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How Will Weight Loss Medications Affect Bariatric Procedures?

Anecdotally, we have heard that throughout 2023, many bariatric practices have seen fewer patients and performed fewer surgeries. This coincides with the meteoric rise in popularity and use of wet loss medications like Wegovy® and ZepboundTM. With upwards of 20% body weight loss possible with these medications, does the introduction of these options make bariatric surgery a thing of the past?

The short answer is that while these weight loss medications have changed the paradigm, there is still a place for bariatric surgery, and both weight loss modalities can work symbiotically. Let’s dive in to find out how.

The Case for Weight Loss Medications

While medications come with possibly significant side effects, their distinct benefits are very real, especially for those who are suffering from significant comorbidities resulting from excess weight or obesity. For patients with a relatively lower obese-level BMI, it makes sense to try weight loss medications if they qualify and if they are well tolerated because they are easier to take and give the patient an option to change their habits and lifestyle to maintain any weight loss they achieve.

While insurance is currently spotty, data showing the effectiveness of these weight loss medications on various comorbidities is compelling. There is the hope that these medications will be widely covered at some point in the future.

Last but certainly not least is the expectation that weight loss medications will be refined and improved over time. Will we have injections that are only needed once a month? Will we have formulations that do not cause as many side effects? Will oral route weight loss medications be as effective as their injectable counterparts? All these options are being fast-tracked in the pharmaceutical world.

The Case for Bariatric Surgery

Bariatric surgery remains the gold standard in long-term weight loss, and even with weight loss medications, it is undoubtedly the go-to option for patients with a BMI greater than 40. Consider that it’s important to compare a total body weight loss of 15 to 20% with an excess body weight loss of 75 to 90%. These are the ranges for some medications and bariatric procedures, respectively. Above a BMI of 40, it becomes clear that weight loss medications may not get a patient below a body weight threshold that eliminates or significantly improves their comorbidities. Here is where bariatric surgery can take over.

Since the cost of bariatric surgery may be covered by insurance and cash pay rates have become very competitive, patients must compare the cost of medications to surgery. Currently, patients may spend over $1000 per month for their GLP-1 medications without insurance. Even with insurance, costs may be high. In some cases, bariatric surgery may be a better long-term option financially.

Finally, many patients believe that bariatric surgery is an extreme option, but in reality, technique, and technology have advanced to such a degree that the risks are comparatively very low versus just a decade or two ago. As such, patients should speak to a qualified weight loss specialist and/or bariatric surgeon to fully understand their options.

How They Can Work Symbiotically

Weight loss medications may be a good option for some patients who have significant surgical risks and would benefit from some weight loss before their surgery. These weight loss medications can be started in the months before surgery.

Postoperatively, weight loss medications can be used to enhance a patient’s weight loss or reset them in case of a weight regain. Of course, there is a delicate balance here, and this should only be done under the guidance and supervision of your bariatric surgeon.

Ultimately, having both weight loss medications and weight loss surgery is an option for patients struggling with significant excess weight or obesity is a good thing, and these modalities can be used separately or together to optimize a patient’s weight loss and get them back to better health. Speak to your primary care physician or bariatric surgeon to understand what options are right for you.

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