About 42% of American adults suffer from obesity with a BMI of 30 or higher. According to a 2018 study, about 9% suffer from severe obesity, meaning they have a BMI of 40 or higher.
Studies have shown that current methods of weight loss show limited results for those with BMIs higher than 30 with only 10% of women and 1 in 12 men losing 5% of their body weight.
Many obese Americans are turning to alternative methods like weight loss injections or bariatric surgery, also known as weight loss surgery, seeing it as the only option. For those with severe obesity, bariatric surgery often becomes a necessary path to reclaim their lives.
Retrospective studies of adults with weight regain or insufficient weight loss after bariatric surgery report that adjunct semaglutide use is associated with ~6% weight loss at 3 months and ~10% at 6 months. Semaglutide after bariatric surgery can be a valuable addition to the post-surgery regimen.
Both Wegovy and Ozempic contain the active ingredient semaglutide, but they serve different medical purposes. Ozempic is FDA-approved for type 2 diabetes management, while Wegovy is FDA-approved for chronic weight management in adults with obesity or overweight. Throughout this article, any reference to semaglutide for weight loss refers to Wegovy. Mentions of semaglutide for blood sugar control refer to Ozempic.
Bariatric Surgery and Its Limitations
Bariatric surgery is undoubtedly effective in promoting significant and often rapid weight loss, making it a valuable tool for individuals with severe obesity. With several weight loss surgeries to choose from, there are options for nearly everyone:
- Laparoscopic Sleeve Gastrectomy (“the sleeve”)
- Roux-en-Y Gastric Bypass (RYGB)
- Adjustable Gastric Band (AGB)
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
- Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)
Most people who opt for a bariatric surgery will lose about 50% of their excess weight, manage to keep it off, and significantly reduce comorbidities, such as type 2 diabetes, hypertension, and sleep apnea.
There are some drawbacks, though, including:
- Sustainability. Sustainability can be difficult and many do regain at least some of the weight several years post surgery. About 20-25% of patients will either regain the weight or deal with insufficient weight loss.
- Nutritional deficiencies. Bariatric surgery alters the digestive tract, affecting nutrient absorption. Patients must carefully manage their diet, including the possibility of requiring supplements to prevent deficiencies, , particularly in vitamins and minerals like B12, iron, and calcium.
- Lifestyle changes. Post-surgery, individuals must adhere to strict dietary guidelines, adopt healthier eating habits, and engage in regular physical activity.
Bariatric surgery is highly effective in promoting significant weight loss and improving health, especially in individuals with severe obesity and related comorbidities. But, it is not a standalone solution.
Semaglutide After Bariatric Surgery: A Complementary Solution for Patients
While bariatric surgery alone can be life-changing, the journey toward lasting weight loss and metabolic improvements might benefit from an additional ally—semaglutide.
Originally developed for managing type 2 diabetes in the form of Ozempic, semaglutide has shown significant results in reducing body weight for obese patients. Semaglutide belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. Its mechanism of action is twofold:
- Appetite control: Semaglutide reduces appetite and slows down gastric emptying, enhancing the feeling of fullness.
- Blood sugar management: Semaglutide regulates blood sugar levels by increasing insulin secretion and inhibiting glucagon release.
For individuals considering or who have undergone bariatric surgery, semaglutide offers several potential benefits:
- Enhanced weight loss: Semaglutide can further augment weight loss, helping individuals achieve their target weight more quickly.
- Metabolic improvements: Beyond weight loss, semaglutide contributes to metabolic benefits, such as better insulin sensitivity, reduced inflammation, and improved glycemic control.
- Fewer plateaus: Weight loss plateaus are a common challenge post-bariatric surgery. Semaglutide after bariatric surgery can help individuals break through these barriers and continue their progress.
With your doctor’s guidance, you might potentially use semaglutide and bariatric surgery together. Semaglutide can be used:
- Before your surgery as part of a preoperative plan and after surgery to further promote weight loss.
- After your surgery to further promote weight loss and support the required lifestyle changes.
- Long after your surgery to help promote weight loss for those who have regained weight post-surgery.
Semaglutide vs Bariatric Surgery
There are many individuals who choose to use semaglutide or bariatric surgery alone. There are many benefits and drawbacks to both.
Benefits and Drawbacks of Bariatric Surgery
Benefits:
- Rapid and substantial weight loss. Bariatric surgery typically results in rapid and substantial weight loss, making it an effective option for those with severe obesity.
- Resolution of comorbidities. Many obesity-related comorbidities, such as type 2 diabetes and hypertension, often improve or resolve after surgery.
- Long-Term effectiveness. In many cases, bariatric surgery leads to long-term weight loss and health improvements.
Drawbacks:
- Invasiveness. Bariatric surgery is an invasive procedure with associated risks and potential complications, including infection, bleeding, and long recovery periods.
- Nutritional concerns. Post-surgery, patients must be vigilant in monitoring nutrient intake and often require lifelong supplementation.
Individuals with severe obesity or urgent health risks may benefit more from the rapid weight loss achieved with surgery.
Benefits and Drawbacks of Semaglutide
Benefits:
- Non-invasive. Semaglutide is a non-invasive option that does not require surgery, reducing the associated risks. It is, however, an injection, which many find to be a drawback.
- Appetite control. Semaglutide is effective in reducing appetite and increasing the feeling of fullness, aiding in weight loss.
- Reversible. Semaglutide usage can be adjusted, and the medication can be discontinued if needed, offering more flexibility.
Drawbacks:
- Slower weight loss. While effective, Semaglutide may lead to slower weight loss and less significant results compared to bariatric surgery.
- Gastrointestinal disturbances. Semaglutide’s common side effects include nausea, vomiting, diarrhea, constipation, and abdominal pain.
- Ongoing medication. Semaglutide requires ongoing medication adherence for sustained effects.
Patients who prefer non-surgical approaches and want to avoid the invasiveness of surgery may opt for semaglutide vs bariatric surgery.
It is always important to discuss options with a licensed physician to determine the most appropriate option based on your individual needs and weight loss goals.
Semaglutide Dosing and Guidelines for Bariatric Patients
The standard semaglutide dosing schedule for weight loss is as follows:
- Weeks 1-4. 0.25 mg once a week
- Weeks 5-8. 0.5 mg once a week
- Weeks 9-12. 1 mg once a week
- Weeks 13-16. 1.7 mg once a week
- Weeks 17+. 2.4 mg once a week (maintenance dose)
Remember, this is the standard schedule and will need to be tailored to the individual needs of the patient. Those who have undergone bariatric surgery may not need the maximum dose.
Enhance Your Weight Loss with Semaglutide After Bariatric Surgery
Bariatric surgery is an excellent option for those who are dealing with severe obesity and obesity comorbidities. While it delivers rapid results, there is still significant potential for insufficient weight loss or weight regain after surgery.
Combining semaglutide and bariatric surgery can enhance your weight loss and help you maintain that weight loss for longer. Semaglutide is a viable option, either alongside or instead of surgery, to enhance weight loss and metabolic benefits.
Schedule a consultation with Heally today to discuss your options and develop a personalized plan.
Sources
National Library of Medicine: The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or Insufficient Weight Loss After Bariatric Surgery-a Retrospective Analysis
ASMBC: Bariatric Surgery Procedures
Healthline: People With Obesity Have Slim Chance of Obtaining Normal Body Weight
CDC: Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018
CDC: Adult BMI Categories
Important Medical Information and Disclaimers
MEDICAL DISCLAIMER
This information is for educational purposes only and is not intended as medical advice, diagnosis, or treatment recommendation. Semaglutide is the active ingredient in two FDA-approved prescription medications: Ozempic, approved for improving blood sugar control in adults with type 2 diabetes, and Wegovy, approved for chronic weight management in adults with obesity or overweight who have at least one weight-related medical condition. Although both medications contain semaglutide, they are approved for different uses and have different dosing schedules. Always consult a qualified healthcare provider before starting, stopping, or changing any treatment plan.
INDIVIDUAL RESULTS VARY
Outcomes with semaglutide treatment vary from person to person. Clinical trial data may not reflect typical real-world experiences. A variety of factors can affect your results, including medication adherence, lifestyle habits such as diet and exercise, metabolic differences, other health conditions, and concurrent medications. No specific result is guaranteed.
IMPORTANT SAFETY INFORMATION
Common side effects of semaglutide may include: Nausea, Vomiting, Diarrhea, Constipation, Stomach pain, Decreased appetite, Indigestion, Belching or gas, Injection site reactions
These side effects are often mild and may lessen over time. Always inform your healthcare provider about any medical conditions, allergies, and all medications you are currently taking before starting semaglutide. Ongoing monitoring is recommended during treatment.
WARNING: Semaglutide has a boxed warning about the potential risk of thyroid C-cell tumors. Do not use this medication if you or a family member has a history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
FDA ADVERSE EVENT REPORTING
You are encouraged to report negative side effects of prescription drugs to the U.S. Food and Drug Administration (FDA).
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Adverse events may also be reported directly to the manufacturer.
