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Pill, Needle Or Knife: Weight Loss Alternatives When You've Tried It All

If you're at a critical point with your weight and your health is going to suffer, drugs or surgery may prove to be a lifeline worth grabbing hold of.

10/25/2017 11:34 EDT | Updated 10/25/2017 11:41 EDT

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You've tried it all: diets and exercise regimens promising weight loss, but delivering no results. Gimmicks and machines that failed to create a fitter you. Not only do you feel hopeless; those pounds you can't lose are starting to take a more serious toll on your overall health — diabetes, high blood pressure, arthritis, depression. You need to lose weight but you don't know where to turn.

First, know you're not alone. Recent OECD data shows that more than 50 per cent of adults are obese or overweight. Second, don't despair — there are options. As the obesity epidemic continues, focus is being placed on accessible, affordable and safe treatments for weight loss.

Before you consider the needle or the knife, though, have an honest look at your nutrition and review the energy you've expended on the exercise front. If you really have done it all without success, it could be time for a trip to the doctor. He or she can help you explore some options that you may not have realized even existed.

There's a drug for that

"Anal leakage." Up until very recently, that's all I had to say when patients asked about weight loss medications on the market. They just had so many side effects, drugs weren't even an option. Now, the tides are turning and, as a patient, you have better options.

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1. Liraglutide (Saxenda) is the newest kid on the block and is winning favour with doctors and patients as an option for those who, despite adherence to weight loss programmes and caloric restriction, just can't lose weight. If you respond similarly to patients in the research trials, you'll likely lose about 18.5 lbs with Liraglutide. A third of patients lost over 10 per cent of their initial body weight. It also improved quality of life and other health indicators such as blood pressure and blood sugar. If you already have Diabetes (type II), this medication may also help prevent future heart attack and stroke.

Patients who take this drug have an increased risk of a certain type of thyroid cancer, so if this cancer runs in your family, it won't be a good fit. Other words of warning: Liraglutide is given by a daily self-injection which can be a deal-breaker for those with needle phobia. Its most common side effect? Nausea, which for some can be intolerable. Finally, studies show that once this medication is stopped, some weight gain can recur. Unless you make significant lifestyle changes with respect to diet and exercise, you may need to use it for the long-term to keep the weight off.

2. Orlistat (Xenical) is a weight loss drug that has been around for a number of years, thus its safety profile and efficacy is well-established. In studies, participants taking this medication lost 11 to 22 pounds (average eight per cent of body weight), compared to seven to 13 pounds lost in the placebo or comparison group. Keep in mind, however, that participants in these studies also adhered to intensive lifestyle regimens.

Side effects are simply an effect of the way the drug works — changing the way your body digests and excretes fat.

Benefits? It's administered in a pill form, which is easier for some to swallow than daily injections. Drawbacks? About 15 to 30 per cent of patients experience uncomfortable or embarrassing side effects, such as cramping, flatus, incontinence of stool and oily spotting from the rectum. These side effects are simply an effect of the way the drug works — changing the way your body digests and excretes fat. They can be limited by following a low fat diet however, so if you're dedicated to your weight loss, it might be worth a try.

3. Bupropion (Wellbutrin), primarily an anti-depressant medication, is also used by doctors in certain circumstances to help patients lose weight. Studies are smaller and fewer, as it's not marketed primarily as a weight loss agent; however, published results show a weight loss of about seven to 10 per cent of participants' initial body weight (about 15 to 22 lbs). Side effects are few, but can include anxiety and insomnia.

For patients concerned about their weight who also require treatment for depression, Bupropion could be a good option since most antidepressants tip the scales in favour of weight gain. Finally, if there are smokers in the audience, this medication is also utilized to help with smoking cessation, so it may be a good choice if you're looking to butt out, too.

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Under the knife

Not so sure about weight loss medication? Not a candidate? Or, perhaps it didn't work out for you. Bariatric surgery is another treatment worth exploring. There are several different types of surgery for weight loss that fall under this umbrella. Each is performed laparascopically, meaning the surgeon uses several small incisions and a camera to work inside of the abdomen to minimize scarring and complications, and hasten recovery. Essentially, with each method, the stomach is made smaller so that you feel fuller, faster.

Surgery is, of course, also not without its risks. Following surgery, you could develop a bowel blockage or ulcers; the surgery could fail or you could require revision; in rare cases, as with other major surgeries, severe complications can be fatal. The entire process from referral to the operating room involves a series of meetings with doctors, psychologists and dieticians which can take upwards of a year to complete. Keep in mind, following surgery, you'll also need to adhere to drastic dietary changes. After all, you'll be eating much less, yet still need to get your essential nutrients.

An upside? The cost of bariatric surgery for eligible candidates is covered in Canada by provincial health insurance plans, such as OHIP.

Parting words

As with any medicine or surgery, get informed, talk to your doctor and have an honest discussion with yourself as to whether or not it's the right path for you. But, if you're at a critical point with your weight and your health is going to continue to suffer unless you lose weight, and lose it now, drugs or surgery may prove to be a lifeline worth grabbing hold of. For some, the results can be astonishing; even life-saving.

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