Posts in category: Questions

I have received a lot of questions about weight regain and using Ozempic or Monjourno after weight loss surgery. I appreciate your ongoing interest in exploring different approaches to weight loss and your dedication to understanding the complexities of our bodies and I want to share my response to this question here. You’ve raised some essential questions about the use of GLP-1 agonists, such as Mounjaro and Wegovy, in weight management.

First, it’s crucial to acknowledge that GLP-1 agonists can indeed be very effective for weight loss, but they do not fundamentally alter the body’s “set point” for body fat. This means that, while these medications can help you achieve significant weight loss, they must be used in conjunction with a healthy diet and exercise to be successful.

The reason behind this lies in the body’s innate mechanisms. Just like with weight loss through traditional means, your body perceives a change in your fat stores when using GLP-1 agonists. It responds by shedding some of that excess fat, leading to weight loss. However, when you stop taking these medications, your body will naturally work to restore its body fat levels back to where they were before.

To put it in perspective, you can think of GLP-1 agonists as being similar to medications used to control blood sugar levels in diabetics. As long as these medications are taken appropriately, they can effectively maintain blood sugar within normal ranges, especially when combined with an appropriate diet. However, the underlying condition still exists, and blood sugar levels will rise to abnormal levels if the medication is discontinued.

In much the same way, when you stop taking GLP-1 agonists, your body fat levels may gradually return to their previous baseline. Adhering to a healthy diet and exercise regimen can help slow down this progression, but studies have shown that around 90% of individuals may experience weight regain after discontinuing these medications.

Now, let’s compare this to weight loss surgery, where the outcomes are quite remarkable. Weight loss surgery not only aids in achieving significant weight loss but also offers an additional benefit, particularly in cases of type II diabetes. Unlike GLP-1 agonists, weight loss surgery can often restore normal blood sugar levels in individuals with type II diabetes without the need for medications.

Moreover, weight loss surgery doesn’t just stop at weight reduction; it goes a step further. It has the unique ability to reset the body’s fat stores to a more normal, physiologic level. This process occurs naturally without the need for additional medications to facilitate or maintain the weight loss.

In essence, weight loss surgery represents a comprehensive approach to improving health by addressing both weight management and related conditions like type II diabetes. It not only helps you achieve a healthier weight but also encourages your body to maintain it without the constant reliance on medications.

The key takeaway here is that GLP-1 agonists can be valuable tools in your weight loss journey, but they are not a permanent solution on their own. To maintain your weight loss successfully, it’s essential to continue with a healthy lifestyle that includes diet and exercise. The medication can provide assistance, but your ongoing commitment is vital.

If you have more questions or would like to discuss this further, please feel free to reach out and submit your question here. Your dedication to understanding your options is commendable, and we are here to support you on your path to better health.

In our mission to continually provide transparent and cutting-edge medical advice, we’ve encountered a compelling question that immediately caught our attention. The inquiry, “What your feelings are on the newer ESG procedure vs traditional sleeve?” is not just a testament to the evolving curiosity in our community but also signals a broader interest in understanding the forefront of weight-loss surgeries. Recognizing the importance of this question and its relevance to many out there considering their options, we’ve decided to dedicate this blog post to elaborating on the nuances between the Endoscopic Sleeve Gastroplasty (ESG) procedure and the traditional sleeve gastrectomy. This comparison is crucial for anyone standing at the crossroads of making a significant life-changing decision about their health and well-being.

We value your curiosity about weight loss solutions. Exploring the differences between the endoscopic sleeve gastrectomy (ESG) procedure and traditional surgical methods like the vertical sleeve gastrectomy (VSG) can provide valuable insights for those interested in weight loss options.

Let’s start by revisiting the concept of the body’s “set point” for weight. Our bodies have evolved over millennia to maintain a certain level of body fat, much like a thermostat maintaining a specific temperature. This set point makes it challenging to sustain weight loss achieved through traditional diet and exercise plans. When you shed pounds, your body perceives this change as a deviation from its established set point and responds by working to restore those fat stores.

Now, when we delve into weight loss surgery, such as the traditional vertical sleeve gastrectomy or gastric bypass, we find that these procedures go beyond merely reducing the size of the stomach. They have a remarkable ability to alter the body’s set point for body fat. This means that the body not only loses weight but actively collaborates with the patient to maintain it, without constant reliance on medications or extreme dietary restrictions.

On the other hand, the newer ESG procedure focuses primarily on reducing the stomach’s capacity for food. While studies have shown good weight loss results in the first year after the procedure, it does not address the body’s set point. It doesn’t alter hunger hormone levels or affect the brain’s hunger centers. Consequently, it lacks the comprehensive, physiologic approach provided by traditional surgical methods.

In my experience, I’ve observed that the ESG procedure can have a higher rate of weight regain compared to traditional surgical options. Additionally, I’ve seen cases where the gastric suture line has completely opened up a year after the ESG procedure, which raises concerns about its long-term effectiveness.

Another aspect to consider is the cost involved. The ESG procedure is not typically covered by insurance and can be an out-of-pocket expense of up to $10,000 for the patient. This raises questions about the value of investing such a significant sum in a procedure that may yield only temporary results.  

It’s important to note that some practitioners, including gastroenterologists, may offer the ESG procedure without fully grasping the physiology of surgical weight loss. They may assume that permanent weight loss comes solely from reducing food intake. However, this oversimplified view doesn’t take into account the complex interplay of factors that contribute to excess body weight.  This is analogous to the lap-band procedure.  A procedure with no metabolic effects that was meant only to reduce intake.  That procedure received quite a bit of attention for over a decade and is now all but defunct due to a high weight regain rate.

In closing, I share your concerns about the ESG procedure. While there may be specific circumstances where it is a viable weight loss option (perhaps in cases where surgery is not an option), it’s essential to approach it with caution and carefully consider the long-term outcomes. Traditional surgical procedures like VSG and gastric bypass have proven to be more effective in helping patients maintain reductions in body fat.

I hope this information provides you with a better understanding of the options available to you. If you have any more questions or would like to discuss this further, please feel free to reach out and submit your questions here. Your health and well-being are of utmost importance, and I’m here to support you in making informed decisions.