Medical Weight Loss: GLP-1s vs. Bariatric Surgery
Choosing the right weight-loss treatment
Choosing the right weight-loss treatment
It’s estimated that nearly three-quarters of adults in the US are overweight or obese, and according to the National Institutes of Health, obesity rates have tripled since the 1960s.
The American diet is shifting away from whole foods to more convenient fare, a rise in sedentary lifestyles and environmental factors, like the availability of supersized foods and less walkable cities, are all thought to be factors.
The effects are clear: being overweight or obese has been linked to numerous health conditions, including cardiovascular disease, metabolic disorders, stroke and certain types of cancers.
Why diet and exercise alone may not work
Diet and exercise have long been the gold standard in turning the tide on weight gain, though genetics, medical conditions and socioeconomic factors can make losing weight difficult to impossible. For people who are significantly overweight, bariatric surgery and a new class of drugs called glucagon-like peptide-1 receptor agonists (GLP-1) are changing the game and sparking hope for a healthy future.
GLP-1s: a new tool for weight loss
Since GLP-1 and similar GIP medications gained FDA approval for weight loss, demand has skyrocketed. The drugs work by mimicking hormones that slow digestion, increase satiety, lower blood sugar and control cravings.
“GLP-1s affect the gut directly and also the brain and appetite. They help people maintain a calorie deficit, and that's how they lead to weight loss,” says Gabriela Jordan, MD, an endocrinologist and obesity medicine specialist at Scripps Clinic Hillcrest. “In trials of the combination of GLP-1 and GIP agonists, patients lost an average of 25% of their initial body weight at the highest dose.”
GLP-1 medications, which are available by prescription only and administered by weekly injection, are approved for people with a body mass index above 30, or above 27 with a comorbidity, such as type 2 diabetes, prediabetes, high blood pressure or sleep apnea.
Though the medications are effective for many people, they also come with drawbacks, says Dr. Jordan. About one in five patients will experience some form of gastrointestinal side effects and there’s a small chance of more serious complications.
They’re also costly and not always covered or entirely covered by insurance. And most people will have to stay on them long term or risk gaining the weight back — and then some.
“Diet and exercise can only go so far and that’s where these medications can play a critical role for a lot of people who really just need that extra push to start to see meaningful weight loss,” she says.
Bariatric surgery for long-term results
For people with a BMI of more than 40, or over 35 with related health conditions, doctors often recommend bariatric surgery, if diet, exercise and medications have not led to significant weight loss.
“In many instances, medications don't achieve the efficacy of weight loss surgery,” William Fuller, MD, a bariatric surgeon at Scripps Clinic. “Though we always stress diet and exercise, surgery remains a more sustainable method of losing weight and ultimately leads to a higher weight loss compared to other modalities.”
There are different types of bariatric surgeries, but they all work by reducing the size of the stomach. Surgery also triggers a secondary effect at the hormonal level that’s similar to that of GLP-1 drugs.
“Bariatric surgery is a very potent tool for many patients,” says Dr. Fuller. “The sense of fullness that patients experience after bariatric surgery is not just relegated to stomach volume. Bariatric surgery has a profoundly beneficial impact on gastrointestinal hormones that help to increase satiety.”
Most bariatric surgeries are performed using minimally invasive techniques, which often result in less time in the hospital and fewer complications. Doctors continue to monitor the patient post-surgery to ensure they are healthy. Physicians and researchers are also looking into using weight loss medication in conjunction with bariatric surgery, whether that’s pre-surgery to make the procedure safer or post-surgery to combat plateaus.
“In the long-term, we still have to get more data to figure out how they interact and whether they'll ultimately be synergistic,” says Dr. Fuller. “But from an anecdotal standpoint, I have seen that these medications have been effective for patients postoperatively in helping them to reduce modest weight regain.”
Watch the San Diego Health video on how to lose weight with medication and/or surgery.
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.