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Given the ubiquity of GLP-1 therapy – and the resulting number of studies being released or planned – it seems as though new information is emerging every week about the possible benefits of GLP-1 receptor agonists (GLP-1 RAs) like Wegovy and Zepbound.
To that end, a growing body of clinical research suggests that GLP-1 RAs – particularly semaglutide (Wegovy) – are associated with improvements in a range of cardiometabolic risk factors, including glycemic control, insulin sensitivity, lipid profiles, and markers of inflammation. While these benefits often occur alongside weight loss, evidence indicates that some metabolic improvements may emerge early in treatment and are not solely attributable to reductions in body weight. A similar pattern has long been observed following bariatric surgery, in which patients frequently experience rapid improvements in glucose regulation and diabetes control soon after surgery, well before substantial weight loss has occurred.
This phenomenon, observed in both GLP-1 RAs and bariatric surgery, may have a similar explanation: the significant physiologic and hormonal changes each produces may reduce inflammation and normalize certain physiological functions, including improved insulin regulation.
The Fasting Component
One hallmark of the success of bariatric surgery and GLP-1 therapy is their effectiveness as hunger suppressants, albeit through different mechanisms. In a sense, both induce a fasting-like state. Indeed, based on the extensive data available on intermittent and water-only fasting, several physiological functions appear to rebalance after only a few days of calorie restriction. Whether it’s fasting, GLP-1 RAs, or bariatric surgery, patients consume significantly fewer calories and, once again, may enjoy the benefits before they’ve lost a large amount of weight.
Does that mean that fasting is equivalent to bariatric surgery or GLP-1 therapy?
The short answer is no. While fasting can be exceptionally beneficial – and many patients should consider it under the guidance of a qualified medical practitioner, dietitian, or nutritionist – these modalities differ in durability. Fasting can be very effective, but as most can attest, when we come off the fast, we tend to return to baseline rather quickly.
GLP-1 receptor agonist medications help us achieve significant long-term weight loss by reducing gastrointestinal motility and, thereby, reducing hunger. The results persist even after GLP-1 RAs have been discontinued, but not to the extent that we could consider this a permanent solution. In fact, patients on older-generation weight-loss medications tended to return to their baseline weight within a year. In contrast, patients receiving newer GLP-1 medications appear to regain much of their prior weight within 2 years. Of course, this is not always the case, but the same goes for patients on a diet alone – only a small percentage maintain their weight loss long-term.
Bariatric surgery offers unmatched long-term durability. To be sure, patients who are not compliant with their postoperative lifestyle, diet, and exercise programs risk regaining their weight soon after their procedure. However, for most, bariatric surgery is an excellent option for maintaining weight loss long-term. Why?
Bariatric surgery combines restrictive, hormonal, and malabsorptive qualities to induce a “trifecta” of weight loss modalities:
- Bariatric surgery practices have finely tuned postoperative programs that keep patients on track, with established protocols to bring patients in early if weight regain begins.
- Depending on the procedure, bariatric surgery can also provide physical feedback loops that assist patients in maintaining their weight over the long term. For example, overeating after a gastric sleeve often causes discomfort, while overeating after a gastric bypass can lead to dumping syndrome – behaviors patients quickly learn to avoid.
- Finally, the profound hormonal and metabolic changes triggered by bariatric surgery – particularly alterations in gut hormones involved in hunger, satiety, and glucose regulation – reinforce both reduced caloric intake and long-term metabolic improvement.
The Bottom Line
Significant lifetime lifestyle changes, such as improved diet and exercise, GLP-1 receptor agonists, and bariatric surgery, have substantial benefits in reducing inflammation and improving or resolving obesity-related diseases. Although they work in different ways, the ultimate goal is to ensure that patients can maintain their weight loss and disease improvement over the long term. It is vital to work with a practice, such as the Gastric Sleeve Center, that tailors a weight loss program to the patient’s current status, rather than attempting to fit the patient into a preferred or “most profitable” weight loss modality.
Dr. Jacobs understands the nuances between the various therapies and has incorporated comprehensive lifestyle change and GLP-1 RAs into our bariatric program.
A Special Note
When we discuss significant weight loss and induced satiety – whether it be fasting, GLP-1 RAs, or bariatric surgery – the importance of maintaining bone health and muscle mass cannot be overstated. Unfortunately, when we lose a significant amount of weight (as we’ve seen particularly with GLP-1 RAs), there is often an accompanying loss of muscle mass and bone density. This can be very problematic, especially for our older patients and any of our menopausal female patients who might be at risk for osteoporosis.
Be sure to attend your follow-up appointments and get periodic blood work to ensure you don’t have any deficiencies in that regard. Furthermore, no weight loss program is complete without a combination of cardiovascular and strength training (supported by appropriate protein intake), which is vital for maintaining muscle mass, burning calories even at rest, and supporting overall physical and mental health.
