Treatment Options

Obesity Treatments

Treating obesity isn’t as simple as eating less and exercising more. It’s normal for some treatments to work for some people and not for others. A wide variety of responses to treatment is normal.

Managing and treating obesity is complex¹. You’ve probably tried diets and exercise regimes. Perhaps they’ve worked in the short term, but most people find they regain the weight they lose, and more².

That’s because your body senses weight loss and actively tries to return you to your starting weight. Your body does this in two ways.

First, the amount of energy your body uses (when resting or exercising) is less than what your body is expecting to use based on your weight and body composition^1,3,4,5. Your body slows down your metabolism and this change can last for years, even if you regain the weight you have lost.

Secondly, your hormones change to make you hungrier, which also pushes your weight back up^1,3,4,5.

No matter how hard you try, it’s like your body is working against you. It’s pretty demoralising, isn’t it?

Lifestyle changes
Prescription medication
Weight loss surgery

Lifestyle changes

Lifestyle changes like dieting and exercise, and behavioural modification are the first steps towards sustained weight loss.

Intensive Lifestyle Change: Diet and Exercise^7†

8 year long diet and exercise intervention with weekly multi-disciplinary medical care for 6 months and monthly sessions for 8 years.

variation of weight loss response

25%

ended up weighing more than their starting weight^7†

25%

kept off less than 5% of their starting weight^7†

50%

reached and kept off more than 5% of their starting weight^7†

...

people losing more than 20% of starting weight is unknown as was not reported in this study^7†

When you choose to make lifestyle changes for weight loss, you’re trying to reduce the amount of energy that you eat so your body uses its stored energy. In terms of outcomes, there isn’t one diet or exercise regime that’s better than another. It’s more about what suits your tastes, budget, household and preferences. You should also choose lifestyle changes you think you can make long term.

A sustainable approach combining healthy eating, regular exercise, and positive habits to achieve lasting weight loss.

Your weight loss lifestyle plan will include a lower energy diet where you calculate the number of kilojoules you’re eating per day. Your diet will include more vegetables, fruit, whole grains, legumes, nuts, seeds, lean meat, eggs and low fat dairy. You will minimise eating energy-dense and processed foods and sugar-sweetened drinks and avoid alcohol⁶.

At the same time, it’s important that you introduce exercise into your routine. At the beginning, water-based exercises might be easier, but you could also try walking and other gentler activities.

You don’t have to do any of this on your own. Any weight loss lifestyle changes should be supported by your GP. You can also get the help from professionals like a dietician, exercise physiologist, lifestyle coach and/or psychologist⁷. They can all help you find the right lifestyle change for you.

Lifestyle changes and behavioural modification can lead to successful and sustained weight loss⁵. Studies have found that even small lifestyle changes can make big impacts on your general health. It can help reduce the risk of diabetes and other obesity-related complications¹. It’s estimated that in one year, you can lose about 3.2% of your body weight with lifestyle changes⁸.

For many people, it’s difficult to maintain this weight loss in the short to medium term. If you have maintained weight loss for 2-5 years, there’s a better chance you’ll keep it off longer term⁹.

If you’re finding it difficult to maintain weight loss with lifestyle changes, there are other options. Have a chat with your doctor about what might help.

Prescription medication

Prescription medication can be a useful addition to lifestyle measures for managing obesity.

Weight Loss GLP-1 Medications^8,9,10

Roughly one year after stopping weekly semaglutide injections: treatment was combined with diet and exercise.

variation of weight loss response

5%

ended up weighing more than their starting weight⁸

30-50%

kept off less than 5% of their starting weight^8,9,10

40-55%

kept off 5-20% of their starting weight^8,9,10

5%

kept off more than 20% of their starting weight for 1 year after stopping injections^8,9

Prescription weight loss medication may be recommended if lifestyle strategies haven’t worked and your BMI remains over 30. They can also be recommended if you have obesity related complications and your BMI is between 27 and 30.5^{8 10 11}

They are also sometimes recommended after a person has been on a very low energy diet to prevent weight gain.¹²

Medications prescribed by healthcare professionals to treat, manage, or prevent specific medical conditions.

Prescription medications usually reduce feelings of hunger. They also work by prolonging the feeling of fullness after eating. ^{5 10 11}

Clinical studies of drug therapies have shown average weight loss of between 3% and 12% of your baseline bodyweight. This depends on your individual body type.

Studies show that your weight loss at 12-16 weeks predicts how much weight you’ll lose a year and beyond. If you haven’t lost at least 5% of your weight within three to four months or you need to lose more, your doctor will discuss additional options with you. ^{5 10 11}

Prescription weight loss medication doesn’t work for everyone. About 32-50% of people won’t lose 5% of their weight by this time^{. 10 11}

Although prescription medicines are promising for many in the short term, people rarely stay on them. Reasons include the cost, concerns about the side effects and a belief that it’s no longer necessary.⁵

If you’re one of the people who didn’t lose 5% of the starting weight in 3 months, or you are adversely impacted by the side effects, there are other options. Have a chat with your doctor about what other obesity treatment might be appropriate.

Weight loss surgery

Weight loss surgery is also known as bariatric surgery. It aims to reduce weight and improve medical conditions which are associated with obesity.¹³

Bariatric Surgeries^{11,12,13,14,#}

5 years after Gastric Bypass or Sleeve Gastrectomy: surgery combined with diet and exercise.

variation of weight loss response

…

Less than 1 in 1000 ended up weighing more than their starting weight^11,13

5-10%

kept off <5% of their starting weight^12‡

5-10%

estimated to have kept off 5-20% of their starting weight¹³

5%

kept off more than 20% of their starting weight at 5 years after surgery^14,Ω

Your doctor may consider you for bariatric surgery if these conditions apply to you:⁷

Your BMI is over 40.
Your BMI is over 35 and you have a comorbidity that may improve with weight loss.
Your BMI is over 30 and you have uncontrolled type 2 diabetes and at increased cardiovascular risk.

You must show that you’re committed to making lifestyle changes and you need to understand the risks of surgery and agree to follow up care.

A professional depiction highlighting the trust and care between a doctor and patient.

Disclaimer: Consult your doctor for weight management and get help to work out what weight loss plan is best for you.

Weight loss surgery works by increasing the feeling of fullness after you eat.^{14, 15}

Most weight loss surgeries in Australia and New Zealand are performed laparoscopically. That means they’re key-hole surgery.¹⁶

When you have key-hole surgery, you usually spend less time in hospital, have fewer complications and it takes less time to make a full recovery compared to open surgery. ^17,18,19

The average length of stay in hospital for patients after bariatric surgery is between 1.9 and 2.8 days, depending on which procedure you have done.²⁰

A weight-loss surgery that removes part of the stomach to help reduce appetite and food intake.

Sleeve gastrectomy or gastric sleeve surgery

72% of weight loss surgeries in 2018/19 were sleeve gastrectomy.²¹

Your surgeon uses a stapling device to create a ‘sleeve’ in your stomach and removes the rest of the stomach.

Your stomach will hold only about a fifth of what it used to.²²

A surgical weight-loss procedure that reduces stomach size and reroutes the small intestine to help with long-term weight management.

Roux-en-y gastric bypass surgery

10% of weight loss surgeries in 2018/19 were roux-en-y- gastric bypasses^.21

In this surgery, your surgeon will use staples to create a small pouch in the top part of the stomach.

The pouch sends nutrients straight to the small intestine, bypassing most of the stomach and making you feel fuller.²²

A minimally invasive weight-loss surgery that reroutes food through a single surgical connection to limit absorption.

One anastomosis gastric bypass surgery

7% of weight loss surgeries in 2018/19 were one anastomosis gastric bypass surgeries, sometimes called mini gastric bypass surgery.²¹

Your surgeon will create a gastric pouch which joins to the loop of the intestine.

It’s considered a less complicated version of the roux-en-y gastric bypass^.23

Of all the weight loss strategies, studies have shown that surgery leads to the greatest and most sustained weight loss for people with obesity.^{7, 24}

After three years, the average weight loss is 24%. By 5 years, the average weight loss is 19%.²¹

There are other health advantages too. 31-77% of people with type 2 diabetes manage normal blood sugar without diabetes medication after weight loss surgery. 80% maintain good glycaemic control with reduced or no medication.²⁵

Other reported improvements include:^{13, 25, 26, 27}

Lower cardiovascular risk factors (stroke, high blood pressure, high cholesterol)
Improved kidney function
Reduced respiratory diseases such as asthma and sleep apnoea
Less reflux disease
A better quality of life

Like any medical intervention, bariatric surgery has risks, including the risk of surgical failure, complications, even in rare cases, death.^{13, 27}

Of the over 70,000 patients in Australia and New Zealand who have had surgery since 2012, 0.8% had to have another operation to fix a problem. Less than 1% have been re-admitted to hospital with a complication.²¹

In 2018-19, the rates of adverse events ranged from 1.6% (sleeve gastrectomy) to 6.3% (roux-en-y gastric bypass surgery).²¹

Bariatric surgery is not a quick fix. You need long term commitment to get the best outcomes.

You will need to make substantial lifestyle changes before your surgery. This might mean giving up smoking and most patients will need to use meal replacements for 2-4 weeks beforehand to increase safety of the surgery.¹³

After your weight loss surgery, you will have to follow a healthy lifestyle plan and you will need to take vitamin and mineral supplements for the rest of your life. It’s important that you work on your mental health and get help if you need it, as it will increase your chances of success.²⁸

Obesity is a chronic and progressive disease and there is a high likelihood that you may regain some weight at some point. If you stay connected with your healthcare team, you can help minimise weight gain and live a healthy, active lifestyle.¹³

Get professional advice and guidance from your doctor for your health concerns.

The research behind the science

World Health Organisation Obesity and Overweight Fact Sheet, 9 June 2021 Available at https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. December 2021.
RACGP. Obesity prevention and management position statement 2019. Available at https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf, accessed December 2021.
Dulloo, A. Explaining the failures of obesity therapy: willpower attenuation, target miscalculation or metabolic compensation?. Int J Obes 36, 1418–1420 (2012). https://doi.org/10.1038/ijo.2012.114 https://www.nature.com/articles/ijo2012114
Australian Institute of Health and Welfare 2017. Impact of overweight and obesity as a risk factor for chronic conditions: Australian Burden of Disease Study. Available at https://www.aihw.gov.au/reports/burden-of-disease/impact-of-overweight-and-obesity-as-a-risk-factor-for-chronic-conditions/contents/table-of-contents, Accessed September 2019.
RACP Action to prevent obesity and reduce its impact across the life course – Evidence Review. 2018. Available at https://www.racp.edu.au/docs/default-source/advocacy-library/racp-obesity-position-statement.pdf. Accessed December 2019
National Health and Medical Research Council. Australian Guide to Healthy Eating. Available from: https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating Accessed December 2021.
ANZOS and ADS. 2020. The Australian Obesity Management Algorithm. Available at: https://static1.squaresp ace.com/static/5e3b5875edc1485d14d6fe3a/t/5f333410b37c0216c50936dc/1597191187793/Australian+Obesity+Management+Algorithm+update_22Jun2020.pdf . Accessed December 2021.
Sumithran P and Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci 2103; 124: 231–41. https://pubmed.ncbi.nlm.nih.gov/23126426/
Wing RR & Hill J (2001) Successful weight loss maintenance. Annu Rev Nutr 21: 323-41. https://www.annualreviews.org/doi/10.1146/annurev.nutr.21.1.323
Fothergill E, et al. Persistent Metabolic Adaptation 6 Years After “The Biggest Loser” Competition. Obesity 2016; 24(8): 1612–19.
Dhurandhar N. Stop the patient blame game: what actually causes obesity. Available at https://www.medscape.com/viewarticle/909500, accessed Sept 2019.
Bray G, et al. The Science of Obesity Management: An Endocrine Society Scientific Statement. Obesity Rev. 2018; 39; 79-132
National Health and Medical Research Council (2013). Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Available at https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity, accessed September 2019.
Dimitriadis, G. K., Randeva, M. S., & Miras, A. D. (2017). Potential Hormone Mechanisms of Bariatric Surgery. Current obesity reports, 6(3), 253–265. doi:10.1007/s13679-017-0276-5 https://link.springer.com/article/10.1007%2Fs13679-017-0276-5
Batterham R.L., Cummings D.E. Mechanisms of diabetes improvement following bariatric/metabolic surgery, 2016 Diabetes Care, 39 (6), pp. 893-901. https://diabetesjournals.org/care/article/39/6/893/29560/Mechanisms-of-Diabetes-Improvement-Following
AIHW National Hospital Morbidity Database Australian refined diagnosis-related groups (AR-DRG) data cubes. Version 8.0, 2017-18. https://www.aihw.gov.au/reports/hospitals/ar-drg-data-cubes/contents/data-cubes. Accessed December 2019
Das B, Khan O. The myths of obesity. Int J Surg 2019; 68: 114–16. https://www.sciencedirect.com/science/article/pii/S1743919119301529
Banka G et al. Laparoscopic vs Open Gastric Bypass Surgery Differences in Patient Demographics, Safety, and Outcomes. Arch Surg. 2012;147(6):550-556.
Reoch J et al. Safety of Laparoscopic vs Open Bariatric Surgery – A Systematic Review and Meta-analysis. Arch Surg. 2011; 146 (11):1314-1322.
Ramos A, et al. The International Federation for the Surgery of Obesity and Metabolic Disorders Fifth IFSO Global Registry Report 2019. Available at https://www.ifso.com/pdf/5th-ifso-global-registry-report-september-2019.pdf, accessed December 2019.
Monash University. Bariatric Surgery Registry 2018–19 Report. Available at www.monash.edu/medicine/sphpm/registries/bariatric, accessed September 2019.
Lee P, Dixon J, RACGP Bariatric–metabolic surgery: A guide for the primary care physician July 2017 46(7), Available at https://www.racgp.org.au/afp/2017/july/bariatric-metabolic-surgery-a-guide-for-the-primar Accessed December 2021
Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ. Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients. Obes Surg. 2017;27(5):1153-1167. doi:10.1007/s11695-016-2428-1 https://link.springer.com/article/10.1007/s11695-016-2428-1
Schwartz M, et al. Endocrine Rev 2017; 38: 267–96.
érez-Pevida B, Escalada J, Miras AD and Frühbeck G (2019) Mechanisms Underlying Type 2 Diabetes Remission After Metabolic Surgery. Front. Endocrinol. 10:641. doi: 10.3389/fendo.2019.00641
De Luca M, et al. Obes Surg 2016; 26(8): 1659–96.
Pareek M, et al. J Am Coll Cardiol 2018; 71(6): 670–87.
Karasu S, Psychotherapy-Lite:Obesity and the Role of the Mental Health Practitioner American Journal of Psychotherapy 2013 67:1, 322 https://psychotherapy.psychiatryonline.org/doi/10.1176/appi.psychotherapy.2013.67.1.3

Obesity Treatments

Treating obesity isn’t as simple as eating less and exercising more. It’s normal for some treatments to work for some people and not for others. A wide variety of responses to treatment is normal.

Lifestyle changes

Intensive Lifestyle Change: Diet and Exercise^7†

25%

25%

50%

...