Obesity, a chronic disease affecting over 40% of adults in the United States, presents significant health risks, including type 2 diabetes, heart disease, and certain cancers. While lifestyle modifications like diet and exercise are crucial, many individuals require additional interventions such as prescription weight-loss drugs or bariatric surgery. This article explores the landscape of bariatric weight loss pills, their effectiveness, potential benefits, and drawbacks, providing a comprehensive overview for individuals seeking information on this topic.
Understanding the Weight Loss Landscape
The realm of weight loss interventions encompasses both medication and surgical options. The past decade has witnessed a surge in popularity for medications like Ozempic, Wegovy, Mounjaro, and Zepbound, which fall under the category of glucagon-like peptide-1 (GLP-1) or dual GLP-1/GIP receptor agonists. These drugs mimic natural hormones in the body, regulating appetite and blood sugar levels.
On the other hand, metabolic and bariatric surgeries, such as Roux-en-Y gastric bypass and sleeve gastrectomy, impact GLP-1 levels and other gastrointestinal hormones to promote weight loss by physically altering the digestive tract.
Weight Loss Medications: A Non-Surgical Approach
How They Work
GLP-1 medications work by increasing feelings of fullness and slowing down how quickly the stomach empties. They can also impact brain regions involved in appetite control and improve blood sugar control, which is extremely helpful for patients with type 2 diabetes.
Benefits
- Non-invasive, no surgery required.
- Potentially significant weight loss, often 10 to 15 percent of initial body weight.
- Improved blood sugar and cardiovascular health in many cases.
- No recovery needed.
Drawbacks
- Potential side effects like nausea, vomiting, diarrhea, bloating, constipation, pancreatitis, gastroparesis-like symptoms, and reflux.
- Medications can be expensive, and insurance coverage varies. The Kaiser Family Foundation estimates the annual net price of Wegovy at $13,600.
- Weight regain is possible if medication is stopped.
- Long-term effects are still being researched.
- Requires consistent injections or daily pills.
- Patients need continual follow-up with their provider to monitor medication and dosage.
Weight Loss Surgery: A Long-Term Solution
Surgical Options and How They Work
These surgeries alter levels of many hormones in addition to GLP-1, impacting appetite, glucose levels, and metabolism. Surgeries like gastric bypass and sleeve gastrectomy change the size of the stomach. The primary mechanism for weight loss is not restriction - it is to change the body’s metabolism through several gut hormones that affect weight.
Read also: Diet Before Bariatric Surgery
Benefits
- Significant and sustained weight loss, often 25-35% or more of initial body weight, typically estimated around 60-80% of excess body weight.
- Dramatic improvements in or resolution of obesity-related conditions like type 2 diabetes, sleep apnea, and high blood pressure.
- Reduces the risk of developing heart disease, strokes, and multiple types of cancer including colorectal, breast, and endometrial, and increases the average lifespan.
- Long-term weight maintenance is more successful than with medication alone.
Drawbacks
- Surgical procedures come with associated risks like bleeding, infection, and complications. Long-term complications can include vitamin deficiencies.
- Requires significant lifestyle changes, including dietary adjustments and recommended regular exercise.
Comparing GLP-1s and Bariatric Surgery: A Recent Study
Researchers from NYU Langone Health and NYC Health + Hospitals conducted a retrospective comparative effectiveness study using real-world electronic medical record data. The study, which included 51,085 patients with a body mass index (BMI) of at least 35, compared the outcomes of patients who had bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass) with those prescribed injectable semaglutide or tirzepatide between 2018 and 2024.
The findings revealed that patients who underwent bariatric procedures lost an average of 58 pounds after two years, compared to 12 pounds for patients who received a GLP-1 prescription for at least six months (24% total weight loss vs. 4.7%). This suggests that while both patient groups lose weight, metabolic and bariatric surgery is much more effective and durable.
The Role of GLP-1s After Bariatric Surgery
Interestingly, a study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that an increasing proportion of patients who undergo bariatric surgery start taking one of the new glucagon-like 1 peptide receptor agonist (GLP-1) weight-loss drugs in the years after their surgery.
The researchers analyzed de-identified national electronic health records covering 112,858 individuals who underwent bariatric surgery from January 2015 to May 2023. They found that 14% of those patients used a GLP-1 such as semaglutide (Wegovy) or tirzepatide (Zepbound) during a follow-up period of up to 10 years after surgery. Individuals with lower post-operative weight loss were more likely to use GLP-1.
This suggests that GLP-1 drug therapy after bariatric surgery is increasingly common, potentially becoming routine for some patients.
Read also: Bariatric Surgery Outcomes
FDA-Approved Weight Loss Medications: A Comprehensive List
The pharmacological treatment of obesity is a fast-changing landscape, with new medications emerging frequently. Here's a comprehensive list of FDA-approved weight loss medications, categorized by their mechanism of action:
GLP-1 Receptor Agonists
- Semaglutide (Wegovy, Ozempic): Administered as an injection, semaglutide is approved for use in adults and children aged 12 years or more with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children) or some adults with excess weight (BMI ≥27) who also have weight-related medical problems.
- Liraglutide (Saxenda, Victoza): A daily injectable medication that acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals.
Dual GLP-1/GIP Receptor Agonists
- Tirzepatide (Zepbound, Mounjaro): Approved to treat obesity in adults with a BMI of 30 or greater, tirzepatide is both a GLP-1 and a GIP receptor agonist that reduces appetite.
Other Medications
- Phentermine (Adipex-P, Lomaira): The oldest and most widely used weight loss medication, phentermine was originally used as a short-term medication to jump-start weight loss, but now newer medical guidelines have added it to long-term therapy.
- Phentermine-Topiramate (Qsymia): A combination of a weight-loss drug called phentermine and an anticonvulsant called topiramate.
- Naltrexone-Bupropion (Contrave): Combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite.
- Orlistat (Xenical, Alli): A lipase inhibitor that comes in a capsule, preventing the body from absorbing fat. An over-the-counter formulation is available at 60 mg capsules with each fat-containing meal.
- Setmelanotide (Imcivree): A melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years and older, with obesity due to certain rare genetic disorders.
Medical Devices
- Plenity: A medical device consisting of a capsule that releases a biodegradable, super-absorbent hydrogel into the stomach, helping to increase satiety.
Emerging Medications and Future Directions
With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Several pharmaceutical companies are developing new options, including oral GLP-1 inhibitors and medications that target multiple hormones involved in appetite regulation.
Important Considerations Before Starting Weight Loss Pills
Before choosing a weight-loss medication, it's crucial to consider several factors:
- BMI: The guidelines for tirzepatide (Zepbound) and semaglutide (Wegovy) state that a patient should have a BMI of 30 or a BMI of 27 with weight-related health problems.
- Medical History: Certain medical conditions may increase surgical risk and require additional evaluations prior to surgery.
- Lifestyle: Successful weight loss, whether through medication or surgery, requires a long-term commitment to healthy habits.
- Cost and Insurance Coverage: Both medications and surgery can be expensive, and insurance coverages can vary.
- Personal Preferences: Some individuals may prefer the non-invasive nature of medication, while others may opt for the more dramatic and durable results of surgery.
The Doctor's Perspective
Ultimately, the decision between weight loss medication and surgery should be made in consultation with a healthcare professional. They can assess individual risk factors, discuss goals, and help determine the most appropriate approach.
It's important to remember that neither medication nor surgery is a magic bullet. Long-term success requires a commitment to a healthy lifestyle, including a balanced diet and regular exercise.
Read also: Is Bariatric Surgery Right for You?
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