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As people struggling to lose weight well understand, in most cases ‘eating a better diet’ or ‘doing more exercise’ does not work (although these are good for you in other ways).  This is because once you are past a certain age, and past a certain weight, the weight has become ‘locked in’, probably due to the gut bacteria we call the ‘intestinal microbiome’.  It has been well-known for many years that in lab mice, one can transfer obesity from one mouse to another by transferring the intestinal microbiome in the stool.  The exact mechanism by which the intestinal microbiome influences our weight is not known, but, for instance, increasing appetite if we lose weight is probably one factor.

For decades the only reliable way of losing weight in those with obesity, assuming that there is not a simple problem such as excessive consumption of soft drinks or alcohol, has been surgery.  Commonly-employed surgeries include Roux-en-Y gastric bypass (RYGB) which alters the ‘plumbing’ of the gut, and laparoscopic sleeve gastrectomy (LSG) where about 80% of the stomach is removed.  These are both effective at causing weight loss that is usually sustained, assuming dietary changes are followed.  The major problem with these surgeries, however, is that if something goes wrong after the surgery, they cannot be reversed.  For the RYGB operation, vitamin supplements are required for life.  There is also a significant recovery period after surgery, usually at least a month.

Many people will now be aware of the new diabetes medications that are being used successfully for weight loss, notably in the USA.  These drugs are called ‘GLP-1 receptor agonists’, and the most well-known currently is semaglutide which is sold under the trade names Ozempic and Wegovy.  Although there are probably several reasons why these drugs can cause weight loss, probably the main reason is they suppress appetite.  The major downside of these medications, however, is that they are only effective when you are taking them and weight regain will occur when they are stopped, and they often cause low grade symptoms such as nausea or constipation that people get tired of over time. 

A third effective weight loss method is now being offered at Wakefield Hospital.  Endoscopic sleeve gastroplasty (ESG) was developed first in 2013 as a way of ‘copying’ the surgery LSG by using a stitching device on an endoscope to reduce the size of the stomach.  With a reduced stomach size you cannot eat large meals, and you also feel fuller for longer after a small meal.  None of the stomach is actually removed, so if things go wrong the procedure is actually reversible.  By performing the entire procedure through the mouth and not cutting the skin, recovery is much faster, and complications are much fewer.  Over time this technique has been improved, and it is now the most commonly performed obesity procedure in the world, with 5 year results comparable with LSG in those with a BMI of 30 to 40.  Dr Rees Cameron is happy to meet with you to discuss the pros and cons of the different weight loss options, and whether ESG is a good choice for you.  If you wish to explore ESG as an option, then he recommends that you also arrange an appointment with the dietitians of FoodSavvy who can provide a dietary assessment to better inform the best way forward.

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