Anti-obesity drugs are closing the gap between dieting and bariatric surgery
September 7, 2023
Time and again, the mantra “eat less and move more” has proven ineffective – and even counterproductive – for patients battling chronic weight problems and medical complications of obesity.
But a class of medications, initially approved to treat diabetes, is closing the gap between the two ends of the obesity treatment spectrum: lifestyle modification and bariatric surgery.
Semaglutide, better known by brand names such as Wegovy, is a glucagon-like peptide-1 (GLP-1) receptor agonist drug that has been approved by the U.S. Food and Drug Administration (FDA) as an adjunct to lifestyle changes for weight management in people with obesity or overweight – with a related medical complication such as high blood pressure. Semaglutide joins liraglutide (Saxenda), which is another GLP-1 receptor agonist that was FDA-approved for weight management in 2014.
GLP-1 receptor agonists can help you lose weight in two ways:
- Making the stomach empty slower – you’ll feel satisfied with smaller amounts of food, which helps you eat less and create a calorie deficit that can lead to weight loss.
- Signaling the brain there is food in the stomach, which helps decrease appetite and cravings. This helps you make more consistent choices aligned with your body’s needs.
In clinical trials of Wegovy, participants lost an average of 15% of their body weight – and more than half lost more. That’s approximately 45 lbs. for a 300-pound patient – up to five times the average weight loss seen with traditional diet and exercise plans.
Patients in UT Southwestern’s Weight Wellness Program often exceed these weight loss results. Our team of physicians, dietitians, and psychologists approaches obesity as a complex condition that requires patient-centered care. Anti-obesity medications help our patients focus on creating sustainable behaviors that support a healthy weight and lifestyle, without the distractions of hunger and cravings.
Treatment plans, medications, and procedures are selected based on an individual’s situation and underlying health conditions. For example, weight loss medications like GLP-1 receptor agonists help to improve blood sugar, blood pressure, and fatty liver. Achieving a healthier weight can decrease the risk of complications associated with obesity, such as diabetes, fatty liver disease, sleep apnea, heart disease, depression, joint pain, and certain cancers.
Three semaglutide medications are currently approved by the FDA:
- Wegovy is approved for weight loss treatment, and can be prescribed to adults and children 12 and older with obesity, as well as some adults with overweight who also have weight-related health problems, such as high blood pressure.
- Ozempic and Rybelsus are approved for treatment of type 2 diabetes, but they have shown effectiveness in weight loss and reducing the risk of heart attack and stroke.
Tirzepatide, another glucose-lowering medication known by the brand name Mounjaro, was approved for diabetes treatment in 2022 and is under fast-track review for weight loss. Its clinical trial participants lost an average of 20% of their body weight within a year and a half of starting treatment.
More than 70 percent of U.S. adults have overweight or obesity. However, anti-obesity medications are prescribed to only about 4% of eligible people due to concerns about safety or effectiveness, lack of health care provider training in weight management, excessive costs due to insurance companies refusing coverage, and a toxic stigma that portrays obesity as a lack of willpower. Advising a patient with obesity to simply “eat less and exercise more” is like telling a patient with depression to “cheer up.” It’s ineffective and often quite hurtful.
Our program has been prescribing GLP-1 receptor agonist medications for many years and found them to be a valuable, effective treatment tool that can help position patients for success and a healthier future. But they are just one of many treatment options for the complex condition of obesity.
How GLP-1 receptor agonist drugs work for weight loss
GLP-1 receptor agonists mimic a protein of the same name that is made naturally in the intestines when we eat. When used for weight management, these medications pump the brakes on our appetites and the rate at which food exits the stomach. As a result, we eat less because we are thinking less about food, and we are satisfied with smaller portions – even if we weren’t overeating.
GLP-1 receptor agonist medications were originally developed to treat type 2 diabetes and were found to cause weight loss while also decreasing the risk of cardiovascular events such as heart attacks and strokes in people with diabetes. These medications are not insulin, and you don’t have to monitor your blood sugars unless directed by your health care team.
For people with chronic obesity and cardiovascular complications, GLP-1 receptor agonists are preferred to amphetamine-based therapies like phentermine, which can worsen blood pressure, heart rate, anxiety, and insomnia.
While any doctor can prescribe GLP-1 receptor agonists, many primary care providers have just recently become familiar with these drugs. Starting at too high of a dose or increasing the dose too quickly can lead to symptoms such as indigestion, nausea, vomiting, diarrhea, or constipation. You will have better outcomes by working with a team of obesity management experts or a primary care physician and dietitian who can help you use these medications to create new, healthy, and sustainable habits.
Weight-loss drug targets fat that endangers heart
According to a study published by UTSW preventive cardiologist Parag Joshi, M.D., a once-daily dose of liraglutide combined with lifestyle interventions significantly lowered two types of fat that endanger heart health.
Obesity, diabetes, and fatty liver disease
GLP-1 receptor agonists have been used for years to treat type 2 diabetes. In the last decade, the FDA has recognized their effectiveness as anti-obesity medications. Liraglutide (Saxenda) was FDA-approved in 2014 for weight-management in adults with overweight and obesity. In 2020, Saxenda was approved for children and adolescents 12 years and older with obesity or overweight with an associated health problem, such as high blood pressure.
In the last couple years, nonalcoholic fatty liver disease (NAFLD) has become the No. 1 reason U.S. women are added to the liver transplant list and the second-leading cause for all adults. UT Southwestern is conducting clinical studies to find and improve medication options for NAFLD.
Other GLP-1 receptor agonists that are FDA-approved to treat type 2 diabetes and may lead to weight loss include:
- Dulaglutide (Trulicity)
- Exenatide (Bydureon)
- Lixisenatide (Adlyxin)
- Other forms of semaglutide (Ozempic and Rybelsus)
Many diabetes medications and insulin reduce blood sugars but also contribute to weight gain. However, GLP-1 receptor agonists help lower blood sugars in people with diabetes – without causing low blood sugars in people who don’t have diabetes.
Weight loss can also help to control and prevent non-alcoholic fatty liver disease (NAFLD) – another condition associated with obesity. Although not FDA-approved for the treatment of NAFLD, GLP-1 receptor agonists – in conjunction with other lifestyle changes – can help people with fatty liver achieve clinically meaningful weight loss and better health. Fatty liver disease can cause liver inflammation and damage that can progress into cirrhosis. One-third of U.S. adults have NAFLD, and 20% of people with obesity develop non-alcoholic steatohepatitis, a more serious form of the disease.
The future of obesity treatment
UT Southwestern plans to open a state-of-the-art interdisciplinary obesity management center at Texas Health Dallas, where patients can see obesity medicine specialists, bariatric surgeons, and plastic surgeons in a single location.
We have also created an Endobariatric Program, where patients can undergo new minimally invasive bariatric procedures like the endoscopic sleeve gastroplasty. This less-invasive version of the sleeve gastrectomy is performed by advanced gastroenterologists and does not require traditional surgery or cutting the skin. Endobariatric procedures can produce significant weight loss with a faster and more comfortable recovery than traditional surgeries. These types of procedures can also treat weight regain in people with a history of bariatric surgery who have regained weight.
Compared with lifestyle changes or older anti-obesity medications, our study in Obesity showed that GLP-1 receptor agonist regimens are superior for treating weight regain after bariatric surgery. We see many patients who underwent bariatric surgery years ago and have experienced weight regain. In these instances, we work on lifestyle modification and collaborate with our endobariatric colleagues to provide the latest minimally invasive techniques for managing weight regain, while also using medications like GLP-1 receptor agonists to help people achieve the healthiest weight possible.
Obesity is a culmination of factors that span genetics, lifestyle, environment, and physical and mental health. After years of living with obesity, achieving a healthier lifestyle without individualized support can be difficult, if not impossible.
While the foundations of a healthy lifestyle will always begin with diet and exercise, and bariatric procedures can be the right choice for patients with the chronic health issues associated with severe obesity, GLP-1 receptor agonists provide another safe, effective, and measured approach.
For information about the UTSW Weight Wellness Program, call 214-645-2800 or request an appointment online.
About the UTSW Weight Wellness Program
We are the only academic medical center in North Texas with a dedicated, multidisciplinary weight management team of obesity medicine physicians, advanced practice providers, dietitians, and mental health professionals. Our specialists empower patients with evidence-based strategies to engage in their overall health and achieve personal wellness goals.
You won’t hear us tell you to start a fad diet or aim for a specific body weight. Instead, we help you create a plan that is aligned with your long-term health and wellness goals. To do this, we partner with other specialists and your primary care provider to recommend appropriate lifestyle plans (including mental health and physical therapy), medications, and procedures so you can start feeling healthier and more comfortable in your own skin.
How to join and next steps
Because so many of our patients have successful outcomes, new appointments are generally scheduled six to 12 months in advance. Getting into our scheduling system is the first step. Call 214-645-2800 to schedule an appointment.
Take these action items to give yourself a head start:
- Ask your doctor to refer you to a dietitian. A nutrition professional can help you find healthy, convenient foods aligned with your body’s needs. Optimizing your diet can be the first step in managing health and improving energy levels.
- Tend to your mental health. Body weight and your ability to look after yourself can be influenced by stress, isolation, depression, anxiety, or feelings related to life events. Seeing a counselor or therapist can help you understand and process some of these barriers to living your best life.
- Surround yourself with positivity. Join a support group, reconnect with your spiritual side, or spend time with family and loved ones – remind yourself that better health is worth the journey. Make a list of why your health is import to you, such as traveling or being independent, to help make a plan that aligns with your goals.
