Can You Use GLP-1 After Gastric Bypass and Gastric Sleeve

Can you take GLP-1, Wegovy, or Ozempic after gastric bypass or gastric sleeve surgery? The question has several points of consideration:

• Will GLP-1 help you lose more weight after the surgery?
• Can your body handle GLP-1 after the surgery?
• If you were using a GLP-1 before, would it make your blood sugar too low after the surgery?
• If you don’t really need GLP-1 for something like diabetes, when should you think about using it after the surgery?

Let’s discuss these important considerations in light of a recent systemic review.

GLP-1 and Bariatric Surgery:

Bariatric surgeries like gastric bypass and gastric sleeve have made a big difference in managing obesity, even for those who are extremely overweight and haven’t responded to other weight loss methods.

However, after 2 to 10 years, some patients start gaining weight again because of changes in their stomachs and not following the diet and exercise plans.

If patients start gaining weight or don’t reach their goal weight, using weight loss medicines with a low-calorie diet and exercise can help them lose more weight.

Among these weight loss options, medicines like Wegovy, Ozempic, Saxenda, Mounjaro, and Zepbound are the most powerful.

Saxenda helps with an 11% weight loss, while Wegovy and Mounjaro (Zepbound) have been shown in studies to lead to a weight loss of 16% and 21%, respectively.

In a recent systemic review, it was observed that combining GLP-1 analogs can enhance weight loss after bariatric surgery.

Key points of the study:

• The systematic review evaluates the weight loss effects and metabolic changes associated with combining glucagon-like peptide 1 receptor agonists (GLP-1 RAs) with endoscopic bariatric therapy (EBT) and bariatric surgeries (BS).
• The review includes 11 studies, encompassing nine that compare weight loss surgery with and without liraglutide and two that compare EBT with and without liraglutide. Only randomized control trials and retrospective studies were considered.
• The addition of liraglutide to bariatric surgery (EBT and BS) resulted in significant weight loss compared to EBT or BS alone. This suggests a potential synergistic effect of combining GLP-1 RAs with these obesity management interventions.
• Within 12 years, more than 50% of the world’s population will be affected by obesity if an effective treatment is not used [ref].

Obesity and Weight Loss Interventions:

Obesity is a pandemic. The reasons are understandable: 

• A sedentary lifestyle (lack of exercise)
• Eating fast foods, eating frequently and more than what is required

Recent weight loss interventions have transformed obesity management. These include potent weight loss medications such as:

• Liraglutide (Saxenda and Liraglutide),
• Semaglutide (Wegovy, Ozempic, and Rybelsus), and
• Tirzepatide (Mounjaro and Zepbound)

However, bariatric surgery is associated with the greatest weight loss. Various bariatric surgical procedures in practice are:

• Gastric bypass surgery (including MGB, mini gastric bypass surgery)
• Gastric Sleeve Surgery (including laparoscopic gastric sleeve and VSG, vertical sleeve gastrectomy)
• Gastric Banding (Lap-Band)
• Biliopancreatic Diversion with Duodenal Switch (BPD-DS)

Endoscopic Bariatric Therapy (EBT) and Bariatric Surgeries effectively achieve substantial weight loss and improve metabolic health.

EBT involves minimally invasive procedures using an endoscope, inducing weight loss by altering the digestive system [ref].

Bariatric Surgeries, like gastric bypass or sleeve gastrectomy, modify the anatomy to limit food intake and nutrient absorption [ref].

While EBT is less invasive, bariatric surgeries often provide more enduring results, their impact extends beyond weight reduction, addressing comorbidities like diabetes.

GLP-1 RAs are medications aiding weight management by regulating appetite and can be used to enhance the therapeutic effects of bariatric surgery and EBT, as studied in this review.

This recent review highlights a hopeful strategy in obesity management, where combining GLP-1 RAs with EBT or bariatric surgery is anticipated to result in briefer hospitalization, fewer side effects, and more sustained weight loss benefits compared to relying solely on EBT (endoscopic bariatric therapy) or  BS (Bariatric surgery) [ref].

Considering the side effects of other treatments, this non-invasive method can help a lot. This remedy is both effective and long-lasting, which is incredible for extended weight loss.

Methodology and analysis of the study:

The systematic review employed a comprehensive search strategy across databases like Cochrane, PubMed, and Google Scholar using terms related to bariatric surgery, endoscopic bariatric therapy (EBT), and GLP-1 receptor agonists (GLP-1 RAs).

To address potential bias, the review also examined reference lists of identified articles and major reviews, involving a second reviewer for validation.

Inclusion criteria specified English-language studies involving participants aged 18 or older, comparing weight loss changes with GLP-1 RAs post-bariatric surgery or EBT.

Exclusion criteria comprised studies with participants under 18, those utilizing GLP-1 RAs without surgical or endoscopic intervention, or studies failing to report GLP-1 RAs’ weight loss effects separately.

Quality assessment utilized checklists recommended by the National Institutes of Health.

Two independent reviewers meticulously extracted data encompassing authorship, study characteristics, participant demographics, interventions (e.g., liraglutide), and study outcomes.

The focus of the study was to evaluate the impact of combining GLP-1 RAs with BS or EBT on weight loss, emphasizing methodological quality and participant characteristics as crucial factors in the analysis.

This method aims to help us understand how well including GLP-1 RAs works when managing obesity.

Findings of the review:

The findings of the review suggest that combining liraglutide therapy with Endoscopic Bariatric Therapy (EBT) or Bariatric Surgeries (BS) results in significant weight loss compared to EBT or BS alone.

The most common side effects reported were related to the stomach and digestive system.

Furthermore, when liraglutide was used together with Endoscopic Bariatric Therapy (EBT), the amount of weight lost was similar to the weight loss seen with Bariatric Surgeries alone.

Considering that bariatric surgery is an invasive procedure, this combination can be a potential way to a non-invasive and long-term weight management therapy.

Still, it is important to mention that studies looking at liraglutide with EBT did not focus on changes in metabolism.

The review points out that combining these methods seems promising for handling obesity.

It could mean shorter hospital stays, fewer side effects, and keeping off weight for a longer time, which might be better than just depending on Bariatric Surgeries alone.

Possible contributions:

The review brings attention to a new way to manage obesity by using a combination of GLP-1 RAs, like liraglutide, Semaglutide, Tirzepatide, and bariatric surgery or EBT.

As we mentioned above, this method is thought to be better than Bariatric Surgeries, owing to its safer and more effective solution to the rising issue of obesity and its problems.

However, the review points out that more research, with better quality and consistent measures, is needed to confirm how well this combined approach works and understand any potential changes in metabolism.

• Will GLP-1 help you lose more weight after the surgery?

Yes. In light of the above study, GLP-1 can help you lose more weight. In addition, the weight loss is sustained for a longer period of time than if you have a bariatric surgery alone.

• Can your body handle GLP-1 after the surgery?

Tolerating GLP-1 immediately after surgery is a concern. However, if there are no compelling indications such as Diabetes, it is best to initiate Wegovy, Mounjaro, Saxenda, or Ozempic after gastric bypass or gastric sleeve when you stop losing more weight or when you start regaining weight.

Generally, it is better to wait for 6 months to 2 years after bariatric surgery and let your stomach get adjusted.

Once you stop losing further weight or start regaining weight, you can start using a GLP-1 then.

• If you were on GLP-1 before, will it make your blood sugar too low after the surgery?

No. GLP-1 causes insulin secretion only when your blood glucose is high. They are not associated with hypoglycemia when used alone.

However, if you are taking an oral diabetes medicine or insulin, adding a GLP-1 can definitely lower your blood glucose.