The benefits of using weight-loss medications before bariatric surgery

Bariatric, or weight-loss, surgery is an effective way for people who are eligible for the procedure to achieve a healthy weight. It’s a journey that requires a commitment to lasting lifestyle changes.

People who need to lose 50 pounds or more will typically be more successful with surgery, or surgery with medications, versus medications alone.

“Surgery has been shown to have greater success in keeping more weight off long term,” says MultiCare bariatric surgeon Benedict Hui, MD. “Medications usually require lifelong use in order to keep the weight off, and the weight will most likely come back once the medications are stopped; whereas surgery is typically a one-time event.”

You must meet certain requirements prior to bariatric surgery, which typically include various tests and blood work, meeting with a psychologist and consulting with a dietitian.

Reasons for medication use

Some people may also need to lose a certain amount of weight prior to surgery, which has several benefits: It lowers the risk of complications during and after surgery; it allows the surgeon to have better access and visibility to the organs they’re operating on during surgery; and patients may achieve more total weight loss after surgery.

The most common reasons someone might need to lose weight prior to surgery: if a person’s body mass index (BMI) is more than 50 or if it’s required by health insurance.

A patient’s surgeon may also set a preoperative weight-loss goal based on the type of surgery.

“I view the relationship between weight-loss medications and weight-loss surgery similar to the treatment of cancer,” says Dr. Hui. “Chemotherapy plays a role in treatment prior to or after surgery for the removal of the cancer. In a similar way, for patients with obesity, weight-loss medications can help enhance the benefits weight-loss surgery can provide.”

Tools and support to help reach weight-loss goals

For all patients undergoing bariatric surgery, one of the foundations of the MultiCare Center for Weight Loss & Wellness is lifestyle support and one-on-one education. This includes ongoing consultations with a dietitian who provides the tools and support to help you lose weight prior to surgery.

If you’re required to lose weight prior to surgery but unable to do so, your surgeon will refer you to one of MultiCare’s bariatricians, or medical weight loss specialists, who can help you reach your weight-loss goal.

“For those who are having difficulty making progress with losing preoperative weight, we can offer medication options,” says MultiCare medical weight loss specialist Carrie Wong, MD.

People who need to lose 50 pounds or more will typically be more successful with surgery, or surgery with medications, versus medications alone.

Medical weight loss specialists like Dr. Wong will review types of medications available and which would be best for your particular situation.

Types of weight-loss medications

Medications that may be used to help with weight loss prior to bariatric surgery include GLP-1s and appetite suppressants.

GLP-1s are medications that mimic a gut hormone called glucagon-like peptide-1 (GLP-1) that increases insulin production following a meal. This release of insulin helps improve glucose control. These medications make a person feel full by slowing gut motility, and lower appetite through receptors in the brain.

Appetite suppressants commonly used include phentermine-topiramate (Qsymia), which is a stimulant, and naltrexone-bupropion (Contrave). These are more affordable alternatives to GLP-1s.

Selection is not only based on how effective a medication is — it’s determined by your health history, how you might tolerate the medication, and if it’s covered by insurance, among other factors. That’s why it’s important to work with a doctor or other health care provider who specializes in managing these types of medications. These providers discuss the following with their patients:

• Are there health conditions that preclude the patient from taking the medication?
• Does the medication interact with other medications the patient is taking?
• What are the side effects?
• Is taking an oral tablet preferable to injections?
• Is the medication covered by insurance?

Health history is a determining factor

“Health history is one of the most important aspects of this determination, as there are medical reasons we can’t offer certain medications,” explains Dr. Wong. “For instance, if someone has a history of pancreatitis or thyroid cancer, we wouldn’t give them a GLP-1.”

Phentermine is another example. If you have a history of insomnia, anxiety or any heart problems, including heart rate rhythm issues or uncontrolled blood pressure, this medication can make those problems worse.

Once the appropriate medication is selected, the medical weight loss specialist will carefully monitor you while you’re taking the medication.

These pre-surgery requirements have an additional benefit of jump-starting lifestyle changes.

“Losing weight before surgery isn’t just about reaching a goal,” Dr. Wong adds. “It’s an opportunity for a person who has made the decision to undergo a life-changing surgery to start making changes now that will serve them post-surgery as well.”