People seem to be struggling with their weight now more than ever. With so many weight‑loss options available, how can anyone know which approach is the best fit? From dieting the old-fashioned way – calories in and calories out – to glucagon-like peptide-1 (GLP‑1) medications and bariatric surgery, there’s a great deal to consider when talking with your doctor about what will work for you.
“Usually the first step is to try lifestyle and behavioral modifications for weight loss. The other part we want to focus on is their medications to see if the patient’s prescription is causing weight gain. We assess what is working and what’s not to establish a plan for the patient,” said Roberto Miranda M.D., a family medicine provider with MUSC Health Pee Dee Primary Care and an expert on the subject of obesity medications.
GLP‑1 medications have been a major topic of conversation in the media over the last few years. Due to celebrity use and the promise of nonsurgical weight loss, they’ve quickly become the latest dieting trend for people looking to lose weight rapidly. Miranda sees many patients who struggle with their weight and want a noninvasive way to achieve their weight loss goals. He said GLP-1 medications can be an effective alternative to bariatric surgery for patients who maintain a healthy lifestyle.
“GLP-1s have been very helpful. Recently, we’ve seen more success with weight loss without surgical intervention because of them,” said Miranda. “When patients start these medications, they begin to lose weight gradually, often about 5% to 10%, and sometimes as much as 30% of their original weight. That level of weight loss can be quite significant, depending on the patient’s discipline.”
In some cases, GLP-1 medications can serve as a bridge to bariatric surgery by helping patients to reach a safer weight for the operation in addition to contributing to overall perioperative optimization. An advanced gastrointestinal and bariatric surgeon at MUSC Health Florence Medical Center, Aftab Jafri, M.D., looks at GLP-1 medications and bariatric surgery as complementary tools rather than competing therapies. While acknowledging the benefits of GLP-1 medications, he explained that bariatric surgery often provides more effective and lasting weight loss effects than medications alone for patients with morbid obesity and obesity-related comorbidities, such as diabetes, sleep apnea or hypertension.
“GLP-1s are often effective in patients with mild to moderate obesity, but when a patient’s body mass index is above 35 with serious comorbidities, bariatric surgery frequently offers the most durable and impactful results. Both of them are great for weight loss, but bariatric surgery has the longest track record of sustained weight loss.”
Jafri added that although GLP-1s are now considered an effective and convenient way to lose weight, the weight loss typically requires long-term therapy with possible increasing cost to the patients. It also comes with the risk of side effects, and long-term safety data, he said, is still evolving. This makes bariatric surgery, in his estimation, a very valuable option – not only to lose weight but to keep it off as well.
“Bariatric surgery has consistently demonstrated more durable weight loss and a higher rate of remission of obesity-related comorbidities compared to medications alone,” said Jafri. “One of the challenges with GLP-1 medications is that weight loss is dependent on continued therapy; patients do well while taking the medication, but significant weight regain is common once treatment is stopped.”
With a growing number of weight loss options available, there’s no single approach that works for every patient. While GLP-1s offer an effective, nonsurgical approach that can lead to gradual weight loss, bariatric surgery remains the most effective and lasting choice for patients with higher BMIs and/or significant obesity-related health conditions. The best approach, he said, is individualized and depends on a patient’s medical history, motivation, ability to change his or her lifestyle and long-term health goals.
“For me, it’s not just about the number on the scale. When my patients come back after bariatric surgery more active, less dependent or no longer dependent on diabetic and hypertensive medications, with decreasing joint pain or are better candidates for joint replacement surgery, that’s what matters to me. I want to see my patients 10 years down the road still enjoying these health benefits and living an active and healthy life. These goals, in my view, are achievable only by utilizing surgery and GLP-1s as adjuncts.”
