More Than a Number: Bariatric Surgery, GLP-1 Medications and Tools to Treat Obesity.

With bariatric surgery and the widespread adoption of GLP-1 RA medications, such as Ozempic and Mounjaro, there are now more effective options to treat obesity than ever before. And for some patients, the best route is a combination of treatments. 

The first step to treating obesity is for patients and providers to recognize it as a medical condition with effective available treatments. Obesity is a complex, chronic disease defined by an increase in the size and number of fat cells in the body. It has many causes, including genetics and family history, medications, and behaviors. People with obesity have a higher risk for other serious health conditions, including:

• Asthma
• Cancer
• Depression and anxiety
• Gallstones and gallbladder disease
• High blood pressure
• High cholesterol
• Heart disease
• Osteoarthritis
• Type 2 diabetes
• Sleep apnea
• Stroke

According to the latest statistics, about 42% of people in the U.S. have obesity. Research finds that by 2030 almost half of the nation will have a body mass index (BMI) greater than 30, the threshold for obesity. 

While discussing weight can be uncomfortable, the sooner patients and providers begin talking about treatment, the earlier we can intervene to improve their health. And with so many effective tools available, now is an excellent time to consider making a change. 

Tools for treating obesity.

As with other chronic medical conditions, the best treatment for obesity may be a combination of methods tailored to each patient’s condition, goals, and lifestyle.
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GLP-1 RA medications.

One of the most recent advances in weight loss treatment are medications called glucagon-like peptide-1 receptor agonists, or GLP-1 RA. You’ve probably heard about brand names like Trulicity (dulaglutide), Victoza (liraglutide), Ozempic (semaglutide), and Mounjaro (tirzepatide). 

Some GLP-1 RA are approved for treating type 2 diabetes, some for weight loss, and others for both. These drugs mimic the action of the GLP-1 hormone to help control blood sugar, reduce appetite, and encourage weight loss by slowing down food’s movement from the stomach to the small intestine, so you feel full longer. 

These medicines are taken either in pill form or, more commonly, by injection. They can help patients lose 10-20% of their bodyweight in six to 12 months when they make lifestyle changes, such as eating healthy foods and exercising. 

Like any medication, GLP-1 RA drugs can have side effects, especially in the gastrointestinal tract. These can include nausea, vomiting, diarrhea, constipation, and bloating. Headaches, injection site reactions, and dizziness are also possible side effects of GLP-1 medications. Public insurance carriers, such as Medicaid and Medicare, may not cover the cost of these drugs for weight loss alone if you don’t have diabetes.

While these drugs offer a convenient option for many patients, we don’t yet have long-term data about side effects or what happens when patients stop taking them. Some early studies have suggested that once the drug is stopped, weight tends to return—time and research will tell whether the same could be true for high blood pressure or diabetes.

Bariatric surgery.

For some patients, bariatric surgery provides more effective, long lasting weight loss. Studies have shown it is better  than GLP-1 drugs for patients with chronic kidney disease, and it’s covered by many insurance plans. 

Many patients can lose more weight following bariatric surgery than with medications, in part because the surgery makes an anatomical change. When we make the stomach smaller or bypass the intestine, it’s harder to regain weight. 

While GLP-1 medications are sometimes prescribed without much support, patients in MedStar Health’s unique bariatric program participate in three important steps:

• Preoperative weight management: A medically supervised weight loss program for three to six months before surgery.
• Surgery
• Follow up: Our experts continue to work with patients throughout their life to help them monitor their weight loss and stay healthy. 

Not everyone is a candidate for bariatric surgery. As an Accredited Center for Metabolic and Bariatric Surgery, at MedStar Health we follow national guidelines for eligibility. Criteria to proceed with surgery include:

• Commitment to a major lifestyle change.
• A BMI of 35 or more with an obesity-related condition or a BMI of 40 or more with no obesity-related condition.
• Healthy enough to have surgery.
• No unstable psychiatric issues.
• No alcohol, tobacco, or substance use.

• Lap-band system: The least extreme surgical option, laparoscopic gastric banding involves placing an adjustable band around the upper part of the stomach to make it smaller.
• Sleeve gastrectomy: This procedure reduces the size of the stomach by about 85% by making the stomach a thin sleeve that holds much less food.
• Roux-en-Y bypass: This most significant surgery divides the stomach to make a small pouch that is attached to the intestine, bypassing most of the stomach and the first part of the small intestine.

Most bariatric surgeries my colleagues and I perform are minimally invasive. With a few small incisions in the abdomen, we insert delicate instruments that allow us to complete surgeries with very little disruption to the nearby tissues. This makes recovery much faster. Many bariatric surgeries now require just one night in the hospital. 

Minimally invasive bariatric procedures have a low risk of complications. The most common side effects are nausea, fatigue, and vomiting in the first few days after surgery.

Lifestyle modifications.

Patients who choose surgery or GLP-1 RA medications to treat obesity should also commit to lifestyle modifications for the best chance of success. For some patients, lifestyle modifications such as these are the best treatment plan:
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• Healthy eating: Consume a variety of fresh, minimally processed foods, such as fruits, vegetables, lean meats, low-fat dairy, and whole grains.
• Activity: Get at least the recommended amount of 150-300 minutes per week of moderate-intensity physical activity. 
• Counseling: Work with nutrition and mental health professionals to help address emotional issues related to eating and build new strategies to support nutritional and exercise goals. 
• Other modifications: Get enough sleep, limit screen time, and manage stress to make a big difference in your overall health.

Related reading: Weighing Your Options: 4 Tools to Break the Cycle of Obesity.

Improving health with obesity treatment.

Bariatric surgery and GLP-1 medications aren’t an either-or choice. For many patients, it’s a combination of these tools that can help them get healthier by losing weight. 

With any obesity treatment, our goal is more than just a number on a scale. It’s about improving health, so patients can better their quality of life and live longer, fuller lives. I have had patients who were able to stop taking diabetes or high blood pressure medications after surgery. These are the outcomes we’re working toward.

There is still too much shame associated with obesity, and more stigma than most medical conditions. While we are making progress, too many patients still tell me, “My doctor never said I had a problem.”

Neither bariatric surgery nor GLP-1 RA medications are an “easy way” to lose weight. My patients can tell you that getting healthier is hard, but it’s worth it. They often tell me with a smile, “I can walk to your office without stopping,” or “I can play with my grandkids again.”

If you have obesity, don’t wait until you develop other medical conditions to seek treatment. We have so many tools that can help—talk with your primary care doctor or an obesity specialist about an evaluation.