Benefits of using weight loss medications before bariatric surgery- MultiCare Vitals

Bariatric, or weight loss, surgery is an effective method for people who qualify for the procedure to achieve a healthy weight. It’s a journey that requires a commitment to long-term lifestyle change.

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

“Surgery has been shown to be very effective in maintaining weight long-term,” says MultiCare bariatrician Benedict Hui, MD. “Medications usually require lifelong use in order to lose weight, and it is possible that the weight will return once the medication is stopped; whereas surgery is usually a one-time thing.”

You must meet certain requirements before bariatric surgery, which usually includes various tests and blood work, meeting with a psychologist and consulting with a nutritionist.

Reasons for drug use

Some people may also need to lose some weight before surgery, which has many benefits: It reduces the risk of complications during and after surgery; allows the surgeon to have better access and visibility of the organs they are working on during surgery; and patients may experience weight loss after surgery.

The most common reasons a person may need to lose weight before surgery are: if the person’s body mass index (BMI) is over 50 or if it is required by health insurance.

The patient’s physician may also set a preoperative weight loss goal depending on the type of surgery.

Dr. Hui says: “I view the relationship between weight loss drugs and weight loss surgery as similar to cancer treatment. “Chemotherapy plays an important role in treatment before or after surgery to remove cancer. Similarly, in obese patients, weight loss medications can help improve the benefits of weight loss surgery.”

Resources and support to help you achieve your weight loss goals

For all bariatric surgery patients, one of the cornerstones of the MultiCare Center for Weight Loss & Wellness is lifestyle support and one-on-one education. This includes an ongoing consultation with a dietician who provides tools and support to help you lose weight before surgery.

If you need to lose weight before surgery but are unable to do so, your doctor will refer you to one of MultiCare’s doctors, or weight loss specialists, who can helps you achieve your weight loss goals.

“For those who have difficulty maintaining preoperative weight loss, we can offer medication options,” says MultiCare medical weight loss specialist Carrie Wong, MD..

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

Weight loss experts like Dr. Wong will review the types of medications available and which may be best for your condition.

Types of weight loss medications

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

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

Commonly used appetite suppressants include phentermine-topiramate (Qsymia), which is a stimulant, and naltrexone-bupropion (Contrave). These are cheaper alternatives to GLP-1s.

The choice doesn’t just depend on how well the medication works — it’s determined by your health history, how well you can tolerate the medication, and whether 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 these types of medications. These providers discuss the following with their patients:

• Are there medical conditions that prevent the patient from taking medication?
• Does the drug interact with other medications the patient is taking?
• What are the side effects?
• Is taking a tablet better than injections?
• Is the medicine covered by insurance?

Health history is a determining factor

Dr. Wong explains: “The health history is one of the most important parts of this determination, as there are medical reasons why we cannot prescribe certain medications. “For example, if someone has a history of pancreatitis or thyroid cancer, we won’t give them GLP-1.”

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

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

These pre-surgery requirements have the added benefit of changing the lifestyle of the jump starter.

“Losing weight before surgery is not just about achieving a goal,” Dr. Wong adds. “It’s an opportunity for someone who has decided to undergo life-changing surgery to start making changes now that will help them even after the surgery.”