Weight loss occurs when you burn more calories than you ingest. But if it’s so easy, why do more than 42% of adults in the U.S. suffer with obesity?

St. Luke’s metabolic and bariatric surgeon Ikemefuna (Ike) Akusoba, MD, of St. Luke’s Weight Management Center said in theory, more calories used than consumed results in weight loss, but it’s more complicated. If it were so simple, very few people would be overweight, let alone be afflicted with obesity.

“There’s a lot more at play. A whole slew of things determines our body composition and what we weigh,” he said, adding obesity is a chronic disease that carries a huge stigma in our society. Many people blame the people with obesity for their condition.

“That’s unfair,” he said. “We don’t blame people for developing diabetes, high blood pressure or heart disease. We have to stop blaming people for having obesity.”

Genetics is an important factor. If you have a parent with obesity, your risk of developing obesity is 50% and, 80% if both parents have it - even if you were adopted and never lived with your paternal and maternal parents. Environment and the type of work you do affect your weight. Also, your body fights weight loss.

“Fundamentally, when you lose weight, your metabolism slows down, and when your metabolism slows down, you have to eat even fewer calories to maintain the lost weight,” he said. “So, you must eat an entire meal less than somebody who didn’t have to lose weight. I have had patients tell me they exercise three hours a day. That’s hard to maintain indefinitely. Professional athletes don’t even exercise three hours a day.”

While there are many causes, there are also many treatment options. These have increased significantly with the availability of GLP-1 agonists, a class of medications that help lower blood sugar levels. Injected daily or weekly, they include Saxenda, Ozempic, Wegovy, Mojuaro and Zepbound. Many more are in the pipeline.

“It’s nice we finally have highly effective medications to treat obesity,” he said. Many patients can lose a significant weight on these drugs. But they are not a cure-all. Downsides include cost and the fact most people must continue taking them for their lifetime or risk regaining weight. Some people experience side effects, such as diarrhea, constipation, stomach pain, nausea and vomiting. GLP-1 medications are ineffective for 15-20% of people.

“If you’re looking to lose a large amount of weight and keep it off, surgery is still the gold standard,” Dr. Akusoba said. St. Luke’s Weight Loss Center offers several types of metabolic and weight loss surgery, all of which are effective.

Body mass index (BMI) - the ratio of weight divided by height - is used to determine insurance coverage for weight loss treatment. Many insurers cover GLP-1 medication for people with a BMI of 27 or above with medical conditions or 30 and above without. Traditionally, people with BMIs of 35 to 39.9 with health conditions, or 40 and above without, qualify for surgery. However, most insurance companies have lowered eligibility to a BMI of 30-35 with conditions or 35 without.

“That means we know surgeries are highly effective in treating obesity, and patients with lower BMI are deriving great benefits with low risk,” he said. “You can see, there’s now an intersection of people with lower BMIs who can be treated with medicine or surgery. That’s where a conversation with the medical provider comes into play.”

For example, if someone has early-stage diabetes, and you start them on a diabetes medication, they’ll be on that medication for the rest of their lives. However, if you treat that same person with surgery, they can live a very long time without having to take diabetes medication.

“We go from treating a condition to having that condition vanish away from the medical chart,” he said. “If you have early-stage diabetes, you will leave the hospital with significantly reduced diabetes medications, or none at all.” People with later stage diabetes will decrease medication. It’s not one size fits all,” he said. “We ensure that the patient chooses the weight loss option that best aligns with their goals and health condition.”

Considering a weight loss method? Visit sluhn.org/weightloss. Attend a virtual or in-person weight loss information sessions.