‘I welcome the obesity medicine revolution,’ weight loss surgeon says

Rana Pullatt, M.D., director of Bariatric Surgery at MUSC Health’s Metabolic and Bariatric Surgery Program who is also Obesity Medicine boarded, sees weight loss drugs such as Zepbound and Wegovy as important new options that are helping doctors’ approach to obesity evolve. “It'll probably become similar to the cancer model of treatment,” the weight loss surgeon said of obesity care.

“There’s both surgery and chemotherapy for cancer. That's the same way we're going to look at obesity. It's going to be multimodal treatment. It's going to be behavioral, dietary, medical and surgical. That's the only way, because obesity is a chronic, lifelong condition.”

Cancer and obesity have clear differences in the way they develop and progress. But the number of people cancer and obesity affect is strikingly similar. Almost 40% of men and women will get a cancer diagnosis during their lifetimes, according to the National Cancer Institute. About 42% of adults have obesity. That’s a lot of people who need and deserve medical help, Pullatt said.

New ways of seeing obesity

“I think, more than anything else, the whole obesity medicine revolution has basically thrown the spotlight on these patients who were poorly understood. They were seen as bringing it on to themselves. We don't say that about diabetics, right? We empathize with people who have diabetes or cancer, and we give them the treatment that they require.”

The same should be true for people with obesity, he said. “Obesity has been studied so extensively that we know that a lot of it is programmed with your genes. Obesity is almost as heritable as skin color or height. Some of it is nutritional, hormonal, socioeconomic – what your mother eats when she's pregnant – has an effect on your adult weight.”

Being in a poorer socioeconomic environment is an important risk factor for obesity, Pullatt said. “Imagine a single parent who is coming back home after her job who is struggling to make ends meet. She does not have the luxury, time or means to stop at an organic store and cook a wholesome meal. She is going to reach out for the cheapest foods, which are fast foods that are heavily processed and calorie dense.”

And Pullatt said children who grow up on fast food have a hard time weaning off it. “When you're a kid, you're hooked. And what you must remember is that all these companies use food scientists. The food scientists’ only job is to make that food more palatable, colorful and more flavorful. We now know with functional MRI studies that fast food and calorie-dense processed food floods and stimulates the same dopamine centers that drugs like cocaine do.”

Team approach to obesity

That’s why he said it’s important for patients with obesity, whether they’re using weight loss drugs or undergoing surgery, to address the psychological factors associated with food choices and learn about healthy eating. 

“The reason bariatric surgery has been very successful over the years is there is a team-based approach. It’s not just giving you a weight loss surgery and then letting you loose. You have a physician, a psychologist, a dietician, all of them working in tandem to make you successful.”

Upsides and downsides of medications

Pullatt has concerns about the popularity of the new weight loss drugs. He said they’re very effective, but it’s important to keep in mind that they are medications for people with obesity, not people who just want to shed a few pounds. 

Another thing to keep in mind: All medicines can cause side effects, and weight loss drugs are no exception. “There have been rare cases of gastroparesis, which is basically where your stomach doesn't empty well,” Pullatt said.

The new weight loss drugs can also cause more common side effects that have been well documented such as diarrhea, nausea, vomiting and constipation. 

Importance of addressing weight issues

But the weight loss drugs can address a major health issue, being overweight, that puts people at higher risk of a lot of other problems. According to the Centers for Disease Control and Prevention, they include:

• A shorter life.
• High blood pressure.
• High LDL cholesterol, low HDL cholesterol or high levels of triglycerides.
• Type 2 diabetes.
• Coronary heart disease.
• Stroke.
• Gallbladder disease.
• Osteoarthritis.
• Sleep apnea and breathing problems.
• Many types of cancer.
• Low quality of life.
• Mental illness such as clinical depression, anxiety and other mental disorders.
• Body pain and difficulty with physical functioning.

Pullatt hopes more patients will get treatment now, both medical and surgical. He also said increasing awareness, along with grassroots advocacy and lobbying, may also lead to improvements in insurance coverage for weight loss medicine and surgery.

Medication after surgery

Pullatt sees the two approaches, medicine and surgery, working together to help his patients. “About 25% of bariatric surgery patients, after seven or eight years, may lose some of the effectiveness of the surgery with resultant weight gain. These medications may help supplement that weight loss and give them less-risky options than revisional bariatric surgery.”

Pullatt has the credentials to back up his point of view. He’s a professor of Surgery at the Medical University of South Carolina, director of bariatric and robotic surgery at MUSC, executive council member of the American Society for Metabolic and Bariatric Surgery and past president of the Carolinas chapter of the ASMBS. He recently was awarded the national clinical excellence award by the ASMBS for advancing surgical care in obesity. Pullatt also runs an observation program for other surgeons to better their technique by watching him perform some of the most complex bariatric procedures on super obese patients.

So he has plenty of perspective on weight loss treatments – perspective that tells him the growing number of options is nothing but beneficial. “As a physician who treats obesity, I welcome anything that would help. Because we know that less than 1% of the patients who require bariatric surgery end up getting it, which means that 99% of the patients are untreated.”