Modern treatment options give people more support than ever.
No matter how motivated and disciplined, managing weight is challenging, with the odds often stacked against us.
Not only is it natural to add around a third of a kilogram each year over the age of 40, but lifestyle, social, and genetic factors combine to make keeping the weight off a stubbornly recurrent issue even for those who shed it in the first place.
That’s according to Southern Weight Loss surgeon Dr Mark Grant, who advocates a holistic and co-ordinated approach to shedding kilos and – more importantly – keeping them off. The available treatments include a combination of surgery, medication, and a dietitian’s guidance targeted at levelling the playing field of weight loss.
“Many are depressingly familiar with the cycle of losing the pounds through hard work and adhering to a strict diet, only to see it come back in what seems like the blink of an eye,” he says.
It’s a pattern many people will recognise – and one that modern medical understanding is finally starting to address.
Until recently, the only way to lose weight was through diet and exercise; these factors remain crucial in any weight loss programme, but he says advances in surgery, medication, dietetics and nutrition have increased the inventory of approaches.
Dr Grant points out that New Zealand has the third-highest adult obesity rate in the OECD, with over one in three adults classified as obese (Body Mass Index – BMI – above 30). Obesity rates are increasing and are more pronounced in Māori and Pasifika communities.
“There is a natural tendency to add pounds as one ages, but to that we must add increasingly sedentary lifestyles,” he says. “Lots of Kiwis are quite active when younger, but we tend to slow down more than we should with age. We also prefer our cars for transport, and we have easy access to calories that we just aren’t burning.”
Moreover, Dr Grant says genetic hangovers make us prone to consuming more than we need. “We’re in an obesogenic environment, where it’s easy to take in more than we need,” he explains. “Essentially, our DNA urges us to eat at every opportunity because thousands of years ago, we wouldn’t know when the next meal was coming.”
With the emergence of factors including electronic entertainment and the convenience of the car, Dr Grant adds that successive generations tend further towards obesity. “There is increased susceptibility. And once you start putting on weight, it becomes a vicious cycle with your body essentially fighting to get back to overweight if you do manage to lose it.”
Only in the past five years have more effective medications emerged to support weight loss, but even those aren’t necessarily effective in the long term unless combined with clinical and dietary advice.
Perhaps the most radical primary intervention is surgical. There are procedure options including gastric sleeve which permanently removes around 85% of the stomach, limiting how much can be eaten (and reducing ghrelin production, suppressing appetite) and several methods of gastric bypass, which limits nutrient absorption.
Dr Grant says these procedures can be among the most effective for long-term weight loss. However, he is quick to note that surgery isn’t for everyone, and that regardless of the approach, effective and lasting support is crucial for long-term success. “Firstly, most of our patients are very well informed, and we have an approach that favours patient choice while sharing all possible avenues,” Dr Grant explains.
Southern Weight Loss advises that surgery can be appropriate for some people with a BMI over 40. “Again, as we have several procedures available, patients often express a preference,” says Dr Grant.
Somewhat self-deprecatingly, Dr Grant says his role as a surgeon is just one cog in the weight loss wheel and hastens to add that an operation is often considered among the last resorts.
“What’s more important by far is having more options available so the best one is available to meet individual patient needs. And, the combination of dietitian and clinician is essential, so you’re getting the right food in the right quantities so you’re maintaining a healthy body and not shedding muscle mass,” he says.
“In our experience, the best opportunity for success is comprehensive support.”
For Dr Grant and the team at Southern Weight Loss, the measure of success is patients who keep the weight off long term. “We want our patients to be successful, because that means living better, improved mental health, being able to play with children and grandchildren, and in many cases not just making life better and more rewarding, but also longer.”
Learn more: southernweightloss.co.nz