Newswise — LOS ANGELES (Aug. 7, 2024) -- A new class of medications called GLP-1s (glucagon-like peptide-1 receptor agonists) have been grabbing headlines for their dramatic results in helping people shed stubborn pounds, thereby controlling diabetes as well as reducing their risk of heart disease.
But medication is not the only option for patients with obesity who need to lose weight to improve their health. Bariatric surgery has helped patients lose considerable weight—and keep it off—for decades.
“A significant benefit of surgery compared with medication management is that we expect the effect to endure decades into the future, if it’s accompanied by healthy lifestyle changes,” said bariatric surgeon Jeremy Korman, MD, medical director of the Cedars-Sinai Marina Weight Management Center.
Korman added that insurance typically covers surgery if a patient meets certain medical criteria. Pricey GLP-1s, sold under brand names like Ozempic and Wegovy, often are not covered by insurance for weight loss purposes and have become so popular they can be hard to find in pharmacies.
To better understand both of these powerful weight loss options, the Cedars-Sinai Newsroom spoke with Korman and Kulmeet Sandhu, MD, associate director of Minimally Invasive and Bariatric Surgery and associate professor in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai Medical Center.
Are there patients who would benefit from weight loss surgery rather than medications?
Sandhu: There are some patients who may benefit more from bariatric surgery, or weight loss surgery, rather than medical weight loss management, or taking medications for weight loss. Those include patients who have had side effects previously for medical weight loss, or who don't have effective results with medical weight loss. We also have some patients who have a much higher BMI [body mass index], which is where their weight is much higher, and they may not see as much effect from medications and may have better long-term benefits from surgery. We have also noticed that the most effective long-term weight loss solution is bariatric, or weight loss, surgery.
What are the most commonly performed types of weight loss surgery?
Korman: When we talk about bariatric, or weight loss, surgery, the two most popular options are sleeve gastrectomy and gastric bypass. The sleeve gastrectomy is an operation where we change the size and shape of the stomach only. The stomach is made narrower and more tube-shaped, looking almost like a banana. What's distinctive about sleeve gastrectomy, which is what makes it popular, is that we maintain the natural pathway from stomach to intestine without making new connections. This makes for slightly easier nutritional management for the patient.
For the gastric bypass, we are also changing the size and shape of the stomach, including making the stomach smaller. But we also create a new connection; we reroute the pathway from stomach into the intestine. This added, “malabsorptive,” element does make it a more powerful operation since we are short-circuiting some of the intestine. There is a drawback to altering the natural pathway since nutritional management becomes a bit more complex. There is then greater responsibility for vitamin supplementation and for monitoring in follow-up. However, for select patients this is a more effective option and therefore the appropriate choice.
What is a common misunderstanding about weight loss surgery?
Sandhu: One of the things I think holds people back from having surgery is concern about the risks of it. But the majority of my patients that have had surgery say the biggest regret they have is not having done it sooner. It's very effective, and it's also very safe. The long-term complications are quite minimal, and people do very well from surgery.
There also is a stigma around weight loss surgery that somebody has failed things like diet and exercise. But that's not the case. Patients may have the same diet as somebody else and not be able to lose weight because their biology is different. What surgery does, it just allows you to have another tool to be able to eat less and have more effective weight loss. And I think that's really important to realize.
What should patients know to help them achieve lasting results?
Korman: In addition to the treatments that we provide, the patients must change their lifestyle. That includes both nutritional and physical activity approaches to their lives. And with changing their lifestyle, they're absolutely going to be able to achieve their potential, the weight loss success that we expect. The odds of successful long-term weight loss increase to the 80% range.
Sandhu: This is not a quick fix. It involves a long-term relationship with our patients. You know, when we become your doctors, we, as bariatric surgeons, say we become your doctors for life.
Read more from the Cedars-Sinai Blog: Bariatric Surgery Myths and Misconceptions
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