Medical weight loss solutions: GLP-1 Medications and Bariatric Surgery 

Obesity continues to be a common, concerning, and expensive problem for Americans and healthcare providers.

According to the Centers for Disease Control and Prevention, the prevalence of obesity in the U.S. has increased by 10% in the last 20-odd years, while severe obesity prevalence has grown by around 5%. Not only is obesity connected to heart disease, diabetes, certain types of cancer, and other serious health conditions, but one study of 2019 data estimated that obesity was tied to almost $173 billion in excess medical costs. It’s no surprise, then, that employers are looking for tried and true weight loss solutions to provide to their employees.

Lifestyle changes—including a focus on and shift in exercise, nutrition, and/or mental health and well-being—are a longstanding and effective option to combat obesity. But these types of weight loss solutions don’t always work, nor are they feasible or sustainable for many people.

Two more popular weight loss solutions are bariatric surgery and, more recently, GLP-1 medications. We’ll cover the pros and cons of each, as well as how to know which option is best suited for which type of patient.

Exploring weight loss solutions: GLP-1 medications

Glucagon-like peptide-1 (GLP-1) medications have been used for some time, although for purposes other than weight loss: The U.S. Food and Drug Administration (FDA) approved the first class of GLP-1 drugs in spring 2005 to treat Type 2 diabetes.

It wasn’t until the late 2010s that doctors and patients started considering and using GLP-1 drugs specifically for weight management, with celebrities and the rich spearheading the trend. In 2021, semaglutide brand names such as Wegovy and Ozempic were the 90th most prescribed medications in the U.S., reaching more than 1.9 million people.

What is a GLP-1 medication?

GLP-1 agonists, or medications, mimic the hormone they’re named after—glucagon-like peptide-1—that stimulates the body to release insulin when blood sugar levels start to rise.

Most commonly, GLP-1 drugs are administered daily or weekly via an injection into a fatty part of the body—think belly, thighs, or back of the arm—but some also come in tablet form to be ingested.

How do GLP-1 medications work?

GLP-1 is a hormone produced by the small intestine and plays an essential role in monitoring and balancing blood sugar levels.

GLP-1 medications, in turn, bind to GLP receptors (that may or may not be faulty) to trigger this hormone, which both tells the pancreas to release more insulin and blocks the secretion of glucagon (the hormone that raises blood sugar levels) when necessary. These actions slow digestion and prevent an excess of glucose from entering the bloodstream, which is often—but not always—caused by diabetes.

While doctors are still unclear on exactly how, weight loss is another possible result of taking such medications.

Research has shown that GLP-1 drugs can curb hunger in patients by impacting areas of the brain that determine whether you’re hungry or satiated. They can also slow down the movement of food from the stomach to the small intestine, making you feel full more quickly when eating and for longer after a meal.

And because of that, GLP-1 medications are now included in the weight loss solutions category.

The types of GLP-1 medications

Types of GLP-1 medications currently available in the U.S. include:

• Dulaglutide, which is sold under the brand name Trulicity and comes in an injection.
• Exenatide, which is sold under the brand name Byetta and comes in an injection. An extended-release (a drug released gradually into the body over time) form of exenatide is sold under the brand name Bydureon BCise.
• Liraglutide, which is sold under the brand names Victoza and Saxenda and comes in an injection.
• Lixisenatide, which is sold under the brand name Adlyxin and comes in an injection.
• Semaglutide, which includes brand names Ozempic, Wegovy, and Rybelsus and comes in injection or tablet form.

A similar dual GLP-1/GIP (glucose-dependent insulinotropic polypeptide) agonist, tirzepatide—or as it’s sold, Mounjaro—is also a popular name in the weight loss solutions space.

The benefits of GLP-1 medications

Possibly the most appealing benefit of GLP-1 medications is the fact that they’re minimally invasive. Rather than experience a potentially cumbersome and/or painful surgery and long recovery, all you have to do is inject yourself via syringe or needle, or consume a pill, every day or few days.

The results of taking these drugs, too, can be life-changing: One 2022 study found that patients who took semaglutide for six months lost on average almost 30 pounds. Another earlier report indicated that adding liraglutide to lifestyle counseling in overweight patient treatment over the course of a year led to a greater weight loss of up to 13 pounds.

Studies have also shown that some drugs in this category can potentially lower the risk of heart diseases and kidney disease and improve blood pressure and cholesterol levels. That said, it’s unclear from current data whether these benefits are a direct result of the medications or their subsequent weight loss.

The potential downsides of GLP-1 medications 

No drug is without side effects, and for GLP-1 medications, these might be:

• Gastrointestinal issues such as constipation or diarrhea
• General nausea and vomiting, or nausea caused by certain smells
• Pain or tenderness in the stomach or abdominal area
• And more serious side effects including hypoglycemia, pancreatitis, and gallstones

The other concern many have with GLP-1 medications is how long a patient must be on them to sustain their weight loss. Some find success with short-term use, but others have reported gaining back the weight after stopping treatment. In other words, you may find yourself having to stay on these drugs indefinitely, which can be expensive and annoying long term.

Exploring weight loss solutions: bariatric surgery

As weight loss solutions go, bariatric surgery predates the rise of GLP-1 medications by several decades, with history documenting the first procedure in the early 1950s (although some historians argue the idea of using surgery to promote weight loss existed as early as the 10th century).

What is bariatric surgery?

Bariatric surgery, also referred to as metabolic or gastric bypass surgery, encompasses any surgical procedure related to weight loss. Most often, this requires removing or dividing up parts of the stomach so less food and liquid can be stored and digested, limiting how much you can eat at any given time and how many calories your body absorbs.

How does bariatric surgery work?

During bariatric surgery, a patient is put under anesthesia; then a doctor makes either a large incision or goes in laparoscopically or via small cuts in the belly while guided by a small instrument hooked up to a camera.

Procedures vary—some surgeons remove a large portion of the stomach altogether to make it smaller, while others remove and reattach parts of the stomach, small intestine, and large intestine to regulate the digestion process.

The types of bariatric surgery

Bariatric surgery can come in one of several forms:

• A sleeve gastrectomy, where 80% of the stomach is taken out. This is arguably one of the most common types of bariatric surgery.
• A Roux-en-Y gastric bypass (RYGB), where the stomach is divided, then the small intestine is attached directly to the smaller pouch, bypassing the rest of the stomach.
• An adjustable gastric band (AGB), where a restrictive band that can be altered depending on diet is placed around the top part of the stomach to limit space for food.
• Biliopancreatic diversion with duodenal switch (BPD/DS), where the size of the stomach is decreased, then a part of the small intestine is reattached.
• Single anastomosis duodeno-Ileal bypass with sleeve gastrectomy (SADI-S), where, like the BPD/DS, two different procedures alter and reattach the stomach and small intestine.

The benefits of bariatric surgery

Bariatric surgery has been proven to have long-term results.

Studies have found that those who undergo bariatric surgery lose more weight—and keep it off longer—than those who pursue other weight loss solutions.

The American Society for Metabolic and Bariatric Surgery also reports that weight loss surgery can potentially treat other conditions associated with obesity, including diabetes, heart disease, high blood pressure, joint pain, sleep apnea, and arthritis, and reduce the risk of cancer.

The potential downsides of bariatric surgery

Bariatric surgery is just that, surgery—which means that while it could bring significant upsides, it is invasive. (With that, it’s still said to be one of the safest elective surgeries out there.)

Other side effects and complications of bariatric surgery include dumping syndrome, where food moves too quickly from your stomach to your bowels, causing symptoms such as cramping, lightheadedness, and diarrhea; kidney stones; and weight regain, or alternatively, not being able to lose the amount of weight you were hoping to achieve.

It’s worth noting, however, that when compared to the issues associated with obesity, the risks of bariatric surgery can be negligible.

Choosing between weight loss solutions: GLP-1 medications versus bariatric surgery

Both GLP-1 medications and bariatric surgery have the potential to significantly improve the health and quality of life of those who are overweight or obese and are considering different weight loss solutions.

There’s no right or wrong answer with either of these weight loss solutions, and the choice ultimately comes down to what’s best for the patient’s needs and lifestyle (including their personal budget and what weight loss solutions their health insurance covers) and should be a decision made between the patient and their care team.

Employers can assist their employees’ weight loss journeys by outlining the perks and downsides of medication and surgery, as well as making both weight loss solutions viable and attainable options in their health benefits stack. By providing ample information and financial support, organizations can cut down on the steep healthcare spend that comes with long-term obesity—while also ensuring their staff stay happy and healthy (both of which will help them be as productive as possible).

How a bariatric center of excellence (COE) program can help

Since GLP-1 medications are, as of now, meant to be taken indefinitely, they could end up costing employers much more than bariatric surgery in the long term. With that being said, bariatric surgery is by no means cheap—and even with the rise of GLP-1 drugs, there will still be plenty of individuals who choose weight loss surgery instead (or in addition to).

Partnering with a bariatric center of excellence program like Carrum Health, which provides upfront bundled payments for bariatric surgical care, can help employers better predict and control the money they spend on weight loss solutions and ensure their employees are getting the most appropriate and effective care possible—at little to no cost for the member.

Programs such as Carrum incorporate comprehensive care coordination—all patients are paired with a dedicated care navigator from day one—which further optimizes outcomes and minimizes costs. In addition, our bariatric program includes a unique provider-held warranty that guards against complications and readmissions. In fact, in addition to helping employers save up to 45% per surgery, our program has also been proven to reduce readmissions by 80% when compared to the national average.

Providing weight loss solutions: Learn more about how Carrum can help employers realize immediate cost savings.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.