World Obesity Day: what happens when diet and exercise aren't enough?

There is no one-size-fits-all solution, with medication, gastric balloons and surgery all recommended by experts on a case-by-case basis

Elipse by Allurion is a pill that expands in the stomach to the size of a grapefruit and helps to curb appetite. Image is for representation purpose only 
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Perpetuating the fantasy of instant fitness is a huge fallout of social media. From Lycra-clad influencers showcasing their transformation journeys to food bloggers proffering recipes for kale smoothies, there is a constant and underlying message: working out and eating right can earn you a stick-thin physique. However, the deluge of "fitspiration" hides an important fact, one that those dealing with obesity are painfully aware of: there is no one-size-fits-all solution to losing weight.

There are some standard guidelines that can be followed, of course. Dr Imtiyaz Zaki, specialist surgeon at RAK Hospital, recommends calorie cutting, eating more plant-based foods and wholegrain carbohydrates, at least 150 minutes of moderate-intensity physical activity a week, and behavioural changes.

'Everyone has different obstacles to managing weight'

Eating right is a crucial accompaniment to all types of weight-loss solutions.

But, he says, at the end of the day, "everyone is different and has different obstacles to managing weight. There are also underlying factors or medical conditions that can lead to obesity including hypothyroidism, Cushing's syndrome and depression".

Nutritionist Cynthia Bou Khalil agrees. "Other than what we eat, many factors interfere with a person's metabolism. We need to consider exercise, daily activity, portion size, habits, medication use, stress levels, history of diets and more to look at the whole picture to accomplish healthy and sustainable weight loss."

The first step is calculating body mass index. If it's is between 25 and 30, a person is considered overweight. Those with a BMI of more than 30 are considered obese. The dangers of being obese are "multidimensional", says Dr Samir Rahmani, consultant laparoscopic, bariatric and general surgeon at Novomed Centres. "It is a major risk factor for general health, and significantly increases the risk of hypertension, diabetes, dyslipidemia, arthritis, sleep apnoea and infertility. Moreover, it has been recorded that 70 per cent of ICU mortality among Covid patients are obese."

This is why, when diet and exercise alone are not proving successful, experts agree there is no shame in looking for alternative procedures and medical treatments to curb obesity. Among non-surgical procedures, Zaki lists anti-­obesity medication approved by the US Food and Drug Administration. “If a patient’s response to a weight-loss medication is deemed effective – that is, the weight loss is 5 per cent or more of body weight at three months, and safe, the medication can be continued. If deemed ineffective, alternative treatment should be sought.”

Gastric balloons

Gastric balloons are one such alternative. The procedure involves placing a saline-­solution-filled balloon in the stomach, which helps patients to lose weight by curbing appetite. Healthcare company Allurion offers the Elipse Gastric Balloon, a treatment that involves popping a pill that expands in the stomach to the size of a grapefruit and passes naturally after 16 weeks, with patients losing 10 to 15 per cent of their body weight in that time.

“You can look at the gastric balloon route six or 12 months after patients have exhausted all their conservative options with dietary regimens and focused exercise,” says Rahmani.

Khalil, who has worked with patients with gastric balloons, says weight-loss results with it are "superior" to diet and exercise alone. "It may result in long-term weight loss when used in conjunction with a diet and exercise programme," she says. However, beware of the side effects, which Zaki lists as "nausea, vomiting, acid reflux and indigestion".

Khalil and Rahmani also caution that a gastric balloon is not a "magic bullet". "Most obesity treatments are weight-loss 'programmes', so they cannot work alone. You need to combine these with professional dietary advice and regular exercise to get the maximum benefits and maintain long-lasting results," says Rahmani.

For those not comfortable with the balloon, "procedures such as endoscopic sleeve, laparoscopic sleeve, gastric band and bypass are considered in the event that the more conservative measures and non-surgical procedures have failed to yield results", says Rahmani. "At the end of the day, only you and your doctor can determine what the right solution for your particular case is."