Role of GLP-1 Medications AFTER bariatric surgery
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In addition to surgery, these medications are an excellent addition to our toolbox for our fight against obesity. These medications can be very helpful if applied to the correct patient and in the right setting. We need to be careful with recommending the GLP-1a medications due to their limitations. Notably, the effects of medications are temporary. Their effects only last as long as the medications are being taken. In addition, taking medications can be problematic. Issues encountered include consistent insurance coverage, cost, storage, and administration. And finally, the medications are not as powerful as surgery and do not result in as much weight loss.
Therefore, given these concerns, I typically recommend these medications for temporary use. One just case is if we are just a couple of pounds away from our goal weight. These medications may be able to help break a prolonged stall. After our goal weight is reached or the stall is broken, I will typically continue these medications for a couple of months afterward and then try to stop the medications. Once we are at our goal weight, we should hopefully be able to maintain using our underlying bariatric surgery.
Another temporary use of these medications is for a “reset.” Patients with a history of a metabolic operation may experience some weight reoccurrence. This can be the result of lifestyle or dietary changes, or simply the result of changes to the metabolism. If we have not gained back a significant amount of weight, these medications are a great option for a “reset”. They can help us get back on track with our diet and help revitalize our metabolism. This can help bring us back to our goal weight.
As noted above, these medications are most appropriate in the temporary setting. Medications are not as powerful as surgery. Therefore, If there is significant weight reoccurrence, if there is significant additional weight to lose, or if we need a more permanent solution, I do not recommend medical therapy. In these cases, I recommend revisional surgery. Depending on the patient and their prior surgery, this can include conversion to a duodenal switch (SADI-S or BPD/DS) or Roux-en-Y gastric bypass. Revisional surgery will result in significantly more weight loss and longer-lasting results than medical therapy.
GLP-1a medications are a great addition to our toolbox in our fight against the disease of obesity. Your surgeon will be able to help you in choosing medications or surgery AFTER your original bariatric surgery!
