Obesity is a prevalent issue in Hong Kong. Beyond impacting appearance, obesity can lead to numerous health problems, including hypertension, high cholesterol, and elevated blood sugar levels. These conditions significantly increase the risk of coronary heart disease and stroke, highlighting the importance of addressing weight loss as a critical health concern.
Q2. What treatment methods for weight loss are available beyond diet and exercise?
There are various approaches for weight loss beyond diet and exercise. Patients must be determined to lose weight in the first place and the doctor’s role is to provide guidance and support. There are multiple medical options for losing weight, tailored to different patients’ needs and their acceptance of intervention. These include injectable medications and endoscopic procedures designed to reduce stomach capacity. For severe cases, surgical options such as sleeve gastrectomy or gastric bypass surgery may be considered to result in significant weight loss.
Q3. Can injectable medications help weight loss? What are the side effects?
Currently, an option of inducing weight loss is through the use of injections administered by healthcare professionals. These "weight loss injections", such as Saxenda or Wegovy, are designed to decrease stomach motility, extending the time food remains in the stomach. As a result, the sensation of fullness lasts longer and appetite is reduced, facilitating weight loss. However, these injections require long-term use, typically given every one to two weeks. Discontinuing the injections after prolonged use may lead to weight regain.
Before starting weight loss injections, several important factors should be considered. Doctors will first tailor the medication for each patient, gradually increasing the dosage to a level that is both effective and tolerable, all while aiming to achieve the patient’s weight loss goals. It is also important to note that because these injections reduce stomach motility, side effects such as acid reflux and vomiting can occur.
Q4. Who is suitable for weight loss surgery?
Traditionally, weight loss surgery is recommended for patients with a high Body Mass Index (BMI) and suffering from various complications of metabolic syndrome. Traditional surgical methods usually involve minimally invasive procedures to reduce stomach size through procedures such as gastric bypass or sleeve gastrectomy, which decrease food intake and nutrient absorption.
Many patients hesitate at the thought of surgery, feeling that they should not need to undergo such a significant procedure merely due to obesity. In recent years, endoscopic methods have gained popularity. Traditional endoscopic techniques may involve placing a balloon in the stomach, while endoscopic sleeve gastroplasty is a newer option that reduces stomach volume to decrease food intake.
Q5. What are the advantages and limitations of gastric balloon treatment for weight loss?
Endoscopic placement of gastric balloons is a well-established procedure, although some patients may experience adverse reactions, particularly immediately after the balloon is placed, as the stomach is not yet accustomed to the device. This can lead to severe vomiting, usually during the first week after the procedure, and some patients may even request the removal of the balloon.
Recent advancements in gastric balloon technology may make the procedure more tolerable. For example, swallowable balloons that inflate automatically in the stomach are now available, without the need for an endoscope. Once swallowed, these balloons will automatically inflate inside the stomach, providing a sensation of fullness. However, these newer balloons typically have a shorter lifespan, lasting for only one to three months. Once deflated, they are will be passed out as faeces, but weight regain may occur afterwards.
In addition, some newer balloons allow for adjustment of the volume of the balloon. For patients who are concerned about the risk of vomiting, we can start with a smaller balloon volume of, say, 300 ml instead of the usual volume of 500 to 700 ml. This is to allow time for the patient to get used to the balloon. If further weight loss is desired, another gastroscopy can be performed to increase the balloon’s volume, increasing the sensation of fullness aiming to reduce hunger. However, it is important to note that the effect of an intragastric balloon is not permanent; the balloon is usually left in the stomach for 8 to 12 months before exchange or removal. Following removal, there is a risk of weight regain, which is a crucial consideration for patients.
Q6. What are the advantages of endoscopic gastric sleeve surgery for weight loss?
Due to the limitations of intragastric balloons, advancements in endoscopic techniques have led to the development of endoscopic gastric sleeve surgery. This innovative procedure utilises the possibility of endoscopic suturing to reduce the stomach size and create a gastric sleeve. As the stomach volume decreases, its capacity is reduced, which leads to decreased food intake and longer retention of food in the stomach.
Many people compare the outcomes of endoscopic and traditional minimally invasive gastric sleeve surgeries and find them to be quite similar. The endoscopic approach offers several advantages, such as the absence of external wounds and faster recovery times. Patients undergoing endoscopic gastric sleeve surgery can often be discharged on the same day or the following day after the procedure.
Furthermore, the endoscopic method minimises the side effects commonly associated with intragastric balloons such as vomiting. It typically results in a reduction of excess weight by 10 to 15%. Another significant benefit of endoscopic sleeve gastroplasty is its long-lasting effects; while the effects of intragastric balloons may be limited to one year, those of gastric sleeve surgery can generally last up to three years. Although the sutures used in the procedure may dissolve over time, research indicates that patients who undergo endoscopic gastric sleeve treatment often achieve more sustainable, long-term weight loss results.
Q7. What should be noted after receiving weight loss treatment?
Patients who have undergone endoscopic or surgical weight loss procedures must adhere to diligent post-operative care. First and foremost, a strong commitment to weight loss is essential; without this determination, the effectiveness of any treatment will be compromised.
After undergoing endoscopic or surgical gastric reduction, if a patient continues to indulge in excessive eating and drinking—such as consuming large quantities of ice cream or sugary beverages—weight loss will likely be ineffective. Therefore, it is crucial for patients to significantly reduce their food intake following surgery. Collaborating with a weight management team can provide valuable support during this process. Consulting with dietitians is highly recommended, as they can offer tailored meal plans and guidance on making healthier food choices. Additionally, adhering to the exercise recommendations of physiotherapists can further enhance the effectiveness of the weight loss programme, helping patients achieve their goals more efficiently.
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