If your weight’s so high your health is at risk, you’re likely tackling the basic question: Which is the best option, bariatric surgery or one of the newly popular GLP-1 agonist medications? You might do best combining both options to lose weight.
The Basics of Major Weight Loss
Everyone should start the weight-loss journey by exercising regularly and adopting a diet rich in grains, fruits and vegetables, and low in animal fats. That’s crucial, yet it likely won’t lead to a healthy goal weight for those with high BMIs.
Many people determined to drop significant weight take one of two routes:
You can start with a prescription to a GLP-1 agonist, short for glucagon-like peptide-1. They are injections or tablets that will curb your appetite. The pharmaceuticals do this in various ways, such as by causing your stomach to empty out food more slowly or regulating some insulin release. They’re a legitimate route for people whose body mass index, or BMI, is below 40. They’ll help you lose up to 15 percent of your total body weight — half of what any of the surgeries will give you. However, if your BMI is 40 or higher, meds alone will not take off enough weight.
The more established option, bariatric surgery, refers to a range of operations that will also lower your appetite, decrease the caloric absorption and regulate the release of insulin and other hormones. Some are more invasive than others, and all involve making internal changes to your digestive system so food travels through your body differently than before. Depending on the specific weight-loss surgery you have, you will lose from 30 percent to 35 percent of your total body weight. This is a tried-and-true route for patients with BMIs of 40 or higher.
How a Combo Works
In some cases, you might start with the medication and then have the surgery done, or the reverse. Here’s how that might play out.
If your BMI is high enough, you might want to start with a GLP-1 agonist. That will get your weight down significantly, which in turn will make it easier for you to tolerate the surgery. The surgeon can operate more easily with less fat in the way, and a healthier body recovers more quickly.
Taking the medications beforehand is also a good bet if your BMI is about 30 and you have diabetes. If you can get down to a BMI of 28, that might improve or eliminate your blood sugar issues. Ideally, everyone’s BMI should be from 18.5 to just under 25; 30 and up is considered medically obese.
A second option is to use the medications after surgery. Allow nine to 12 months to recover fully; you’ll drop a significant amount of weight in that time. Adding on the medications afterward, as an adjunct, might nudge your body toward yet more weight loss after you’ve reached a plateau.
Either way, you’ll need to adopt a healthy lifestyle after the surgery and will only be able to eat small amounts at a time, for life; your body will reject too much food. The GLP-1 agonists only work while you’re taking them. Without surgery and lifestyle changes, you’ll return to your former state once you stop the prescription.
Ask Your Doctor These Questions
Insurance will determine part of your decision. Your plan might approve coverage for one option, the other or both.
Get your facts about the weight-loss methods. The first step is to book an appointment with at least one comprehensive medical practice that offers surgical and medication weight-loss options. You’ll do best working with a team that involves a family doctor, a bariatric surgeon, a psychologist and a nutritionist or dietitian. They can look at your situation from several angles and together come to a recommendation tailored to your needs. Just as medical teams approach cancer care with a holistic multi-disciplinary approach, so do weight-loss teams.
Have these questions and requests handy when you meet with a weight-loss specialist.
- Which bariatric surgeries work best with a GLP-1 agonist component? You’ll need to choose a surgery and a medication that work well together. Some of each can reduce emptying of the stomach, for example; you’d want that from one or the other, not both.
- How long should I wait after starting the meds, or getting the surgery, before adding the second option? You’ll generally be given a window of nine to twelve months post-surgery so your body can fully adjust to the first change before adding a second change. Or, you might be on the meds for half a year or so before having surgery.
- What allergies and/or side effects might I have from the meds? In rare cases, you can develop pancreatitis from the GLP-1 agonists.
- Can I take weight-loss meds if I had surgery long ago? GLP-1 agonists might be an option if you’ve put on too many pounds after losing them post-surgery, even 20 years ago.
- What Can I Expect?— Your team should spell out clearly how much weight you can expect to lose with a medication, surgery or both; what those scenarios will do for your diabetes; and what benefits and challenges to anticipate.
If you have more questions once you get your answers, be savvy. Either ask the medical team follow-up questions, or do research from legitimate sources such as national research organizations. Do not trust social media influencers who do not have medical licensing. Similarly, do not trust online companies that will prescribe weight-loss medications without meeting you first. You’re taking these steps to get healthier; let trained and licensed experts treat you personally.
When it comes to taking big measures to lose a large amount of weight, you can choose surgery, medication or a combination. Work with pros who deal with this every day, and get satisfactory answers to all questions before taking the next step in your weight-loss journey. You’re sure to emerge healthier and more energetic.