If you’re like nearly half of all adults in the U.S, you’re actively trying to lose weight or struggling to keep it off. Every year, millions of people attempt to shed pounds by dieting, hitting the gym or trying the latest trends, only to find that the excess weight is stubborn and often returns.
That’s because weight loss is much more complex than simply “eating less and moving more.” It’s shaped by a combination of factors, including metabolism, hormones, genetics, mental health, stress, sleep and even certain medications.
Long-term weight loss success—whether through lifestyle changes, medications or surgery—often depends on addressing all of these influences together.
Lifestyle Changes: The Foundation of Every Weight Loss Plan
The first step in any weight loss journey is usually a change in daily habits, including food choices, exercise, sleep patterns and stress management.
Here’s how each plays a role in maintaining a healthy weight:
Nutrition
A balanced, whole-food diet that prioritizes lean proteins, healthy fats, vegetables and fiber-rich carbohydrates (such as fruit, legumes and whole grains) is usually the best sustained approach for weight loss. Consuming adequate water is another key element of how dietary habits can affect well-being and weight loss. For most patients, drinking at least 64 ounces of water per day is the routine recommendation.
Many people can also benefit from meal planning (which reduces temptations and eating out of convenience), practicing portion control with help from mindful eating, and in some cases, working with a registered dietitian.
Exercise
Regular movement—like walking, strength training, yoga or swimming—can aid in weight loss by preserving muscle mass and bone health, and fighting stress. Most adults should aim for at least 150 minutes of moderate-intensity exercise per week (or about 30 minutes or more most days of the week).
Mindful Eating
Approaches like intuitive eating and hunger awareness can help retrain your relationship with food and prevent emotional eating and overeating. Examples of mindful eating include slowing down when you eat, avoiding distractions and stopping as soon as you feel full.
Pros of Lifestyle Approaches:
- No side effects
- Improves overall well-being and energy while promoting healthy aging
- Can be done at any stage of life
Limitations:
- Weight loss is often slow and may plateau
- Hard to sustain with metabolic resistance or underlying medical issues
- Many people regain the weight without long-term support
Bottom line: Lifestyle changes are always necessary, but they may not be enough on their own for everyone, especially those with obesity-related health concerns.
Medications: New Tools for Appetite and Metabolism
For people who struggle with significant cravings, appetite control or insulin resistance, prescription weight loss medications are a non-surgical option for weight loss that can be helpful additions to lifestyle efforts.
Medications that can support weight loss include:
GLP-1 Receptor Agonists (like Semaglutide or Tirzepatide):
These medications are designed to reduce appetite, increase feelings of fullness and affect how your body processes food.
Common options include GLP-1 receptor agonists like semaglutide or tirzepatide, which mimic natural hormones that help regulate hunger and blood sugar.
Other medication options include combinations like bupropion/naltrexone or phentermine/topiramate, which target appetite and cravings.
Medications are most effective when combined with healthy eating and exercise and are typically prescribed for those with a BMI of 30 or higher, or 27+ with weight-related health issues, such as type 2 diabetes.
Pros of Weight Loss Medications:
- Helps jumpstart weight loss when combined with diet and exercise
- Many people lose 5-15 percent of their total body weight
- Can reduce appetite and improve metabolic health (like blood sugar and cholesterol)
- Non-invasive and often well-tolerated
Limitations:
- Results vary, and some people may not lose as much weight as they hoped for
- May cause side effects like nausea, GI discomfort or fatigue
- Muscle mass can decrease if strength training isn’t regularly included
- Weight often returns when the medication is stopped
- Long-term safety is still being studied for newer drugs
Bottom line: Medications can usually help, but they work best in combination with a structured weight loss and exercise plan and may not deliver the lasting results many people hope for.
Surgery: A Long-Term Solution for Sustainable Results
Bariatric surgery is one of the most effective treatments for people with obesity, especially when other methods haven’t worked. At weight loss centers, such as Stony Brook’s Bariatric and Metabolic Weight Loss Center, several surgical options for weight loss are available:
Sleeve Gastrectomy (Gastric Sleeve)
This is the most commonly performed weight loss surgery in the U.S. and involves removing about 75-80 percent of the stomach, leaving behind a smaller, tube-shaped “sleeve.”
With less space in the stomach, you feel full sooner and consume fewer calories. The surgery also reduces levels of the hunger hormone ghrelin, helping to decrease appetite.
Gastric Bypass (or Roux-en-Y Gastric Bypass)
This surgery creates a small pouch at the top of the stomach and connects it directly to the small intestine, bypassing most of the stomach and part of the small bowel.
This procedure helps patients lose weight in two ways: It limits how much food they can eat and reduces how many calories and nutrients the body absorbs. It also leads to favorable changes in gut hormones that reduce appetite and improve blood sugar control, making it particularly effective for people with type 2 diabetes.
Duodenal Switch
This is a two-part surgery that starts with a sleeve gastrectomy, followed by rerouting a significant portion of the small intestine. It typically leads to significant weight loss, up to 30-40 percent of someone’s initial body weight, and offers dramatic improvements in obesity-related conditions like diabetes and high cholesterol.
However, because this surgery significantly reduces the body’s ability to absorb calories and nutrients, it carries a higher risk of vitamin and mineral deficiencies. This option is typically reserved for individuals with severe obesity (BMI over 50).
Pros of Weight Loss Surgery:
- Average weight loss of 25-40 percent of initial (total) body weight within 1-2 years
- Improves or resolves many obesity-related conditions like type 2 diabetes, sleep apnea, high blood pressure and joint pain
- Long-term success when paired with healthy habits and follow-up care
Limitations and Considerations:
- Requires surgery and recovery time
- Requires lifelong nutrition monitoring and supplements to prevent deficiencies
- Not a “quick fix”—success still depends on long-term lifestyle changes
Bottom line: Bariatric surgery can be life-changing, and even life-saving, for people who haven’t found success with other methods. It’s generally very safe and can be effective at improving overall health when obesity is contributing to other conditions.
How Do You Know When Surgery Might Be Right for You?
You might be a good candidate for bariatric surgery if:
- You have a BMI of 40 or higher, or 35+ with a serious health condition like type 2 diabetes or hypertension
- You’ve tried diet, exercise and/or medications without long-term success
- Your weight is impacting your daily life, mobility or mental health
- You’re ready to make lasting lifestyle changes with the support of a dedicated medical team
At Stony Brook’s Bariatric and Metabolic Weight Loss Center, we take a personalized, evidence-based approach to weight loss. Whether you’re just starting out or considering surgery, our experienced team of surgeons, dietitians, and support staff will help you explore your options and choose the plan that fits your needs. Learn more or schedule a consultation here.
