Benefits of bariatric surgery plus weight loss medication
Bariatric Surgery is the most aggressive form of weight management offered to patients. The main two procedures being done these days are a sleeve gastrectomy or a Roux-en-Y Gastric Bypass. When performed by a highly-experienced surgeon in a center of excellence, these two procedures have gotten safer over the years and can be successful for those in whom medical weight loss (including weight loss medication, proper medical management, intensive lifestyle intervention, healthy eating and physical activity) proved inadequate. These procedures are not a substitute for medical management, healthy eating, physical activity and support – the procedures are an adjunct to these other tools.
In the sleeve gastrectomy, the greater curvature of the stomach is removed, resulting in a very small residual pouch resulting in getting full very quickly, and changing our gut hormones by removing the part of the stomach responsible for making ghrelin, a hormone that makes us feel hungry. It also causes a quicker release from the small intestine of the hormones that help us feel satisfied after eating (including GLP-1).
The Roux-en-Y Gastric Bypass takes the sleeve gastrectomy and then also bypasses a part of the small intestine resulting in the benefits of the sleeve plus reducing the absorption of nutrients. This procedure has slightly better weight loss, somewhat better long-term weight loss, and is preferred for patients with severe gastroesophageal reflux disease.
Both procedures are also excellent for patients with type 2 diabetes, and can put that disease into remission for many years. The average weight loss from the procedures is around 33% of the body weight – so for a person at 300 pounds, the average weight loss is 100 pounds. However, over time, people tend to regain about a third of the lost weight, so the sustained weight loss at 7 years in the above example would average 75 pounds.
The adjustible gastric band is rarely performed these days, as it is quite a bit less effective than the above procedures, takes a lot of maintenance work
A study published in June 2020 in Obesity looked at the effect of combining weight loss medications with gastric bypass surgery. One problem with the surgical procedures is that many patients can regain some or even all of the lost weight, and others may not lose the desired amount. The authors state that one-half of patients regain at least 15% of the lost weight while two-thirds gain back more than 20% of the lost weight. In this study, patients were given weight loss medications PLUS surgery.
The study clearly showed an additive benefit of weight loss medications + surgery, improving weight loss by ~10%, and significantly reducing weight regain. Studies like this add to the thought that surgery should be done only after medical weight loss, and that weight loss medications should be continued even after the surgery is completed.
At Clinical Nutrition Center, we manage many patients after surgery, and have found that the medications in our post-surgical patients are highly effective.
If you think you might be a candidate for surgery, or if you have had surgery and are interested in medical options to maximize your health improvements, give us a call at 303-750-9454 and set up an appointment with Dr. Lazarus or Heather Thomas, PA-C to discuss the best options for you.
