Are Weight Loss Medications Like Wegovy the End of Bariatric Surgery?
We’ve covered weight loss medications like Wegovy and diabetes shots like Ozempic and Mounjaro in a previous article. Should you wish to learn more about these drugs currently being used on- and off-label for weight loss, we encourage you to read about them before continuing with this blog. However, if you have done your research and understand a good deal about the weight loss options available to you, this article will explain how we approach weight loss medications and surgery for various BMI levels.
Before delving further into whether weight loss medications will supplant bariatric surgery for most patients, it’s essential to understand the benefits and limitations of the BMI calculation itself. BMI is a somewhat arbitrary but helpful measure of weight compared to height. Currently, it is the best and easiest way to classify patients from underweight to obese. According to the BMI, patients from 25 to 29.9 are considered overweight. Patients with a BMI of 30 to 34.9 are obese, those with a BMI of 35 and over are considered obese II, and a BMI of 40 or greater is obese III or morbidly obese. But what does this all mean? We use this primarily to decide whether patients are candidates for medical or surgical intervention to lose weight and deal with the diseases commonly associated with obesity. However, the BMI is inherently flawed, and it doesn’t consider several traits, including gender, musculature, and frame size, among other things. For example, when predicting the risk of cardiovascular disease, a person’s waist size is often much more valuable than their BMI.
That notwithstanding, BMI can give us a good idea of a patient’s suitability for various weight loss interventions. For patients who are classified as overweight but not obese, diet and exercise are often the best way forward. They may need to lose between 20 and 40 pounds, which could be done by strictly adhering to a diet and exercise plan. To be sure, these patients may have weight-related concerns, such as high blood pressure, high cholesterol, high blood sugar, GERD, or osteoarthritis, but at this level, losing some weight and treating the individual concern may be more fruitful than the risks of surgery. These patients may also benefit from weight loss medications if they are experiencing comorbidities or lifestyle impediments.
Once we get into the relatively lower levels of obesity according to BMI, typically from 30 to 40, we get some overlap between the medical and surgical benefits. Considering the results from clinical trials of Wegovy, for example, many patients lost up to 15% of their body weight. This may be sufficient for relatively lower BMI obese patients to drop into the overweight or normal weight category. While bariatric surgery can do the same and more, many patients wish to avoid going under the knife and may not be good candidates for one reason or another. On the other hand, we know that medications are not always effective, and some have severe side effects. These cases may require discontinuing the drugs, and the balance shifts towards surgery.
What Are the Circumstances in Which One Would Stop Using Weight Loss Medications Like Wegovy?
Several documented and well-known potential risks are associated with weight loss medications, known as GLP-1 receptor agonists or semaglutides like Wegovy. Some patients experience inflammation of the pancreas, known as pancreatitis. This can be very serious. Other patients experience nausea and vomiting, while others may also develop gastroparesis, resulting in delayed food movement through the GI tract. All these issues may make continuing weight loss medications impossible, at which point patients will often regain their weight and possibly even more over time. Some patients have also reported suicidal ideations and thoughts of self-harm, and European and UK authorities are currently evaluating all GLP-1 receptor agonist medications for this problem. The investigation is expected to be completed this fall or winter.
When Weight Loss Medications Do Not Make Sense
For many patients with higher BMIs in the obese range – for the sake of this article, let’s say 40 or more, even the best-documented results from weight loss medications may not be enough to offer sufficient disease-state improvement. In other words, if a patient weighs 400 pounds and their ideal weight is 200 pounds, 15% weight loss is only a 60-pound drop. This will keep them squarely in the obese range and remain at very high risk for metabolic disease and early death. On the other hand, weight-loss surgeries can offer 60 and up to 90% excess body weight loss, which would get the patient much closer to their goal weight.
Further, it’s worth stressing again that weight loss medications only work if you take them, so patients who stop taking them for any reason will likely regain that weight. On the other hand, most bariatric patients maintain their weight loss long-term and even for the rest of their lives.
Can Weight Loss Medications and Bariatric Surgery Work Symbiotically?
The answer is yes, they certainly can. Patients with very high BMIs may have severe health conditions that make performing bariatric surgery more difficult or risky. For these patients, losing significant weight before surgery may not solve all issues, but it can make bariatric surgery safer. As such, patients interested in bariatric surgery, who may not be candidates due to their health, should speak to their primary care physician or Dr. Higa about possibly starting on weight loss medication to drop enough to make surgery an option.
Weight loss medications may also be helpful after surgery. We stress to our patients that after about a year and a half or two of losing weight, there will be a plateau, and this is where some patients become discouraged. Whether through liberalizing their diet, not maintaining their exercise program, or being frustrated that they are no longer losing weight, they may begin to regain. While motivation during these times is the key to maintaining their weight loss, they sometimes need a reset to get them back on track. This is where weight loss medications come in. They can help avoid a bariatric conversion or revision, where a second surgery is performed to help restart weight loss.
The Bottom Line
As you can see, while weight loss medications are a very exciting and welcomed assist to traditional medical and surgical weight loss programs, they are not suitable for every obese patient. We encourage anybody considering weight loss medication to understand the breadth of weight loss options available to them, including bariatric surgery. By watching our online seminar and subsequently visiting Dr. Higa for a consultation, patients can understand what is best for them in the caring and supportive environment our office strives to offer.
You can contact us to schedule a consultation and see what is best for your circumstances.