You’ve probably seen stories in the news about the new class of weight-loss medications that are suddenly everywhere. Sold under brand names like Ozempic, Mounjaro and Wegovy, glucagon-like peptide-1 (GLP-1) receptor agonists are prescribed both to treat diabetes and help with weight loss. Now, a few small studies have suggested that combining these medications with bariatric surgery can lead to even more weight loss. But is that a good idea?
What Are GLP-1 Receptor Agonists?
Glucagon-like peptide-1 is a hormone that your body produces after eating and causes the release of insulin. This process also helps signal to your body that you are full. For people with diabetes, this process doesn’t often work as well.
Taking a GLP-1 receptor agonist can help your body release insulin the way it is supposed to, which is why many people with Type 2 diabetes benefit from the medications. Since GLP-1 is connected to feeling full, the medications also help reduce appetite. Studies have found people taking these medications have lost more than 5-10 percent of their weight compared to those taking placebos.
Many of the drugs are available as weekly injections, which makes them appealing to people who may struggle to stick to a daily medication schedule. However, many insurance plans will not cover them specifically for weight loss, and out-of-pocket costs can run over $1,000 monthly.
What Is Bariatric Surgery?
Bariatric surgery is a type of surgery on your gastrointestinal tract that can help you lose weight. There are a few types of bariatric procedures, including:
- Adjustable gastric band. During this procedure, a bariatric surgeon places an adjustable band around the upper stomach, which restricts the passage of food through your stomach.
- Roux-en-Y gastric bypass. In this procedure, the surgeon reorganizes the anatomy, creating a smaller stomach but does not remove anything. This procedure is restrictive and malabsorptive.
- Sleeve gastrectomy. This procedure is restrictive and anti-hormonal, eliminating Grehlin (an appetite stimulant).
While the approval process may take 3 – 6 months, bariatric surgery is usually covered by insurance if you are obese and have failed non-surgical methods.
The Research on Medications After Bariatric Surgery
Bariatric surgery is an effective form of weight loss for the right candidates. However, some people still do regain weight after surgery. Several studies in the past few years have looked at the use of GLP-1 receptor agonists in bariatric surgery patients who had regained weight. Similar to patients who haven’t had bariatric surgery, the studies so far seem to show most patients lost weight on the medications. However, research may not show the full picture.
Often, when a patient comes back after bariatric surgery with weight regain, it’s usually just because they were unable to maintain the lifestyle changes that they needed to make after surgery.
Do You Need Medications Before Surgery?
Some people may choose to have bariatric surgery after trying GLP-1 receptor agonists and either not having the desired result in managing their diabetes or losing weight.
These medications are safe to use prior to bariatric surgery, especially for people with diabetes. But they may not always be necessary.
Before bariatric surgery, patients spend several months making lifestyle modifications, such as changing dietary patterns and building exercise habits that will help them maintain long-term weight loss.
It is important for patients to establish these habits before surgery. But if they rely on medication to do the work for them without adopting healthy habits, those patients have a 50 percent failure rate after weight loss surgery. This means that they may lose weight for the first few months, but then they are at an increased risk of weight regain.
Weight-Loss Medications Have Risks
An additional drawback to GLP-1 receptor agonists is their side effects. Many patients report experiencing problems such as:
- Abdominal pain
- Diarrhea
- Dizziness
- Gas or bloating
- Headaches
- Nausea
- Vomiting
While most patients feel side effects lessen as their bodies get used to the medications, not all do.
Providers caution that the medications may carry the risk of pancreatitis and gallbladder disease and even potentially increase the risk of certain cancers for some people.
There Is No Magic Pill for Weight Loss
Whether you’re changing your diet, trying one of the new medications, or planning for surgery, losing weight takes time and patience. Working with a provider who can ensure you receive individualized care is the best way to find a method that works for you.
Research has shown repeatedly that bariatric surgery does successfully keep weight off for many patients. GLP-1 receptor agonists have not been around long enough for long-term studies, but preliminary research shows many patients regain weight when they stop taking them.
Additionally, medications’ weight loss rate differs greatly from weight loss surgery. Research on medications has found patients may lose an average of 30 to 40 pounds a year. Whereas with weight loss surgery, most patients lose 15 to 20 pounds per month for the first three months, which slows thereafter often leading to 100 pounds in a year.
Weight Loss Surgery Outcomes on Diabetes
Weight loss surgery is a very safe procedure. Complications occur in less than 1 percent of surgeries. Bariatric surgery is also successful in reducing the health complications associated with obesity.
Around 80 percent of patients resolve their Type 2 diabetes after surgery if they stick with their new, healthier lifestyle habits. In these patients, their diabetes is gone forever. They don’t need to take medication anymore, and the effects of diabetes will not cause any further damage to their body.
More to Read
- GLP-1 Agonists for Diabetes: Can They Also Be Used for Weight Loss?
- The Benefits of Bariatric Surgery Beyond Weight Loss
- Strength Training for Weight Loss: Gaining Muscle and Losing Fat
- 7 Tips for Healthy, Lasting Weight Loss
Medical contributions and review by Alexander R. Aurora, MD, FACS, FASMBS, Director of Bariatrics and Advanced Minimally Invasive Surgery at the Upper Chesapeake Bariatric Surgery Program, UM Upper Chesapeake Health.
