Initiatives — whether surgery, medication, or diet — help people conquer obesity and improve their health
Weight loss is a personal journey. Whether the goal is to lose weight or look and feel better, everyone’s motivation differs.
Amber Cornelius’ motivation: a fear of contracting Covid-19. “I was hearing that people who were significantly overweight were more likely to need hospitalization or die,” says Cornelius, 45, of Lindenhurst. “I have way too many people depending on me. I thought, ‘I have to do something now.’ I wanted to feel better in my own skin.”
A wife and mother of two young sons, Cornelius teaches full-time and cares for her medically fragile, 78-year-old father. She habitually says yes when anyone asks for a favor, even if she doesn’t have time. With all those demands on her, she knew she had to make a change.
The effects of carrying extra weight — sleep apnea, high blood pressure, and painful arthritis in her knees and hips — were nagging at her. After meeting with surgeons and talking to people who had lost weight, she decided to undergo a full gastric bypass.
Meanwhile, Marlena Boruch-Krol chose a different route for her weight loss journey. Once she reached middle age and quit smoking, she felt like she couldn’t stop gaining weight. She didn’t like the way she looked. She tired easily, had high cholesterol and high blood pressure, and whenever she went shopping, she couldn’t fit into any of the clothes she longed to wear.
“I lost my confidence, my joy, my energy,” says Boruch-Krol, 50, of Prospect Heights. “I lost good self-esteem, and I didn’t realize it at the time. The one thing I knew is that I wanted to change.”
She had tried the Atkins low-carb diet with little long-term success. Then her doctor told her about a clinical trial of a weight-loss drug for people who have obesity or are overweight, and she decided to try it.
I have way too many people depending on me. I thought, ‘I have to do something now.’ I wanted to feel better in my own skin.”
Obesity has many health consequences. It puts individuals at increased risk of high blood pressure, high cholesterol, type 2 diabetes, heart disease, stroke, osteoarthritis, sleep apnea, and depression, according to the Centers for Disease Control and Prevention (CDC). Having obesity or being overweight is also linked to 13 types of cancer — from breast and uterine cancer to kidney, liver, and colon cancer.
Obesity is a common condition in the U.S. About 42% of people age 20 and older in the U.S. have obesity, and about another 32% are overweight, according to the CDC.
While lifestyle changes are enough for some people to lose weight, others need to take more drastic approaches, like surgery or weight-loss medication. The choice is personal, but conquering obesity is necessary to prevent chronic diseases and extend a person’s lifespan, says Amit Parikh, DO, a bariatric surgeon with Vista Health System in Waukegan.
Through their weight-loss journeys, Cornelius and Boruch-Krol discovered that obesity is not a life sentence. People can overcome it, and evidence suggests their health depends on doing so.
Root causes of obesity
Excessive fat tissue around the abdomen can cause inflammation and metabolic changes in the body that steer the development of chronic illnesses and some cancers, says Lisa Tussing-Humphreys, PhD, RD, associate professor in the department of kinesiology and nutrition at the University of Illinois Chicago and leader of the cancer prevention and control program at the University of Illinois Cancer Center.
“Inflammation is a major driver of cancer, and obesity is a state of low-grade inflammation,” she says. The cause is not as simple as overeating or consuming too many calories, Tussing-Humphreys explains.
One culprit is the quality of the food we eat. Our food supply contains a plethora of processed foods. Eating these refined carbohydrates can produce a metabolic effect in the body that favors fat storage, she says.
Our gut microbiome — the important microbes and bacteria that live in our intestines — also plays a role in our overall health. Some of the foods we eat — along with antibiotics, inactivity, poor sleep, and poor mental health — can disrupt our gut microbiome. This, in turn, can promote weight gain and throw off our immune system and metabolic health.
Where we live likely also contributes to obesity, Tussing-Humphreys says. For example, living in a neighborhood with easy access to fast-food restaurants and less access to fresh fruit, vegetables, and whole grains increases an individual’s risk of having obesity.
Other factors come into play, too. Quality sleep is important to a person’s body weight and mental health. And chronic stress may alter hormones, changing how a person eats or promoting fat accumulation.
While obesity may run in families, diet, exercise, and lifestyle have more influence than genetics, says Pankaj Vashi, MD, medical director of gastroenterology/nutrition and vice chief of staff at Cancer Treatment Centers of America, Chicago.
“Where we used to bike to work, we are now taking cars,” Vashi says. “People are not exercising and being physically active, and that impacts obesity. This has become a more serious problem during the pandemic. If you don’t burn enough calories, you will end up accumulating calories in the form of fat in your body.”
Those detrimental factors add up over time. “The earlier you become obese in your life, the longer you have the inflammatory and carcinogenic effect of extra fat. This will increase your likelihood to develop obesity-linked cancers later in life,” Vashi says.
A healthy diet and regular exercise can prevent and conquer obesity, lessening the chance of cancer reoccurring.
Vashi recommends starting good habits in childhood, beginning with sitting down to family dinners each night. Make sure your dinner plate contains vegetables and greens to provide antioxidants, low-fat protein (such as chicken, turkey, fish, or plant-based protein), and fiber in the form of whole grains. To avoid overeating, eat at the same time each day, and turn off the TV so you’re more mindful of what you’re eating.
Gastric bypass surgery
When diet and exercise don’t work or when someone has health issues because of their weight, bariatric surgery may be an option.
In high school, college, and after her first child was born, Amber Cornelius had some success following a Weight Watchers plan, but life always got in the way. Similarly, she didn’t have luck with an ultra-low-carb keto diet or using the Noom weight-loss app.
At 5-foot-11, she was 312 pounds. With the threat of Covid-19 looming, Cornelius opted for a full gastric bypass.
In gastric bypass surgery, a surgeon divides and reroutes the stomach and first portion of the small intestine. The procedure shrinks the stomach and causes hormonal changes that leave people feeling less hunger and more satisfied eating less food, says Parikh, who performed Cornelius’ surgery.
To be eligible for bariatric surgery, people need to have a body-mass index (BMI) over 40, or over 35 with weight-related health conditions. A BMI of 25 or higher indicates overweight, and 30 or higher indicates obesity.
Usually, individuals have already exhausted other methods of weight loss prior to considering surgery, Parikh says. Many insurance plans cover the procedure for people who meet the criteria, considering it medically necessary.
In May 2020, Cornelius began the process of proving she could stick to a lifestyle plan — a prerequisite to gastric bypass surgery. She had a psychological evaluation, started an exercise program, regularly met with a nutritionist who put her on a strict diet, and visited Parikh to check her progress and her weight. Five months later, on her 44th birthday, Cornelius had the surgery.
Like any other major surgery, bariatric surgery carries the risk of bleeding and infection. People can experience nutritional deficiencies due to the body’s limited ability to absorb nutrition.
When people combine bariatric surgery with lifestyle changes — healthy eating, regular exercise, and counseling to understand the motivation behind why they eat — the result is long-term weight loss, Parikh says. Still, it takes a lifetime of commitment.
Now, more than a year after her surgery, Cornelius has lost 125 pounds.
“My sleep apnea has gone away, my blood pressure is in the normal range, and while I will always have arthritis, it doesn’t affect me as much because I’m not putting as much stress on my joints,” she says. “I’ve got so much more energy.”
For Marlena Boruch-Krol, the path to weight loss, through a clinical drug trial, was different.
Her doctor, Liana Billings, MD, suggested that she participate in a clinical trial for the weight-loss drug semaglutide (Wegovy). Billings serves as vice chair of research and education and director of clinical and genetics research in diabetes and cardiometabolic disease at NorthShore University HealthSystem. She also is a consultant for the drug’s maker, Novo Nordisk, and was involved in the clinical trial.
Semaglutide helps cause weight loss by mimicking a hormone that targets areas of the brain that regulate appetite and food intake. It also slows stomach-emptying to make people feel fuller faster.
Billings says the drug is good for people with a BMI of 30 or higher or a BMI of 27 or higher with a weight-related health condition such as high blood pressure. With a BMI of 34, Boruch-Krol qualified for the drug trial. Each week during the 68-week trial, she injected a substance into her stomach. At the time, she didn’t know whether she was taking semaglutide or a placebo, although she later found out she was taking the drug.
Throughout the clinical trial, participants engaged in intensive behavioral therapy, followed a low-calorie diet, and met regularly with a dietitian.
Originally, Boruch-Krol aimed to lose 60 pounds, but she lost nearly 100 pounds, and her BMI dropped to a normal range.
“My blood pressure went down. My blood sugar is lower. I have so much more energy, and physically I feel so much better,” she says. “I can go on walks and not feel tired.”
In the trial, almost 50% of participants who took semaglutide lost 15% or more of their body weight, compared to 5% of participants in the placebo group. The most common side effect was nausea.
“Diet, exercise, and intensive intervention will result in some weight loss,” Billings says. “But there is more weight loss by adding medication.”
The Food and Drug Administration approved Wegovy in June 2021. Physicians can now prescribe the injectable medication for adults with a qualifying BMI. Many insurance plans, such as original Medicare, do not pay for weight-loss medications like semaglutide, so individuals should check with their insurance carrier.
Weight-loss success stories
Participating in the clinical trial and engaging in behavioral therapy taught Boruch-Krol how to manage cravings, prepare satisfying meals that are low in calories, and make walking and swimming routine. Now when she goes shopping, sometimes the clothes she wants to try on are too big.
Cornelius says the best part of her weight-loss journey was establishing a good example for her kids about setting goals and working toward them.
“It’s not just about the weight loss,” she says. “It’s about them seeing me do something hard and letting them know that we can do hard things, and we can overcome challenges. And when something really matters to us, we’ll find a way to make it happen.”
The most difficult part for her, Cornelius says, was changing a lifetime of patterns and not using food as a coping mechanism. She has been working with a therapist on mindfulness and setting boundaries, which has taught her to say no when someone asks too much of her.
“Honestly, I think so much of it is that mental piece,” she says. “Start talking to a therapist. It’s about the food, but it’s not really about the food.”
Changing eating patterns and lifestyle habits takes work — a lot of hard work. While surgery and drugs may help, they still go hand in hand with a diet and exercise plan. Using some of these tools can help people lose weight and gain good health.