In a society preoccupied with appearance, weight carries plenty of baggage that has nothing to do with the number on a scale. Expectations about how people should look can quickly become judgments about health, character and discipline. And while some will never give it a second thought, for others, the very real challenge of losing weight is a daily struggle.
But sometimes, the stakes go well beyond appearance, beauty standards or the latest social media fixation. For people who need to lose a significant amount of weight before undergoing a medical procedure, the goal isn’t about looking different. It’s about being able to get the care they need. And watching the numbers on the scale tick down can bring a surgery or other treatment that much closer.
The emergence of more effective obesity medications has changed the equation. For appropriate patients, weight loss that once might have required considerably more time – or even bariatric surgery – can now be achievable with medical therapy, creating new possibilities not only for treating obesity but also for helping patients to become healthier candidates for other procedures.
Patients seeking a joint replacement or organ transplant, for example, may need to lose weight before surgery, as obesity can increase the risk of complications during and after an operation. Two decades ago, patients trying to lose a significant amount of weight had far fewer options. Changes in diet and physical activity remained the mainstay of treatment, but for many people, losing enough weight – and keeping it off – proved difficult.
Marc-Andre Cornier, M.D., director of the Division of Endocrinology, Diabetes and Metabolic Diseases at MUSC, specializes in cardiometabolic diseases and has spent nearly three decades in obesity research and advocacy. A past president of The Obesity Society (TOS), an international organization focused on obesity science, prevention and treatment, Cornier has seen significant changes in both treatment and attitudes toward weight loss – particularly with the emergence of new medications such as GLP-1 receptor agonists.
“Now, we have newer medical therapies that are much more effective than what we’ve had in the past, which has truly opened the door to treating patients more aggressively with medical therapy,” Cornier said. “That’s been the biggest change, especially in the past five years. We’re talking now 15%, 20%, 25% weight loss with medical therapies, which we’ve never seen before.”
Combined with lifestyle changes, new medications can reduce the need for weight-loss surgery for some patients. For patients who need other types of surgeries, the medications can also help them to reach an appropriate weight and improve obesity-related conditions, such as uncontrolled diabetes, hypertension and hyperlipidemia, all of which can increase surgical risks.
“With the GLP-1 base, if we can intervene prior to surgery, we can help control those medical conditions related to their obesity in a way that potentially makes the surgery safer,” he said. “A big one would be if they have diabetes; getting their A1Cs down to a safer range.”
For some patients, medication and surgery can also work together as part of a longer-term approach to obesity treatment. GLP-1s may help patients to lose weight and improve obesity-related conditions before surgery, while continued medical therapy after surgery may support long-term weight management. Rather than treating surgery as the finish line, continued support can be the key to managing obesity. Sustaining that weight loss, after all, can be just as important as achieving it in the first place.
For Cornier, the significance of the newer medications goes beyond how much weight patients can lose. He believes they may also help to change how people understand obesity itself.
“There is so much stigma and bias toward obesity. I think that medicines legitimize this as a disease more and raise more awareness,” Cornier said. “This is a true disease caused by neurometabolic changes in the brain and in the body that put people at risk in the right environment, which we live in.”
But the medications are neither appropriate nor accessible for everyone. Cost and insurance coverage can limit access, and some patients cannot tolerate the medications or experience side effects that prevent them from continuing treatment. For those patients, treatment doesn’t necessarily stop there; it may simply require a different approach.
Cornier also emphasized that patients taking GLP-1s require appropriate medical monitoring, particularly as the medications produce levels of weight loss that previously were more commonly associated with bariatric surgery.
“You can’t just throw people on them. With surgery, where we see 30% weight loss on average, we monitor those patients very closely for dehydration, excessive weight loss and mineral deficiencies. With these new medications, we’re losing similar amounts of weight, yet we’re not giving patients the same close monitoring.”
Perhaps nowhere is that change more tangible than for patients whose weight has stood between them and another treatment they need. “In the past, we used to get referrals, such as, ‘This patient needs to lose 50 pounds before they can get hip or knee replacement.’ Or many kidney or lung transplants, because of their obesity, they’re not good candidates.”
Previously, helping patients to lose enough weight to become eligible for surgery could take considerable time. Newer medications are changing that, Cornier said. Drugs such as Wegovy (semaglutide) and Zepbound (tirzepatide) target hormonal pathways involved in appetite and food intake, helping some patients to achieve levels of weight loss that were previously more commonly associated with bariatric surgery. That can shorten the path to the treatment they need.
“In the past, we would put people on liquid diets and this and that, and yes, we could get people down, but it took a while. Now with these newer treatments, it’s easier, more effective, faster weight loss so we can get these patients their treatments quicker.”
For Cornier, that ability to help patients to receive the other treatments they need underscores a larger shift in obesity care: treating obesity as a biological disease – and treating it effectively – can improve health far beyond the number on a scale. And for patients who have struggled to lose the weight they need to lose, that shift can mean something even more personal: another chance to move forward with their lives.
Intern Robin Adams contributed to this story.
Mikie Hayes
Mikie Hayes is director of writing services and enterprise copy editor at MUSC. A seasoned communications, crisis management and development professional, she has served as a trusted speechwriter to three MUSC presidents, numerous deans and department chairs. She has written and edited extensively for MUSC’s publications. She previously led a U.S.-based organization with global reach that worked closely with global media outlets and government partners worldwide, developing a range of complex strategies and specialized publications to support high-level initiatives. With experience spanning health care, scientific research, higher education and national and international security, she brings more than 35 years of experience in writing, editing, strategy and program development. An experienced public speaker, she has presented to audiences nationally and internationally.
