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There is a lot of excitement about the GLP1 agonist drugs like Ozempic and Zepbound, and indeed we are excited to have more options to help our patients, but it is important to know that these drugs are only appropriate for a weight loss goal of 15% or less. Even then, only half of the people using them will achieve 15% weight loss. For patients who needs to lose more than that, they are very unlikely to get you there.
Bariatric Surgery is the gold standard treatment for patients with a BMI of 35 or higher if they have additional obesity-related medical conditions, or 40 or higher if they do not. Bariatric surgery helps people lose weight in several ways. After surgery, patients have significantly decreased food capacity. Their stomach is smaller and thus they can eat less food at a time. Some procedures impact the small intestine and the way food is absorbed, resulting in a lower absorption of calories. Bariatric surgery also significantly impacts hormone levels related to hunger, satiety, and fat storage.
Patients undergoing these procedures typically lose 50-80% of their excess body weight over an average of 18 months. Other benefits of bariatric surgery include:
The recovery time from surgery varies upon procedure and each patient, but most patients return to work in 2 weeks. Restrictions after surgery include a 30lb weight limit for 4 weeks.
Post-operatively, patients need to adhere to a healthful diet, active lifestyle, and they need to take bariatric-specific multivitamins. We see our patients 5 times in the first year, twice in the second year, and annually after that. Regular follow up with us is important for monitoring nutrition levels and to have accountability that helps you stay on track. We are always available for more frequent visits for patients who want more regular follow up.
We offer a multitude of ways to support our patients through their journey. Our medical team and dietitians are always here to guide, help, and support our surgical patients. We have a coaching program available to patients, as well as our Sage Circle community of patients who can help support each other and celebrate together.
Potential side effects after surgery can include dehydration if patients don’t drink enough water, and vitamin deficiencies if patients do not take bariatric multivitamins. Sort-term issues like small amounts of hair loss can occur during the rapid weight loss phase for some patients, but with proper nutrition resolves within 3-6 months. Gastric Bypass patients sometimes experience “dumping syndrome”, which is an intolerance to sugar that can cause nausea, sweating, lightheadedness. This can be avoided by not consuming foods that are high in sugar by themselves.
Short-term post-operative complications are uncommon in experienced hands. The safety profile of bariatric surgery in the hands of an experienced bariatric surgeon is similar to that of having a gallbladder removed.
The treatment of overweight and obesity has been helped recently by the use of Glucagon-Like Peptide 1 receptor agonist drugs (GLP1a) such as Ozempic® (semaglutide), Wegovy® (semaglutide), Saxenda® (liraglutide), Mounjaro® (tirzepatide), and Zepbound® (tirzepatide). These drugs work by slowing the emptying of the stomach which helps you feel full longer and helps decrease the total amount of food eaten. These drugs mimic the hormone GLP1 that signals fullness to the brain, thus decreasing one’s appetite.
GLP1a drugs are good treatment options for patients with a BMI of 27-34. They usually provide a 5-15% loss of excess body weight. On average, diabetic patients experience a 1-1.5% decrease in their Hemoglobin A1c. Studies have shown a cardiovascular risk reduction of 13-26% with GLP1a drugs.
An important thing to note about these drugs is that they require continued use. There are no anatomical or physiological changes that last once the drug is stopped. The majority of patients who stop these drugs experience weight regain.
Mounjaro® and Ozempic® are approved for patients with a diagnosis of diabetes. Zepbound®, Wegovy®, and Saxenda® are approved for weight loss. For those who don’t like needles, Rybelsus is a samaglutide tablet, but it is only approved for diabetes. Injections are done in the abdomen, thigh, or arm, and we usually recommend rotating the injection site. Zepbound® and Wegovy® are weekly injections. Saxenda® is a daily injection. Some of the brands allow adjusting of the dose on the pen, such as Saxenda®, but others like Wegovy® have dose-specific injections pens that cannot be adjusted.
The cost of these drugs can be up to $1500 monthly, but some insurances do cover them. Compounded forms of these drugs are available and are currently allowed by the FDA due to the shortage of many of these drugs. Compounded versions of these drugs are NOT FDA regulated for safety or efficacy, so it is very important that if you choose a compounded drug, you get it from a vetted and reputable source. Some sources of compounded drugs use salts, which can be harmful, unsafe preservatives, and ‘watered down’ active ingredients. At Sage Bariatric, our compounded drugs are made by a pharmacist who sends their batches to an FDA-approved lab for safety testing.
Side effects of these drugs can include (but are not limited to) nausea, vomiting, diarrhea, constipation, abdominal pain, heartburn, pancreatitis, and hypoglycemia. Patients should have their kidney function monitored periodically. Patients with a personal or family history of multiple endocrine neoplasia syndrome type 2, or MEN 2 should be aware of an increased risk of medullary thyroid cancer. In rare cases, GLP1a drugs may affect mood or mental health. It’s important to speak with your healthcare provider immediately if you experience any of these.
When choosing your first or next step in your weight loss journey, it is important to consider what your goals are, what your other health conditions may be, and to discuss your options with an experienced, knowledgeable physician. It is also important to remember that losing weight and maintaining a healthy weight is a lifelong process. One tool may be best for you at one point in your journey, while another may be more appropriate down the road. Often we use multiple modalities at the same time to help patients reach their health goals. The important thing is that we are here with you every step of the way. Your journey is our passion. You can do this! We can help!
