GLP-1s and Weight Loss Surgery: What You Need to Know
GLP-1s, commonly called ‘weight loss injections,’ can help you lose weight, but how they fit into your weight loss treatment plan is best decided by a weight loss specialist. According to Jennifer Norris, PA-C, a medical weight management specialist at Duke Health, “GLP-1s are often hyped as 'miracle drugs', but the reality is more nuanced. They are highly effective for many people but they come with limitations.”
With the right supervision, glucagon-like peptide-1 receptor agonists (GLP-1s) can be part of a staged approach to help you reach your weight loss goals. Here, Norris, a physician assistant, explains what you need to know about GLP-1s and how they complement weight loss surgery.
How do GLP-1s Work?
GLP-1s are injected under the skin once a week. They work by mimicking the body’s GLP-1 hormone that increases insulin and lowers blood sugar. At the same time, the hormone makes you feel full, so you eat less.
Are GLP-1s Safe for Everyone?
GLP-1s are generally considered safe when used as prescribed. They may cause side effects, such as nausea, vomiting, diarrhea, constipation, and stomach pain which can be mild to severe. Obesity specialists know how to taper up the dose over time to manage some of these side effects.
GLP-1s are not recommended for people with medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, or severe gastrointestinal disease.
Not All GLP-1s Are the Same
While Ozempic (semaglutide) is the most “talked” about GLP-1 on the market, there are several others.
Some GLP-1s, like Ozempic, Mounjaro (tirzepatide), and Victoza (liraglutide), are approved to treat type 2 diabetes, meaning these medications are only prescribed if you have type 2 diabetes. Insurance often covers these medications for this diagnosis.
Wegovy (semaglutide) and Zepbound (tirzepatide) are approved for weight loss and obesity management. It can be hard to get insurance to cover use for this purpose. Without coverage, these medications can be very expensive.
GLP-1s vs. Weight Loss Surgery
It’s possible to take a weight loss drug instead of surgery, Norris said. On average, people lose about 15-25% of their total body weight on these medications, which is very good. However, it’s important to remember that obesity is a chronic disease, and these are long-term treatments that may not be covered by insurance. They are only effective for as long as they are used. Once treatment stops, the weight can return.
In contrast, weight loss surgery is a more permanent treatment that is often covered by insurance. Studies show weight loss surgery can also improve conditions caused by obesity, such as diabetes, sleep apnea, hypertension, and high cholesterol. However, surgery is not without risks and requires life-long lifestyle commitments, as well as vitamin supplementation to manage vitamin deficiencies that can occur.
Best Approach for Some: Combine GLP-1s and Bariatric Surgery
For some people, the best approach to weight loss may be a combination of GLP-1s and weight loss surgery. “Obesity often requires a comprehensive treatment approach,” said Norris. “If a GLP-1 is available and appropriate, it can be an effective option to try prior to surgery.” Other times, GLP-1s are recommended for people with extremely elevated BMIs to help them lose weight in preparation for weight loss to surgery, which can lead to a safer surgery.
GLP-1s may also be prescribed after weight loss surgery if weight returns.
Bottom Line: Work with an Obesity Specialist
If you are obese and want to lose weight, it’s best to work with an obesity specialist who can tailor your treatment to your needs. "My team also works with people on lifestyle modification such as eating right to ensure you’re getting enough protein and the right nutrition, and exercising so that you lose body fat, not muscle mass," Norris said.
If your weight loss goals are not met, an obesity specialist can help determine which weight loss surgery is right for you.
