By Dr. Trace Curry
Dr. Curry is the medical director of JourneyLite Surgery Center and JourneyLite Physicians in Cincinnati, Ohio.
What are GLP-1 Receptor Agonists and How Do They Work?
In order to understand these medications, we must first learn a little about the hormone that they mimic: glucagon-like peptide 1. This this is such a long name, it’s usually just abbreviated as GLP-1. To make it simple, this molecule helps your body secrete more insulin when you take in some carbs. Diabetics have been shown to have reduced levels of GLP-1, which can explain why their sugar levels run higher since their pancreas is making less insulin than a non-diabetic with normal levels of GLP-1.
GLP-1 receptor agonists are molecules which mimic actual GLP-1 and can bind to the same receptors, causing the same effect as the original molecule. As you could imagine, a drug that has this ability could really help type 2 diabetics, as it would increase their insulin levels when eating carbs, thus lowering their blood sugar. Fortunately, for overweight patients, these GLP-1 receptor agonists (GLP-1 RA’s) have effects that go beyond just this one function. They also delay gastric emptying, causing food to remain in the stomach for a longer time period before entering the small intestine. Guess what happens when your GLP-1 receptors are more occupied, and your stomach is fuller? You aren’t as hungry, and you lose weight!
With all of the press that these new medications have been getting, one might think that drugs that include Wegovy (semaglutide), Mounjaro (tirzepatide), and Ozempic (also semaglutide) would be the solution to the world-wide obesity epidemic! Although it is indeed exciting to have a new weapon in our arsenal, I think that weight loss surgeons will be able to keep their day jobs for now. Although there are some situations were GLP-1 RA’s might be a great option, for many patients, surgery will still be the best tool.
So–what are the pro’s and con’s of medications like WeGovy (semaglutide), Mounjaro (tirzepatide), or Ozempic (semaglutide); and how do you know which is the best option, medication or surgery? Here are the top 5 things you should know when deciding whether a GLP-1 RA or weight loss surgery is right for you!
1. Insurance coverage and cost is a major issue
Despite the fact that obesity is a leading cause of diabetes and other major health issues, many patients who medically qualify for life-saving weight loss surgery lack the necessary insurance coverage. At present however, even fewer patients have coverage for Wegovy or other GLP-1 RA’s for weight loss. Even if you do have coverage, if you have a high-deductible plan it is still going to cost you a lot of money before you reach that deductible. For those without coverage, most of the time these drugs are just too expensive for patients to pay out-of-pocket also–typically in the range of $1100-$1500+/month (even with a manufacturer’s savings card). When you consider the fact that most patients who stop the drug down the road will have a very high chance of weight regain, this is a seemingly endless expense that neither the patient (nor the healthcare system) can likely sustain forever. On the other hand, surgery is a one-time expense, and with the cost of weight loss surgery coming down dramatically for self pay patients over the last 20 years, these procedures can easily pay for themselves relatively quickly when you look at the significant savings patients will see in reduced food and medication expenditures. Fortunately, Novo Nordisk, the manufacturer of Wegovy, makes it easier to find out what your cost might be. Just go to Wegovy.com and click on “Check your cost and coverage” in the middle of the page.
2. Both surgery and GLP-1 RA’s can have side effects
Patients are often rightly concerned about the side effects of weight loss surgery, however all medications have at least some side effects as well. In many cases, with GLP-1 RA’s such as Wegovy, Mounjaro, and Ozempic these can be severe. As these drugs tend to slow gastric emptying, nausea is the most common side effect and is also the number one reason that patients stop taking them. With time the body becomes used to the slower stomach emptying and this symptom will usually resolve, but in some cases it remains severe. Acid reflux, or GERD, also can be a major issue for some patients. Usually (although not always) the side effects of surgery are temporary and likewise subside with time.
In addition to nausea and GERD, GLP-1 RA’s have been shown to increase the risk of certain thyroid cancers, especially with prolonged use.
3. Weight loss will likely be considerably less with GLP-1 RA’s than with surgery
Some patients only need to lose 10 or 20 pounds, others need to lose 100 or 200 pounds. If you’re in the latter group, it’s unlikely that GLP-1 RA’s will get the job done. In fact, I have seen few patients lose more than 50 pounds with GLP-1 RA’s, and most lose in the range of 20 or 30 at the most. Surgery is simply a much more powerful tool and can lead to much more (and much more sustainable) weight loss than with medications of any kind.
4. Do you want to take these meds forever?
Although approved for long-term use, the prospect of injecting yourself with a very expensive and side-effect-prone medication for the rest of your life is somewhat daunting. Certainly, you don’t have to take these meds forever, however after stopping them the likelihood of weight regain is high. Basically, it’s just like any diet you’ve done in the past–how many times were you able to keep the weight off permanently? Weight loss surgery, in contrast, provides the patient with a permanent tool to increase the chance that the extra weight will be gone permanently. Don’t get me wrong, it takes work! But, the chance of long-term success is much higher than abruptly stopping a medication with no backup.
5. Surgery does not rule out the use of GLP-1 RA’s in the future
Fighting obesity is a life-long battle, even in patients who have had weight loss surgery. After surgery, if patients sees some weight regain years down the road, GLP-1 RA’s can be the perfect option to get them back on track. Although we don’t have any long-term studies as of yet, it is likely that the combination of weight loss surgery and GLP-1 RA’s such as Wegovy, will be far more successful than with either as a standalone treatment.
In conclusion, it remains to be seen how these new GLP-1 RA medications will impact the wordwide obesity epidemic. Issues such as cost, insurance coverage, side effects, and limited power will likely prevent them from being a universal solution to excess weight for all patients. The fact remains that weight loss surgery such as gastric sleeve, gastric bypass, SIPS, and Lap Band can be a more effective solution with a higher long-term success rate for the majority of patients who need to lose more than 50 lbs.
At JourneyLite, our team of expert medical and dietary providers offer state-of-the-art surgical weight loss options, and incisionless procedures such as the Spatz and Orbera gastric balloon systems. We also treat patients with standard weight loss medications like Adipex and phentermine, as well as advanced medications such as GLP-1 RA’s. To speak to a patient service representative about your options, simply complete the form below!