GLP-1s Vs. Bariatric Surgery For Weight Loss

In the United States, more than 40 percent of adults have obesity —a body mass index (BMI) over 30. In addition to being an epidemic, obesity is also a chronic disease. Over time, it can lead to additional health problems and complications. That's why it's important to lose weight and maintain a healthy BMI.

Weight loss can be difficult. For some people, diet and exercise are enough to move the needle on the scale. But if you struggle to drop pounds, you may need more help. Fortunately, surgery and medication options are available. Igor Wanko Mboumi, MD, FACS, a bariatric and general surgeon at Franciscan Physician Network Indy Southside Surgical in Indianapolis, explains how bariatric surgery and GLP-1 medications can promote weight loss.

For many people, wellness means different things, walking without pain, keeping up with kids, sleeping soundly or simply feeling good in your own skin. Achieving a healthier weight can help support those goals, but wellness always includes more than a number on the scale.

Key Takeaways: GLP-1s Or Bariatric Surgery For Weight Loss

• Bariatric surgery procedures restrict stomach size or reduce hunger hormones to help patients lose weight.
• GLP-1 medications also control hormones that reduce appetite.
• Some patients may need surgery and weight-loss medication to lose weight and keep it off long term.

What Is Bariatric Surgery And How Does It Help Me Lose Weight?

Bariatric surgery involves physical changes to your stomach and intestines that decrease the amount of food you eat and reduce how much your body can absorb. Although these procedures can be expensive, research shows they may lead to several health improvements.

"Bariatric surgery is costly, but it's a lot cheaper for patients to have an operation than to be on pricey medications for long periods of time," Dr. Wanko said. "In terms of getting patients close to a healthy weight — or a BMI of 25 — nothing has been shown to have the same success as bariatric surgery."

Bariatric surgery also offers these health benefits:

• Decreased rates of uterine and esophageal cancers
• Faster metabolism
• Improved type 2 diabetes
• Less medication use
• Lower blood pressure
• Reduced heart failure and heart disease

Dr. Wanko said weight loss surgery is a good option for patients who:

• Have a BMI over 40 with no other health conditions
• Have a BMI over 35 with at least two obesity-related complications, including chronic gastroesophageal reflux disease (GERD), diabetes, heartburn or high blood pressure

What Bariatric Surgery Procedures Are Available?

Franciscan Health offers two types of bariatric surgery:

• Gastric bypass surgery: Gastric bypass restricts the size of your stomach. It creates a new, smaller stomach pouch that bypasses roughly 150 centimeters of your small intestine. As a result, your body can absorb fewer nutrients and you may need to take supplements.
• Gastric sleeve surgery: Also called sleeve gastrectomy or vertical gastrectomy, the gastric sleeve removes up to 80 percent of your stomach, shrinking it to the size of a banana. It triggers weight loss because it removes the part of your stomach that produces the hunger hormone ghrelin.

"Ghrelin hormone increases appetite and makes people hungry or crave different foods," Dr. Mboumi said. "When we take away that part of the stomach, patients get a hormone effect that modifies behavior. So, sleeve surgery isn't simply a restriction surgery. It's also a hormonal surgery."

How Do GLP-1 Medications Help Weight Loss?

Surgery can be an effective option, but it isn't for everyone, Dr. Wanko said. For those people, GLP-1 (glucagon-like peptide-1) medications designed to control blood sugar levels can also help with weight loss.

"GLP-1s are good for people who either don't qualify for surgery, don't need surgery or who simply don't want it," he said. "But, like surgery, they work by reducing appetite."

Basically, GLP-1 medications impact your hypothalamus, the gland in your brain that controls your feelings of hunger and thirst. These medications activate receptors in your hypothalamus to lower your appetite and make you feel fuller for longer. They also slow your digestion, so your stomach doesn't empty as quickly.

In addition to helping with weight loss, GLP-1s have been shown to support better overall wellness, including improved blood sugar control, lower risk of heart and kidney disease and relief from joint or sleep-related issues caused by excess weight.

Who Is A Good Candidate For GLP-1 Medication?

According to Dr. Wanko, GLP-1 medication is a good weight-loss option for patients who:

• Have a BMI over 30
• Have a BMI over 27 with at least one weight-related health problem like diabetes, high blood pressure or high cholesterol
• Need additional help to increase or maintain weight loss after bariatric surgery

To improve your health, a GLP-1 must be part of a more comprehensive approach.

"Taking a GLP-1 for weight loss overall isn't the answer," Dr. Wanko said. "You still need to exercise and eat the right food. If not, you could stop taking the medication and gain back more weight than you lost."

For most adults, get at least 150 minutes of physical activity each week for weight loss or 200–300 minutes to maintain it. Strength training twice per week helps preserve muscle as you lose fat. Pair that with whole-food meals rich in plants, fiber and lean proteins for the best long-term results.

Are There Disadvantages To Taking A GLP-1?

Although GLP-1 medications can lead to significant weight loss, they don't work for everyone, Dr. Wanko said.

"Some patients are non-responders. They can't tolerate the medication or may be genetically resistant," he said. "If you lose less than 5 percent of your total weight within six months of starting the medication, you're most likely a non-responder and these types of medications will not work for you."

In addition, severe side effects are possible. For some patients, dehydration can lead to acute kidney injury. Other patients may experience optic ischemia (low blood supply to the eye) or optic neuritis (inflammation of the optic nerve). Both eye conditions can cause blurry vision or sudden blindness.

Address Your Weight Early

Dr. Wanko said being proactive is the key to tackle obesity and maintain a healthy weight long term. Talk with your doctor about bariatric surgery or GLP-1 medication. They can help you choose the right path for your weight loss journey. As a result, you may reduce your chances of developing additional weight-related health problems in the future.

"Obesity is a chronic disease and a lifetime struggle. The sooner we address it, the better. You should take steps as young as you can to live your best years and be in the best possible health," he said. "Still, even when you're older, weight loss has many benefits. So, don't wait to reach out for help."