Bariatric surgery and weight loss drugs: key points to know

Written on February 22, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• Bariatric surgery
• GLP-1 medications for weight loss
• Do I need to continue using the medication to keep the weight off?
• GLP-1 medication has promise in maintaining weight loss after bariatric surgery
• Key points
• Weight management with Everlywell
• Related content

Obesity remains a significant public health issue affecting many people from all walks of life. Losing weight can be a challenging journey and often requires considerable commitment of your time, effort, and resources. Obesity increases your risk of developing chronic and acute health problems [1]. Many factors contribute to obesity, including genetic predisposition, poor dietary choices, and a sedentary lifestyle [2].

Obesity is a complicated health problem requiring personalized treatment [2]. You, as an individual, have different weight loss goals and unique challenges from other people, which can make losing weight difficult. While losing weight can be challenging, weight loss can improve your quality of life and reduce the risk of developing other chronic diseases.

Advances in medicine have allowed for more treatment options to help with weight loss when exercise and dieting are no longer effective in achieving weight loss goals [1,2]. Weight loss medications are an option to help you lose weight without requiring bariatric surgery.

Bariatric surgery

Lifestyle change and weight loss medication effectively treat obesity, but bariatric surgery remains the most effective treatment for severe obesity [3]. Positive health outcomes from bariatric surgery far outweigh the usual treatment in the long-term improvement of reduced mortality and decreased incidence of diabetes, heart disease, and strokes [4]. Despite these positive health outcomes, bariatric surgery still poses significant health risks, which may include bowel obstruction, gallstones, and acid reflux [5]. Sometimes, bariatric surgery may not help you achieve your weight loss goals. Surgery itself entails significant risk, and candidates are carefully screened and vetted before surgical operations. Not all patients will qualify for bariatric surgery because of their substantial underlying health issues, and they will have to lose weight without surgery.

GLP-1 medications for weight loss

Surgical treatment has been the only effective long-term treatment of obesity [3]. However, a newer class of weight loss medication that targets the glucagon-like peptide-1 (GLP-1) receptor is an effective treatment option for obesity without surgery. GLP-1 is a hormone produced in the gut, and it is released when you eat to help reduce appetite by lowering glucagon concentration, increasing insulin, and delaying gastric opening [6,7].

The US Food and Drug Administration (FDA) has approved two GLP-1 medications, liraglutide and semaglutide, for the long-term management of obesity [8]. Depending on the dose, patients treated with liraglutide saw about 5%-10% average weight loss [8]. Patients treated with semaglutide saw an average of about 15% weight loss [8]. GLP-1 drugs are effective in reducing weight, but there are side effects associated with taking the medications, including diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, and dizziness [8].

Do I need to continue using the medication to keep the weight off?

Obesity is a complicated health condition that is treated as a chronic disease. This makes obesity a challenging disease, even with surgery and medication. Although GLP-1 weight loss medications effectively treat obesity, patients have regained weight if the medication is withdrawn.

In a recent study investigating the withdrawal of semaglutide after one year, the patients regained two-thirds of their prior weight [9]. Not only did patients regain weight, but the health benefits of losing weight also reverted back to when the patient started the GLP-1 drug treatment. Clinical evidence from two studies shows that GLP-1 treatment helped patients maintain 5%-10% weight loss and health benefits [10, 11]. Based on these trials, more than likely, you will have to continue on the GLP-1 medication to keep the weight off [9-11]. If you are experiencing difficulties keeping your weight down after treatment or have reached your goal weight, you should consult your healthcare provider to determine the best next steps in your treatment.

GLP-1 medication has promise in maintaining weight loss after bariatric surgery

Despite the effectiveness of bariatric surgery in treating obesity, about 20% of patients will experience weight regain within five years of their surgery [12,13]. Weight regains in these patients were attributed to various factors such as increased appetite, physical and mental health, or lack of weight management and focus. New research investigating the use of GLP-1 as an adjuvant for post-bariatric surgery to maintain weight is promising. The researchers saw that the patients on GLP-1 medication achieved greater than 5% weight loss control within 3-9 months compared to patients not on GLP-1 medication [14].

Key points

• Obesity is an important public health concern, and treating obesity is challenging
• Bariatric surgery has traditionally been a long-term effective treatment option for obesity, but surgery can pose chronic health risks that include bowel obstruction, gallstones, acid reflux
• The US FDA has approved two GLP-1 drugs, liraglutide and semaglutide, for the long-term management of obesity
• Studies with GLP-1 medications show an average weight loss of around 15%, comparable to bariatric surgery

Weight management with Everlywell

The choice of multiple therapy options to treat obesity can help you reach your weight goals and keep the weight off. Maintaining a healthy weight will improve your health and lifestyle. At Everlywell, we provide access to a weight management telehealth option where you can schedule a virtual visit with a licensed healthcare provider. The healthcare provider may prescribe you medication, if appropriate for you, and provide clinical support to help you lose weight and reduce your risk for long-term health issues.

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References

1. Pi-Sunyer X. The medical risks of obesity. Postgrad Med. 2009;121(6):21-33. doi:10.3810/pgm.2009.11.2074. URL.
2. Lin X, Li H. Obesity: Epidemiology, pathophysiology, and therapeutics. Front Endocrinol (Lausanne). 2021;12:706978. doi:10.3389/fendo.2021.706978. URL.
3. Sarma S, Palcu P. Weight loss between glucagon-like peptide-1 receptor agonists and bariatric surgery in adults with obesity: A systematic review and meta-analysis. Obesity (Silver Spring). 2022;30(11):2111-2121. doi:10.1002/oby.23563. URL.
4. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219-234. doi:10.1111/joim.12012. URL.
5. Seeras K, Acho RJ, Lopez PP. Roux-en-Y gastric bypass chronic complications. [Updated 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. URL.
6. Ard J, Fitch A, Fruh S, Herman L. Weight loss and maintenance related to the mechanism of action of glucagon-like peptide 1 receptor agonists. Adv Ther. 2021;38(6):2821-2839. doi:10.1007/s12325-021-01710-0. URL.
7. Nauck MA. Glucagon-like peptide 1 (GLP-1): a potent gut hormone with a possible therapeutic perspective. Acta Diabetol. 1998;35(3):117-129.doi:10.1007/s005920050116. URL.
8. Bays HE, Fitch A, Christensen S, Burridge K, Tondt J. Anti-obesity medications and investigational agents: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2022. Obesity Pillars. 2022;2:100018. doi:10.1016/j.obpill.2022.100018. URL.
9. Wilding JPH, Batterham RL, Davies M, et al. weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. doi:10.1111/dom.14725. URL.
10. Wadden TA, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study [published correction appears in Int J Obes (Lond). 2013 Nov;37(11):1514] [published correction appears in Int J Obes (Lond). 2015 Jan;39(1):187]. Int J Obes (Lond). 2013;37(11):1443-1451. doi:10.1038/ijo.2013.120. URL.
11. Astrup A, Carraro R, Finer N, et al. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide [published correction appears in Int J Obes (Lond). 2012 Jun;36(6):890] [published correction appears in Int J Obes (Lond). 2013 Feb;37(2):322]. Int J Obes (Lond). 2012;36(6):843-854. doi:10.1038/ijo.2011.158. URL.
12. El Ansari W, Elhag W. Weight regain and insufficient weight loss after bariatric surgery: definitions, prevalence, mechanisms, predictors, prevention and management strategies, and knowledge gaps-a scoping review. Obes Surg. 2021;31(4):1755-1766. doi:10.1007/s11695-020-05160-5. URL.
13. Tolvanen L, Christenson A, Surkan PJ, Lagerros YT. Patients' experiences of weight regain after bariatric surgery. Obes Surg. 2022;32(5):1498-1507. doi:10.1007/s11695-022-05908-1. URL.
14. Gazda CL, Clark JD, Lingvay I, Almandoz JP. Pharmacotherapies for post-bariatric weight regain: real-world comparative outcomes [published correction appears in Obesity (Silver Spring). 2021 Sep;29(9):1567]. Obesity (Silver Spring). 2021;29(5):829-836. doi:10.1002/oby.23146. URL.