Learn about bariatric surgery and GLP-1 RAs used to treat obesity.
Science has come a long way in better understanding obesity. Obesity is considered a chronic condition and often medical treatments, whether prescription drugs, surgery or both, may be needed to help patients with weight management and care.
Weight loss surgery is one option. Recently, newer medications have become available. You may be wondering about the similarities and differences between surgical and medical weight loss and which one to choose.
Two Vanderbilt Health experts explain. But first, they want to clear the air about what obesity is.
“For many years obesity was incorrectly considered an issue of not having enough willpower or not getting enough activity,” said Dr. Matthew Spann, medical director of the Vanderbilt Weight Loss Center. “And it’s far from that. When you look at the physiology of someone who has obesity, their hormones are quite different than those of someone who does not have the condition.”
Dr. Sahar Takkouche, a nationally recognized weight loss expert and Spann’s colleague, agreed. “For individuals with obesity, the body’s response to food is fundamentally different,” she emphasized. “There is often a genetic predisposition that makes weight gain more likely.”
“For many years obesity was incorrectly considered an issue of not having enough willpower or not getting enough activity.”
Weight loss surgery
Weight loss surgery involves restricting parts of the gastrointestinal tract to help reduce hunger hormones and increase feelings of fullness, even with small amounts of food, Spann said. The various procedures are minimally invasive. Their risk profile is similar to that of having gallbladder surgery, a common procedure.
What is weight loss surgery?
Weight loss surgery includes three main types: sleeve gastrectomy, gastric bypass and duodenal switch.
- Sleeve gastrectomy: Your surgeon will remove a portion of your stomach to reduce its size by about 70%. The portion removed produces about 90% of the body’s hunger hormones, Spann said.
- Gastric bypass: Your surgeon will create a small gastric pouch. The procedure also bypasses about one-third of your intestines to minimize calorie absorption and helps food move faster through your GI tract. This procedure works on hunger hormones, but it also increases hormones that tell your brain you’re full. The procedure helps with the body’s processing of blood sugar, which is important for the prevention or even reversal of Type 2 diabetes.
- Duodenal switch: This procedure combines elements of sleeve gastrectomy and gastric bypass. It bypasses about half to two-thirds of the intestines.
Who is a candidate for weight loss surgery?
The National Institutes of Health recently changed the criteria for weight loss surgery, Spann said. Patients who qualify are those with a body mass index of 35 or higher who don’t have comorbidities (additional and related health conditions). Patients with a BMI of 30 or higher who have significant Type 2 diabetes also qualify.
How long does it take to see results for weight loss surgery?
“Usually folks have lost about 15% of their excess body weight around that first-month visit and around 30% of their excess body weight by the three-month visit,” Spann said. “So it starts pretty quickly.” Most excess weight will have been lost at the full-year mark.
What happens long term?
About 65% to 75% of patients who undergo weight loss surgery tend to remain within 10% of their lowest body weight. You’ll continue to follow up with your doctor. If you are starting to gain weight again or are experiencing cravings, your doctor may prescribe a medication to help bolster weight loss or aid maintenance, Spann said.
“Anyone who feels burdened by their weight or has developed conditions related to obesity is welcome to seek our assistance.”
Medical weight loss and GLP-1 RAs
“Medical weight loss is a comprehensive, multidisciplinary approach,” Takkouche said. “It involves guided treatment to help individuals with obesity achieve weight loss.”
This approach may include support from a variety of health care professionals, such as doctors or nurse practitioners, dietitians, pharmacists, licensed clinical social workers, psychologists and exercise physiologists.
A common topic in medical weight loss right now is the use of glucagon-like peptide-1 receptor agonists, commonly called GLP-1 RAs and also known as peptides or injectables. GLP-1 RAs include semaglutide (under the brand names Ozempic, Rybelsus and Wegovy), tirzepatide (Monjouro and Zepbound), liraglutide (Victoza and Saxenda) and more.
Some GLP-1 RAs are only approved for treating Type 2 diabetes, while others are approved for treating obesity or a combination of the two. Most GLP-1 RAs are injectables, while some are oral tablets.
What is medical weight loss?
GLP-1 RAs work by mimicking the body’s natural GLP-1 hormone, which is released from the intestinal wall. “These medications primarily enhance satiety, delay gastric emptying and mitigate what we refer to as ‘food noise,’ the persistent sensation of hunger,” Takkouche said.
Who is a candidate for medical weight loss?
“Anyone who feels burdened by their weight or has developed conditions related to obesity is welcome to seek our assistance,” Takkouche said. “Traditionally, we use the body mass index to define obesity.”
However, she noted that BMI is an imperfect metric, as individuals with high muscle mass might be incorrectly classified as having obesity due to an elevated BMI.
Obesity is typically defined as having a BMI of 30 or greater, which qualifies an individual for consultation, Takkouche said. Additionally, a BMI of 27 or greater, accompanied by comorbidities also qualifies someone for consultation with the Vanderbilt Medical Weight Loss team.
Comorbidities include diabetes, hypertension, high cholesterol, fatty liver disease, obstructive sleep apnea and other related conditions. Medication eligibility is assessed on a case-by-case basis to ensure the most appropriate and effective treatment plan for each patient.
How long does it take to see results from medical weight loss?
The timeline for weight loss results can vary significantly from patient to patient. Each individual’s journey is unique. Typically, patients attempting weight loss on their own may expect to lose around 0% to 5% of their total body weight. “This is why we strongly encourage reaching out to our weight loss team for professional guidance and advice,” Takkouche explained.
Weight loss progress using a multidisciplinary approach with first-generation weight loss medications varies, with patients gradually losing about 8% to 14% of their body weight over the first year, Takkouche said.
However, recent advancements in second and third-generation injectables have shown promising results, with total body weight changes approaching those seen with surgical interventions.
What happens long term?
Weight loss results with GLP-1 RAs also vary among individuals. Patients may lose up to 20% of their body weight within the first year of treatment. However, not all patients are able to maintain these changes after discontinuing the medication. “This is why our team needs to evaluate whether you are a suitable candidate for long-term use of injectables or if surgical intervention may be better suited to your long-term goals,” Takkouche said.
How to choose between medical and surgical weight loss
The best way to understand which option or combinations of treatments is right for you is to talk to your doctor or an expert at the Vanderbilt Weight Loss Center.
Advanced care for weight loss
The Vanderbilt Surgical Weight Loss program offers advanced care to help you lose weight and improve your overall health. If you’ve been unable to reach a healthy weight with nutritional and lifestyle improvements alone, surgery might be a better and safer option for achieving your weight loss goals. The team will work with you to develop a personalized care plan combining surgery, nutrition, exercise and psychological support.
