Non-Surgical Weight Loss Options

Depending on your health needs and goals, non-surgical weight loss might be right for you. Your physician-led, multidisciplinary team will collaborate with you to find the right treatment. Together, we will ensure you are provided the necessary treatment options to change your life. Medical therapies monitored by physicians, nurse practitioners, physician assistants and registered nurses may include:

  • Monthly visits with our nurse practitioner or physician to monitor progress
  • Medications for weight loss, if appropriate
  • Consultations with specialists, if appropriate (such as cardiologist, pulmonologist)
  • Referral to our surgical weight loss program, if appropriate

Types of Non-Surgical Procedures

Endoscopic procedures

Endoscopic procedures offer a minimally invasive alternative to traditional weight loss surgeries. Endoscopic suturing is a technique in which stitches are inserted in the stomach to reduce its size, in turn reducing the amount of food that can be consumed and helping the patient adjust his or her eating habits. This can jump-start weight loss.

What can I expect?

Unlike other types of weight loss procedures, endoscopic suturing requires no incisions in the skin and produces no visible scarring. The procedure is performed while the patient is under anesthesia.  A narrow, flexible device called an endoscope is inserted into the stomach through the mouth and down the esophagus. The endoscope is equipped with a video camera that your surgeon will use as stitches are made in the stomach using the OverStitch Endoscopic Suturing System. The entire process takes between 45 and 90 minutes.

This same technique can also be used to reduce the size of the stomach pouch in patients who have regained a significant amount of weight after another type of bariatric surgery. Typically, patients who undergo endoscopic suturing lose 8 to 15 percent of their total body weight over a one to three-year period. Multiple procedures may be needed to improve durability beyond three years.

Is endoscopic suturing right for me?

Your physician can help you decide if endoscopic suturing is the best choice for you, based on your medical history, weight loss goals and other factors. Because it does not involve surgical incision, the recovery time is much faster and the risks of this type of procedure are lower than for other forms of bariatric surgery, but complications can occur.

Currently, this procedure is offered to patients who have previously undergone RNY Gastric Bypass with weight regain from stoma or pouch enlargement. However, complications can still occur, and weight regain is possible. It’s important to continue to maintain a healthy diet and exercise after endoscopic suturing to keep your weight-loss goals on track.

Intragastric Balloon

The intragastric balloon is temporarily placed endoscopically in the stomach for six months. It helps your body adapt to smaller portion sizes. The balloon is inserted through the mouth into your stomach. The balloon is then inflated with saline and is about the size of a grapefruit. After six months, the balloon is removed endoscopically. This therapy is used with diet, exercise and possibly medicines before, during and after the balloon.

Ideal Candidate

  • Age 18–65
  • BMI 30–40 with or without co-morbidities
  • No previous stomach or GI surgery
  • Team approach

Benefits

  • Outpatient procedure with sedation
  • No incision or scar
  • Easy to perform
  • Faster recovery
  • Safe
  • Excess weight loss of 25 percent at 6 months post removal.

 Risks

This device may cause nausea/vomiting/abdominal pain/GERD. Although it is rare, there is a risk of: obstruction, perforation, aspiration pneumonia and death. The device intolerance is five percent, and the long-term durability is unknown.

Types of Treatment

Medical: Visits with medical providers will help determine factors that contribute to your struggle with weight loss. Our physicians and mid-levels will complete an extensive history and physical and will work with you to determine appropriate treatment options, including evaluation for use of weight loss medications, changes in medications that may be causing weight gain or inhibiting weight loss, need for laboratory work-up and routine follow-up. Our medical providers will also collaborate with your primary care physician to ensure they are involved as part of our treatment team.

Lifestyle: Visits with medical and behavioral health providers will help you develop new habits. Participation in interactive groups is also highly encouraged. Topics range from meal planning, tips for meals and snacks, mindful eating out, managing triggers, incorporating healthy changes into the family as well as several groups that focus on changing the thought process and behavior for eating. These groups help provide broader health information so that you can get started with the basics and allow for individual visits to be tailored to your specific needs.

Fitness: Our Medical Weight Loss pathway includes working with a physical therapist to identify how best to incorporate exercise into your new lifestyle. You will begin with individual appointments and group fitness opportunities, with an end-goal of a self-sustaining, long-term plan to continue your weight-loss success.

Nutrition: Proper nutrition is an important part of non-surgical weight loss. Therefore, you will have individual visits with registered dieticians. They will guide you to make good decisions about food, help you change negative behaviors about food, and provide tips and tricks for your new lifestyle—all with a goal to help you reach your weight-loss goals.

Expert Answers

How long does each of the three phases of Medical Weight Loss last?
Phase 1 and 2 both last approximately six months and each include 14 or more sessions. Phase 3 is about maintenance of your new lifestyle, and usually lasts approximately 12 months with quarterly visits with your team.

What happens after I complete the program, but I “fall off the wagon?”
It is extremely common for patients to resort back to old habits, especially when life throws you a curve ball. Obesity and overweight are chronic health conditions and need to be treated as such. We recommend you continue to follow up with your team every three to six months after completion of the program. That way if life throws you a curveball, we help you problem solve and get back on track.

How fast can I expect to see results?
Each patient and situation is different, and results may vary.

Average Memorial Wellness Center Medical Weight Loss Results:
Percentage of Total Body Weight Loss

  • After 12 months: 8%
  • After 18 months: 17%

BMI Reduction

  • After 12 months: 3 point reduction
  • After 18 months: 5 point reduction

Waist Circumference

  • After 12 months: 4 inch reduction
  • After 18 months: 7 inch reduction

What is Visceral Fat?
Visceral, or "deep" fat, wraps around the inner organs and spells trouble for your health. Visceral fat drives up your risk for diabetes, heart disease, stroke and even dementia. Visceral fat is thought to play a large role in insulin resistance—which boosts risk of diabetes. Studies have shown a link between visceral fat and dementia. In a study, records of more than 6,500 members of Kaiser Permanente of Northern California, a large health maintenance organization, were studied for an average of 36 years, from the time subjects were in their 40s until they were in their 70s. The records included details on height, weight and belly diameter—a reflection of the amount of visceral fat. The study concluded subjects with higher visceral fat had a higher risk of dementia than those with less visceral fat. Possible speculation of the trial is that substances such as leptin, a hormone released by the belly fat, may have some adverse effects on the brain. Leptin plays a role in appetite regulation but also in learning and memory. Normal visceral fat values: Women: 9-10; Men: 12.

In regard to weight loss, what type of exercise is more beneficial: strengthening or cardio?
Both! Cardiovascular exercise is anything that gets your heart rate up for a sustained period of time, makes you feel sweaty and gets more oxygen pumping through your blood. Running, cycling and aerobic classes, like Zumba, are all examples. Government guidelines suggest adults should do 150 minutes (30 minutes, 5 times a week) of moderately high intensity aerobic activity. Your heart and lungs will benefit immensely from consistent cardiovascular exercise. It is especially important for beginners, as it thickens the tendons and ligaments in joints in preparation for higher intensity exercise. Health benefits include improved circulation, increased bone density (to help combat osteoporosis), improved sleep and reduced anxiety levels. Moderately high intensity cardio also increases your energy levels. The secret is to find an exercise you love, or something to do with friends. It will help you stick to it, which is key to any type of exercise.

Strength training is any exercise that helps the different muscles in your body become stronger and more powerful. It can include using weights or even your own body weight like press-ups and squats. It can be resistance-based, using different forms of resistance like elastic gym bands or gym fit balls. Strength training helps tone muscles and strengthens bones. It is also the key to losing weight. By doing strength or weight training, you are looking at increasing your muscle tissue. The more lean muscle tissue you have, the more calories you burn. One kg of muscle burns 50 extra calories a day, whereas 1kg of fat burns just three calories a day.

What is the best time of day to exercise?
The key is to exercise whenever you can—whether it's morning, afternoon or evening. Your goal should be to move your body as much as possible. But, by starting your morning with physical activity, you set the day's pace. Starting your day with activity can help boost your physical energy and mental alertness for the day ahead. Research shows morning exercisers tend to stick with their exercise habits. By doing the bulk of exercise first thing in the morning, you get your exercise in before other distractions can intrude. Research suggests that morning exercise improves sleep, a benefit that could also promote weight loss. A study of overweight women between the ages of 50 to 75 showed that those who engaged in consistent morning exercise (about four hours a week) slept better than those who exercised later in the day. The evening exercisers had more trouble falling asleep—even if they fit in the four hours a week. How does sleep affect weight loss? Poor quality of sleep influences certain hormones that control appetite. It is possible that by exercising in the morning—instead of evening—the exercise affects the body's circadian rhythm (your internal body clock) so you get better-quality sleep. Good sleep helps control the hormonal balance that helps control appetite. One way to think of your morning exercise is schedule it like a business appointment—one you can't easily cancel. It takes discipline, but consider the fact that exercise can be the highest priority for your health.

If you know you can put the time aside to exercise regularly, lunchtime exercise is a good option. You’ll be awake and alert and your muscles will be warmed up so you might be less likely to injure yourself. Plus, you can grab an exercise partner—a friend or colleague—and this will help you commit to exercise regularly and make it a lot more fun. Exercising in the middle of the day could help to relieve daily stresses and boost blood flow to your brain so you are sharper for your afternoon duties. Additionally, you might find that exercising in the middle of the day makes you more mindful of what you are eating for lunch and later in the day. On the down side, time constraints might mean that you cannot get in a full workout.

Exercising later might be your best option if you want to gain muscle mass. Studies have shown exercising in the evening is a good way to gain strength which is why strength trainers, like weightlifters, train in the evening. The reason: the muscles have warmed up by the afternoon or evening and certain hormones that are necessary for muscle-resistance work are optimal later of the day. Evening exercise might also help you regulate the amount of food you feel like eating for dinner, which is beneficial if you tend to eat big meals at night. It can also be a great stress reliever after a busy day at work or home. On the downside, some research suggests that vigorous activity just before bedtime isn’t a good idea, so you’ll need to exercise approximately three hours before you go to sleep. This is because exercise raises your body temperature and increases hormone activity, which could interfere with sleep as previously discussed.

Shouldn’t I eat less and move more to lose weight?
Fad diets are not the best way to lose weight and keep it off. These diets often promise quick weight loss if you drastically reduce what you eat, or avoid some types of foods. Some of these diets may help you lose weight at first. But these diets are hard to follow. Most people quickly get tired of them and regain any lost weight. Fad diets may be unhealthy. They may not provide all of the nutrients your body needs. Also, losing more than 3 pounds a week after the first few weeks may increase your chances of developing gallstones (solid matter in the gallbladder that can cause pain). Being on a very restricted calorie diet for a long time may be a health risk which could lead to serious heart problems. Research suggests that safe weight loss involves combining a balanced plate, scheduled meals and snacks with physical activity to lose 1/2 to 2 pounds a week (after the first few weeks of weight loss). The key is a balance of making healthy food choices and building exercise into your daily life. Combined, these habits are a healthy way to lose weight and keep it off. These habits may also lower your chances of developing heart disease, high blood pressure, and Type 2 diabetes.

What is my biological or physiological age? How does it affect my health?
Biological, or physiological, age is a measure of how well or poorly your body is functioning relative to your actual calendar age. For example, you may have a calendar or chronological age of 65, but because of a healthy and active lifestyle (avoiding longevity threats like tobacco and obesity), your body is physiologically more similar to someone with a chronological age of 55. Your biological age would therefore be 55. While not an exact science, the concept of biological age can incorporate objective measures like resting heart rate, blood pressure and visual acuity, as well as more subjective criteria like ease of performing daily tasks, muscle strength and general mobility.

Will I develop a lot of excess skin folds as I lose weight, and if so, is there anything I can do to get rid of them?
With dramatic weight loss of 100 pounds or more, excess skin can be problematic. Excess skin is most pronounced in people with pre-operative morbid obesity who have the greatest weight loss and who are older at the time of surgery. Common problems are abdominal skin folds and skin folds at the buttock which can lead to discomfort when sitting and bending over. In addition, excess skin at the upper arms, thighs and breast area can develop infections leading to rashes and unpleasant odors.

Exercise and muscle toning help with firming, but with significant weight loss, plastic surgery is the most advantageous means of excess skin removal and body contouring. Studies have shown that patients who have plastic surgery after bariatric surgery have improved quality of life scores and more successful weight maintenance.

Sometimes, excess skin depends on a person’s body shape before weight loss. If someone has an even distribution of body weight, they may have very little excess skin folds even with a 50-60 pound weight loss. People with more central weight mass (apple shapes) with very thin legs tend to have more abdominal skin folds even with modest weight loss. People with pear shapes tend to have more skin folds in the thigh area after modest to significant weight loss.

Non-surgical means of tightening skin include maintaining or increasing muscle tissue. Muscle tissue is the key to minimizing loose skin. If muscle mass is lost in addition to fat, it creates an even larger void under your skin's surface. Increasing lean muscle tissue fills the area underneath the skin, which helps to keep the skin taut. A strength-training and muscle-building regimen with progressive resistance training may yield better results over one that optimizes endurance. Strength training specializes in increasing the overall size and volume of your muscles, allowing your skin to cling tighter to the underlying muscle tissue.

Is there a way to reduce my waist circumference? Will sit-ups do this?
Waist circumference is not affected by performing hundreds of crunches or sit-ups. In order to decrease stomach girth, you have to focus on lifestyle changes. Lifestyle changes include proper nutrition, intensified exercise and increased activity throughout the day. Nutritional changes which include healthy food choices, balanced plates, scheduled meals and snacks and food logging, as well as decreasing daily calorie intake, are keys to weight loss and especially a decrease in waist circumference.

Increasing moderate-intensity cardiovascular exercise to 30-60 minutes (150-250 minutes per week), 6 days a week assist with weight loss. Adding interval training to cardiovascular program can help target belly fat. Strength training helps burn calories more efficiently. Increasing physical activity throughout the day (taking the stairs, parking farther away from the door, walking on breaks) helps, but is not a replacement for purposeful cardiovascular and strengthening exercises.

How does exercise change as I get closer to my goal weight?
Exercising to maintain your weight loss isn’t much different than working out to lose weight, get fit or stay fit. People who struggle with their weight usually have metabolisms that naturally want to store extra energy as fat instead of burning it off. That’s not going to change just because you lost weight. You’ll have to work out just as hard to keep your metabolism in high gear and keep the weight off. Exercise and other lifestyle activities are essential to doing that. 

Make sure your exercise program for maintenance includes these three elements:

  • At least 30-45 minutes of moderate-intensity cardio exercise, 5-6 days a week. This helps your body use more energy (especially stored fat) even when you’re not exercising, which will aid you in maintaining your weight loss. Increasing exercise intensity so you are working in the upper 2/3 of your target heart rate zone is also essential.
  • Strength training: building and maintaining lean muscle mass will keep your metabolism elevated so that you burn calories more efficiently, even at rest. Muscle confusion is also essential. Doing the same exercise routine every day and every week allows the body to become accustomed to the exercise and benefits of strength and cardio routines decrease.
  • Extra lifestyle activity: every little bit of activity you do throughout the day can make a big difference. However, lifestyle activity is an enhancement, not a replacement, for purposeful exercise.