GLP-1 Medication After Bariatric Surgery
Bariatric surgery is the most effective long-term option for patients with significant excess weight or morbid obesity. For over 50 years, bariatric surgery has been used to improve the metabolic issues associated with obesity and change patients’ lives, both physically and psychologically. Most of the benefits, particularly in terms of weight loss and disease improvement or resolution, occur in the first couple of years after surgery. After this time, some patients may start to regain some weight, which is perfectly normal.
Sometimes, this weight regain can spiral out of control. It could happen to anyone and for a multitude of reasons. For some, this could be due to life stresses, such as changes in a work situation, family problems, or other factors. For others, sticking to their diet and exercise program may give way to a loss of motivation and liberalization. Regardless of the circumstances, significant weight regain after bariatric surgery requires attention.
Before the advent of GLP–1 drugs, patients who began to gain weight after their bariatric procedure were limited to diet and exercise counseling. If that didn’t work well, the next step was a revisional surgical procedure, which, while very effective, also increased patient risk.
Today, however, we have a new tool in the form of exceptionally effective medications that can help people get back on track without a surgical procedure and with predictable outcomes.
When can we employ GLP-1 meds after bariatric surgery?
The decision to start medication after bariatric surgery depends on the patient’s circumstances and the reasons for regaining weight. It also makes a difference how much weight they’ve regained and how much time has passed since their procedure. Patients will experience the most post-surgery weight loss in the first six months as the body goes through hormonal changes. Every individual is unique, and it’s important to talk to your provider about any concerns you may have.
It’s essential to remember, however, that the incremental improvement achieved with GLP–1 medication lasts only as long as the medication is taken. Unfortunately, due to the cost and side effects, many patients are not able or willing to take these medications over the long term.
To that end, as with any weight loss modality, including bariatric surgery, it’s critically important that patients use GLP–1 receptor agonists to jumpstart their new life rather than rely on them as a crutch – it isn’t practical or effective for long-term weight loss.
Soon, GLP-1 drugs will be formulated for easier dosing – most likely an oral route version of what is currently available. We expect that these GLP–1 pills will be somewhat less effective but may be precisely what patients need after their bariatric procedure.
When might you need a bariatric revision?
GLP-1 medications only offer a certain level of effectiveness after surgery. Thus, if patients are not losing enough weight, even with GLP-1 meds, a revisional work conversion or bariatric procedure can be discussed with your surgeon.
Another reason for a switch or revision surgery is the onset of new or worsening chronic reflux after a gastric sleeve. While we have made great strides in reducing this risk, about 10 to 12% of patients still experience this problem. A revision procedure may be needed to correct this postoperative reflux – something that GLP-1 medications cannot do.
A note about bariatric conversion procedures: A bariatric revision is a higher-risk procedure that only a very skilled surgeon is capable of. Deciding whether a patient needs or not, and the reason for it, is crucial to be evaluated by an experienced surgeon. It’s important to be open with your healthcare team regarding your personal concerns and goals at every step of your weight loss experience.
The bottom line
GLP–1 receptor agonists are a watershed moment in the management of diabetes, obesity, sleep apnea, the prevention of cardiovascular disease, and even pre- and postoperative bariatric surgery. For many, these drugs can be an appropriate adjunct to bariatric procedures, especially if they find they are starting to regain some weight down the road.
GLP-1 drugs should not be relied on to maintain a new goal weight. Instead, they work best as a catalyst for a new diet and exercise routine. GLP-1 medications, or any medication for that matter, will not be effective to their maximum capacity unless lifestyle modifications are added to your weight loss plan. This is the best way to maintain weight loss over the long term without continued medical intervention.