Two Postboxes

Surgery Plus a GLP-1: One Plus One Equals Three?

“If you thought that GLP-1 agonists would replace bariatric surgery you are wrong.” Neil Floch is not alone in saying this and new research adds to the reasons we suspect that he is right. In JAMA Surgery, Jessica Mok and colleagues tell us that one plus one equals three with the combination of bariatric surgery and a GLP-1 obesity medicine. Specifically, they found that:

“24 weeks of liraglutide, 3.0 mg, as an adjunct to a lifestyle intervention in people with poor weight loss and a suboptimal GLP-1 response after metabolic surgery, was safe and well tolerated and led to clinically meaningful reductions in body weight.

“Importantly, participants in our trial did not reach weight loss nadir at the end of the 24-week treatment period, suggesting further weight reduction and health benefits may be achievable with a longer treatment period.”

Speculation About a Slowdown in Surgeries

Last month, investors fretted about the implications of GLP-1 medicines for the bariatric surgery market. An anecdotal observation from the CFO of Intuitive Surgical Inc, Jamie Samath sparked their angst. He said:

“Within one of our target procedure areas, bariatric surgery, our growth rate in the U.S. slowed during the quarter. Some customers have indicated that they are seeing increased patient interest in weight-loss drugs.”

Complimentary, Not Competing Options

But we align more with the perspective of ASMBS President Marina Kurian. She told Verywell Health recently:

“Obesity is such a chronic disease. What we know about obesity and its causes is just really the tip of the iceberg and the majority is submerged underwater. Doing more than one treatment in the same patient and tailoring it can really be far more effective to ensure successful and sustained weight loss.

“We actually think we’re going to see an increase in patients coming to surgery.”

In short, we have much better therapies for obesity today than we had even just five years ago. But obesity is different in every person it affects. Many people will need both surgery and medicines simply because it is both chronic and heterogeneous. So it’s foolish to think that one therapy will meet the needs of enough people to make other therapies obsolete.

We are a long way from that.

Click here for the study by Mok et al, here and here for commentary on it. For further perspective, click here. For even more, join Francesco Rubino, Ricardo Cohen, and a panel to include ConscienHealth’s Ted Kyle at an IFSO symposium later this month (details here).

Two Postboxes, photograph by Lewis Hulbert, licensed under CC BY-SA 3.0

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August 16, 2023

One Response to “Surgery Plus a GLP-1: One Plus One Equals Three?”

  1. August 16, 2023 at 5:16 pm, David Mahony said:

    I would agree with Dr. Kurian. The combination of surgery and medication will most likely get the best results – for long-term weight management. The problem is that the best treatments are not always the most utilized. Up until now bariatric surgery was by far the best and only way to treat obesity yet less than 1% of the eligible pts seek it out. There are many reasons for this and some of these reasons will apply to the GLP-1 inhibitors. I’ve already heard pts rejecting them because they see it as “the easy way out.” They believe that they have to lose the weight through diet and exercise even though they have tried unsuccessfully for years.