but they are needed in different sequences.  As our bodies lose weight, they can undergo metabolic adaptation that can make it hard to keep the weight off. Satiety hormones which tell us when we are full can decrease, hunger hormones can increase, and the resting metabolic rate may decrease.

When this happens, we need to adjust our approach and add new tools or change the ones we are using so that we stay ahead of our bodies’ attempts to gain weight. Some patients have bariatric surgery and feel so amazing after losing 100 pounds that they feel ‘cured’, but if there is metabolic adaptation and/or they fall back into old eating patterns and behaviors, they can start to regain weight.  They may not want to come back to us for help because they are afraid we will be disappointed in them. Nothing could be further from the truth. We understand this is a lifelong process and we’re here to help our patients on every step of this journey.

The best approach for treating obesity:

Obesity management requires continual effort with the right tools and the most experienced team. Our team consists of bariatric surgeons, doctors, nurse practitioners and dieticians who are specifically trained in obesity management.  We offer all evidence-based surgical and medical tools.  We work very closely with physical therapists who teach our patients how to work out in a way that burns fat, and with counselors who specialize in addressing relationships with food and eating behaviors.  It is a total approach to obesity with a full toolbox, which is the best way to achieve successful and sustainable weight loss.


ᶦ Excess mortality associated with elevated body weight in the USA by state and demographic subgroup: A modelling study Zachary J. Ward,a * Walter C. Willett,b,c Frank B. Hu,b,c,d Lorena S. Pacheco,b Michael W. Long,e and Steven L. Gortmaker f

www.thelancet.com Vol 48 Month June, 2022