Mega Doctor News
CEDAR SINAI – A new class of drugs called GLP-1 (glucagon-like peptide-1 receptor agonists) has made headlines for its dramatic success in helping people shed stubborn pounds, thereby controlling diabetes and reducing the risk of heart disease.
However, medication is not the only option for patients with obesity who need to lose weight to improve their health. Bariatric surgery has been helping patients lose significant weight—and keep it off—for decades.
Jeremy Korman, MD. Image courtesy of Cedar-Sinai
“A key advantage of surgery over drug treatment is that we expect the effects to last for decades when combined with lifestyle changes toward health,” said bariatric surgeon Jeremy Korman, MD, medical director of the Cedars-Sinai Marina Weight Management Center.
Korman added that insurance will usually cover the surgery if the patient meets certain medical criteria. Expensive GLP-1s sold under brand names such as Ozempic and Wegovy are often not covered by insurance for weight loss and have become so popular that they are hard to find in pharmacies.
To better understand these two effective ways to lose weight, 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 more from weight loss surgery than medication?
Sandhu: Some patients benefit more from bariatric surgery or weight loss surgery than from medical weight loss or taking medication. These include patients who have previously had adverse effects from medical weight loss or who have not had effective results from medical weight loss. We also have some patients who have a much higher BMI (body mass index), meaning they are much heavier. For them, medication may not work as well and surgery may be better in the long term. We have also found that the most effective solution for long-term weight loss is bariatric surgery or weight loss surgery.
What are the most common weight loss surgeries?
Korman: When it comes to bariatric surgery or weight loss surgery, the two most popular options are gastric sleeve and gastric bypass. With gastric sleeve surgery, we only change the size and shape of the stomach. The stomach becomes narrower and more tubular, so it looks almost like a banana. The thing about gastric sleeve surgery that makes it so popular is that we keep the natural path from the stomach to the intestines without creating any new connections. This makes feeding a little easier for the patient.
With gastric bypass, we also change the size and shape of the stomach, including making it smaller. But we also create a new connection; we reroute the pathway from the stomach to the intestine. This additional “malabsorptive” element makes the procedure more effective because we are bypassing part of the intestine. However, changing the natural pathway has a disadvantage, as nutritional management becomes a little more complex. There is then a greater responsibility for vitamin supplementation and monitoring in follow-up. However, for selected patients, this is a more effective option and therefore the appropriate choice.
What is a common misconception about weight loss surgery?
Sandhu: I think most people shy away from surgery because they are worried about the risks involved. But most of my patients who have undergone surgery say that their biggest regret is that they didn’t do it sooner. The surgery is very effective and also very safe. The long-term complications are quite low and patients recover very well from the surgery.
There’s also the stigma that weight loss surgery is the failure of things like diet and exercise. But that’s not the case. Patients can follow the same diet as others and still not lose weight because their biology is different. Surgery just gives you another tool to eat less and lose weight more effectively. And I think that’s really important to recognize.
What should patients know to achieve lasting results?
Korman: In addition to the treatments we offer, patients need to make lifestyle changes. This includes both diet and physical activity. And by changing their lifestyle, they will be able to achieve their full potential, the weight loss we expect. The chances of successful long-term weight loss increase to as much as 80%.
Sandhu: It’s not a quick fix. It’s about a long-term relationship with our patients. When we become your doctors, we as bariatric surgeons say we are your doctors for life.
Read more on the Cedars-Sinai blog: Myths and misconceptions about bariatric surgery
INFORMATION SOURCE: CEDARS SINAI NEWSROOM
