HCA Virginia Physicians - September 29, 2023

Pictured left: Matthew Brengman, M.D., Pictured right: Aquilina Gretchen, M.D.

What’s the deal with all of these weight loss options?

“Weight loss drugs are on the news, in your social media feed, and you might even know someone taking them,” says Matthew Brengman, MD, board-certified general surgeon and fellowship-trained bariatric surgeon, with Advanced Surgical Partner of Virginia in Richmond, part of HCA Virginia Physicians network and affiliated with Parham Doctors’ Hospital.

Online pharmacies, medical spas, and diet clinics take advantage of the fact that our country has alarming statistics on obesity and that the situation is truly an epidemic. 

Dr. Brengman says more than one-third of adults — or 78.6 million people — are obese, often leading to an increased risk of chronic and life-threatening diseases like heart disease, kidney failure, stroke, and Type 2 diabetes.

“Much of these statistics are from before the pandemic. The pandemic negatively impacted our health and weight in many ways,” Dr. Brengman says.

He says the key to finding what works for you is partnering with an experienced physician who can create a plan that will work with your body.

“We work with our patients to ensure we can come up with a plan that is personalized and specific to their goals and medical history. We want to provide patients with a plan for lasting, long-term success,” Dr. Brengman’s surgical partner Gretchen Aquilina, DO, board-certified and fellowship-trained bariatric and gastrointestinal surgeon at Advanced Surgical Partners of Virginia, says.

Short-term weight loss solutions

Diet pills and fad diets: Dr. Brengman says quick fixes like pills or fad diets aren’t the key to long-term, successful weight loss. “At our practice, our team works one-one-one with patients to help them approach their weight loss goals with lifestyle changes. This includes a meal plan and physical activity that will help them achieve their goals,” he says.

Weight loss injections: Dr. Aquilina says weight loss injections do not work for everyone, and they are not risk free which is why it’s important to work with a physician. “Injectable weight loss medications can make a big difference in helping a patient with their weight loss goals, but it’s important for patients to partner with their physician who is experienced in weight loss and can ensure that the medications are being utilized properly as part of an overall weight loss plan that is customized to the patient’s individual goals and health,” she says.

“Weight loss injectables can be prescribed to patients both preoperatively and post operatively to help a patient meet their goals,” Dr. Brengman says. “These medications can help change the way a patient’s metabolism works which is often more effective than fad diets and pills.”

Dr. Aquilina says the medication in injectables immobilizes the muscles of the stomach wall for about three months and prevents them from contracting. This keeps food in the stomach longer, slowing digestion and helping you feel fuller faster and for a longer time.

Dr. Aquilina says weight loss injections may be a good option for adults who:

  • Have moderate weight loss goals such as to lose weight before an elective surgery or to assist with fertility
  • Have a body mass index (BMI) of 30 to 40
  • Have not had success with lifestyle modifications such as diet and exercise
  • Want to jump start a healthier lifestyle
  • Want to reduce the risk of weight-related illness, such as high blood pressure, diabetes, stroke, sleep apnea, or heart disease.

Dr. Brengman and Dr. Aquilina both recommend strategic lifestyle changes like keeping a food journal, tracking daily steps, setting daily goals, and eating breakfast.

“I am passionate about providing patients with individualized care and helping them meet their weight loss goals. We are proud to offer so many weight loss options to patients at our practice and find that injectable medications can help patients in the short-term as they prepare for longer-term solutions,” Dr. Brengman says.

Dr. Aquilina also says creating a long-term plan is key.

“Clinical trials have proven that when patients stop taking the injectable weight loss medications, that they gain the weight back,” Dr. Aquilina says. “We are able to help patients choose the path that is right for them to meet their long-term goals, whether that includes surgical or nonsurgical intervention.”

Long-term weight loss solutions

“After patients meet some of their short-term goals, we are able to help them with next steps which sometimes can include weight loss surgery or other nonsurgical procedure,” Dr. Brengman says.

Based upon their specific needs and goals, there are several minimally invasive and robotic-assisted weight loss options, including gastric bypass, gastric sleeve, duodenal switch, and gastric balloon.  Dr. Brengman and Dr. Aquilina are also part of the only program in the region offering a new minimally invasive nonsurgical endoscopic sleeve gastronomy (ESG) for patients with a lower BMI. It just depends on the patient’s needs and risk factors to pick the right procedure for them.

Gastric bypass: This procedure does NOT remove anything; however, they do separate the stomach into a smaller section for the food intake and then a new end of the intestines is attached in order to empty the food and reconnect with the rest of the digestive juices a bit further downstream.

Gastric sleeve: This procedure removes a significant portion of a patient’s stomach, reducing food intake capability. The normal stomach can hold about 1.5 liters of fluid, and it’s downsized to a four- to six-ounce capacity. A person undergoing gastric sleeve surgery has the potential to lose 50 to 80 percent of their excess body weight.

Duodenal Switch (and SADI-S): Think of it more like a more advanced technique that combines the gastric bypass and gastric sleeve. They use this more for much more severe obesity and resistant comorbid conditions. This is a good option for a revision from a sleeve if they had weight regain after surgery.

Gastric balloon: This is a nonsurgical way to help people lose weight who haven’t had success losing weight with other diet programs. “This nonsurgical, endoscopic procedure is temporary. The procedure involves placing a soft, deflated gastric balloon through the mouth and into the stomach. We then fill it with a safe saline solution until it’s the size of a grapefruit,” Dr. Aquilina says.

She says it stays in place for six months and patients work closely with their doctor, dietitian and other specialists to develop healthier eating and lifestyle habits. After six months, the balloon is removed in a similar, nonsurgical procedure.

Endoscopic Sleeve Gastroplasty (ESG): Endoscopic sutures are placed on the inside of the stomach to induce reduction of digestive enzymes and motion. It also downsizes the stomach because of the permanent stitches.

Whether you choose weight loss injectables or weight loss surgery, Dr. Brengman says the right combination of tools and lifestyle changes are essential to a successful weight loss treatment plan.

“We are here for our patients throughout the entire process and encourage them to approach their weight loss plan as a lifestyle change,” Dr. Brengman says. “We are proud to offer more options for patients than any other program of its kind in the Richmond area and take great pride in helping our patients live a healthier life and achieve their goals.”

At HCA Virginia Physicians, our caring and knowledgeable weight loss surgery team is here to help you take charge of your health. Our expert bariatric surgeons will provide you with advanced weight loss surgery options and recommend a coordinated treatment plan that is best for you. This plan includes education, nutrition counseling, meal planning, exercise planning and support programs.

Find out if you’re a candidate. Take our weight loss surgery health risk assessment.