By Lauren Johnson
Medical professionals from Ascension St. Vincent’s Birmingham Bariatrics say that Glucagon-like peptide-1 receptor agonists (GLP-1) are the most effective weight loss medications. While other weight-loss drugs can help patients see up to a 12 percent weight loss, GLP-1 routinely results in about 15 to 20 percent excess body weight loss, and in some cases more than that. Not only are GLP-1 agonists an option for some patients in place of bariatric surgery, but they can also help patients who regain weight after surgery.
Aimee Rothe, BSN, RN, the director of Metabolic and Bariatric Surgery at Ascension St. Vincent’s Birmingham, said that St. Vincent’s physicians have performed almost 300 bariatric surgeries since 2020, and starting in 2022, they began including obesity medicine like GLP-1 agonists. This class of drugs, first introduced in 2005, were primarily used to treat diabetes before being approved for weight loss in 2014.
“GLP-1 drugs have revolutionized the weight-loss industry,” said Katie Novitski, MD, MPH, a bariatric surgeon at Ascension St. Vincent’s Birmingham. “It’s a great tool to have in our arsenal, but I don’t think they will ever replace surgery. It’s important to note that bariatric surgery is a metabolic surgery, so we actually change the metabolic processes by going in and altering the patients’ anatomy. It’s possible for patients to see anywhere from 60 to 75 percent excess body weight loss with bariatric surgery. They can also see remission and improvements in other health conditions like heart disease, liver disease, high blood pressure and diabetes. Likewise, anywhere from 40 to 90 percent of these patients are able to come off all their medications.”
Novitski and her colleagues follow up with patients at least six times within the first year of surgery. After the first year, the patient has annual checkups. These checkups help the patients stay accountable and continue on the right track to keep the weight off. St. Vincent’s also offers a back-on-track weight-loss program for bariatric surgery patients. This classroom session includes information on the three-pronged approach – diet, exercise and metabolic workup.
“If a patient starts to regain some weight after surgery, GLP-1 agonist is a great tool to use, along with an appropriate diet and exercise routine,” Aimee Rothe said. “We want to help decrease the stigma around bariatric surgery by making patients aware of the GLP-1 medication and its use after surgery. A patient can experience a self-perception of failure if they regain weight post-surgery. So, understanding that we’re treating a medical problem, and even though they may be in remission by losing weight, they still have obesity.”
Novitski said GLP-1 offers a new opportunity for patients. “After bariatric surgery, you actually have a spike in your own hormone GLP-1. In other words, we see the same metabolic response within the body, post-surgery, that we get when some takes the GLP-1 agonists. This metabolic response helps the body regulate insulin, glucagon and sugar. It can also help decrease appetite. This encouraged me to begin offering the medication to patients. If we can get the same response with a medication, then the patients can have a great result.”
For consideration of medications, the patient needs to have a BMI (body mass index) of 28 with an obesity-related comorbidity, like high blood pressure, diabetes, liver disease or sleep apnea. For patients in need of long-term results or patients with a BMI greater than 35, Novitski said surgery is the best option. This way patients won’t need to take medication for an extended period of time, or in some cases, a lifetime.
