How to Approach Weight Loss Medications Like Wegovy & Mounjaro

As discussed in a previous article, there is a significant shortage of weight loss medications in the US and worldwide. Some of you reading this article have started or eventually may start an injection-based weight loss regimen. This can reinforce the results of your bariatric procedure or can be pursued as a part of a standalone medical weight loss program. GLP-1 agonists like Semaglutide (Ozempic® & Wegovy®) have shown promising results in helping diabetic and obese patients, respectively, and are FDA approved for those diagnoses. We have previously discussed how these medications are used and sometimes abused by those who do not qualify for treatment and should probably focus on diet and exercise to lose the relatively small amount of weight they desire. However, there are also considerations to follow if you are approved to take these drugs due to obesity or diabetes.

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Do We Reinforce a Sleeve or Bypass Staple Line?

When you watch an online seminar and first come in for a consultation, having decided that bariatric surgery may be the right option, you will undoubtedly hear about the potential risk of a staple line leak. This can be a severe complication after a stapled bariatric surgery like the gastric sleeve, gastric bypass, and duodenal switch. Derivative surgeries, like mini gastric bypass, one-anastomosis gastric bypass (OAGB), or single anastomosis duodeno-ilesostomy (SADI), also have the potential for this complication because they all divide the stomach.

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How Quickly Can You Get Bariatric Surgery?

It’s common for patients who finally decide that bariatric surgery is the right option for them to want to get bariatric surgery as fast as possible. After all, choosing to have bariatric surgery is not easy, and it’s hard to control the excitement of the prospect of living life without the impediment of excess weight and obesity. However, most patients find that the road to weight loss surgery is relatively long compared to other procedures and may involve impediments.

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A Discussion on Non-Surgical “Acid” Reflux Treatment

When our patients discuss their chronic reflux or GERD, a condition that affects more and more people every year as we continue to struggle with the obesity epidemic, we often add the word “acid.” To some degree, this makes sense as the stomach produces acid, which has a known adverse effect when refluxing onto the sensitive lining of the esophagus. But does including the word acid miss the point of reflux therapies? And is treating the acid alone enough to neutralize the damaging effects of reflux? The answer is a resounding no, and there are a few reasons.

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Telling Causes of The Ozempic® / Wegovy® Shortages

If you haven’t heard, there is a significant shortage of a diabetes drug marketed as Ozempic® along with another semaglutide formulation, known as Wegovy®, FDA-approved for obesity. Semaglutides are a very effective therapy for those with sugar control issues as they stimulate insulin production in the body. However, this class of drugs has also shown significant weight loss potential by reducing hunger. While the drug is not approved as a therapy for casual weight loss, many people who only wish to lose a few pounds have received it via off-label prescription from their doctors. The result has been an overwhelming demand for the drugs and a shortage for those who genuinely need them for diabetes and obesity control.

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Can You Stretch Your Stomach Pouch After a Gastric Sleeve or Bypass?

The gastric sleeve and gastric bypass comprise most of the bariatric surgeries performed in the United States and worldwide. There’s a good reason for this, as these two procedures safely and effectively address the obesity and excess weight concerns of most patients that qualify for bariatric surgery. Both procedures also cut away a significant portion of the stomach, leaving only a fraction of the original stomach volume (though the sleeve involves removing stomach tissue while the bypass does not). As such, there is concern from most patients, quite rightly, that they could stretch their gastric pouch at some point in the future.

If you’re asking whether it is possible to stretch your gastric pouch, the answer is yes. The answer is more nuanced if you’re asking whether it’s easy to do so. In short, stretching your gastric pouch requires consistently straying from your postoperative diet program for months, if not years.

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Do We Remove the Gallbladder During a Bariatric Procedure?

You may have heard of a dual procedure, single anesthesia surgery, where a friend or family member had their gallbladder removed at the same time as their bariatric procedure. You may be wondering if the same will happen during your bariatric surgery. Of course, it depends.

One of the most significant risks of gallstones and consequent gallbladder disease is obesity, and many obese patients also experience gallbladder problems. Some will already have had their gallbladder removed, while others may be experiencing gallbladder pain at the time of their surgical procedure.

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It’s Time for Some Me Time

We all need some “me” time, but that time becomes even more critical in the bariatric surgery world. Spending time to reflect on the opportunities and challenges we face as bariatric patients can be very calming, help us regroup, and ultimately help us take on the day.

Our hectic schedules sometimes cause us to forget our responsibilities after surgery, which, if left ignored, can spiral into bad days. When we don’t stick to our post-surgical commitments, we may struggle with the physical implications and mental and emotional setbacks. Sometimes this can, in turn, lead to discouragement and less-than-ideal weight loss results.

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New Bariatric Guidelines Released by Major Societies

If you have spent time researching bariatric surgery, you’ll note that the basic guidelines to qualify for surgery are pretty much set in stone. You must have a BMI of 40 or a BMI of 35 or above with one or more comorbidities (diseases associated with obesity) to qualify for most bariatric procedures. These guidelines have been in place since 1991 and have guided our decision-making in choosing the ideal patient for surgical intervention. While these guidelines have allowed millions of people to choose weight loss surgery as a long-term sustainable option, it can be argued that these relatively restrictive criteria have also limited many from getting bariatric surgery, even if their metabolic state would suggest they were good candidates. For this and several other reasons, only one to two percent of people who qualify for bariatric surgery will have the procedure.

The New Guidelines

The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation of Surgery for Obesity and Metabolic Disorders (IFSO) have released their joint recommendations on qualifications for bariatric surgery, and they are far more relevant to the situation today. Patients with a BMI of 30 to 34.9 with one or more obesity-related diseases should be considered for bariatric surgery. Patients with a BMI over 35 should qualify according to these new suggestions, even without weight-related diseases. The new guidelines importantly also consider the patient’s racial and ethnic background. They suggest that people of Asian descent should consider bariatric surgery at a BMI of 27.5 based on data showing they suffer from metabolic disease at a lower BMI than those of other races.

Why Have the Guidelines Changed?

The answer is straightforward – the evolution of knowledge and technology. When these guidelines were established in 1991, bariatric surgery was a very different landscape. For one, the predominant technique used at the time was open surgery, which came with several potentially significant consequences, including incisional hernias, risk of infection, blood loss, and prolonged recovery. Right around that time, we were starting to transition over to laparoscopic, minimally invasive surgery and, in doing so, reduced those risks dramatically. Today, bariatric surgery is one of the safest major surgical procedures in the United States and worldwide, with a risk profile similar to other gastrointestinal procedures like gallbladder removal.

Technique and technology have also changed, and we now have more surgical options than ever, giving patients with varying conditions additional options. For example, patients with uncontrolled or poorly controlled type two diabetes or gastroesophageal reflux may benefit the most from a gastric bypass. Those with very high BMIs may opt for the duodenal switch or SADI. Of course, a gastric sleeve is also an excellent option for most patients. These procedures have also been standardized. We know how much of the stomach to remove and where to connect limbs of the small intestine. While we take this knowledge for granted, the picture was far less clear just a decade ago, and results were more erratic. Older bariatric procedures with higher complication rates are no longer being performed. We also have far better follow-up protocols that set patients up for success long into the future.

What Do These New Guidelines Mean?

Unfortunately, new guidelines take some time to be adopted universally. However, they can and will eventually be used as guidance for policymakers, insurance companies, and physicians. Despite the delay in widespread adoption, society’s guidelines are based on the best available scientific evidence and should be considered the gold standard for what patients qualify for bariatric surgery.

The Body Mass Index

While we’re at it, it’s probably worth taking a deeper look at the body mass index and whether it is as useful as we once believed. In short, it probably shouldn’t be the only measure of qualification for bariatric surgery. Stay tuned next month on our blog to learn more about utilizing the body mass index.

Ultimately, these new guidelines are an exciting step in the right direction. We look forward to updating you when governmental and regulatory guidance has caught up to the data we have. In the meantime, if you qualify for bariatric surgery, feel free to watch our online seminar or visit us in person to learn more about your options.

Surviving Thanksgiving After Weight Loss Surgery

After weight loss surgery, you’ll likely notice how much of our celebrating is centered around food. Several of our holidays and special events are punctuated by special food and drink. The most obvious of these holidays has got to be Thanksgiving! Your tiny stomach doesn’t allow for a typical Thanksgiving, so you must adjust how you celebrate. But that doesn’t mean you can’t have a good time! And, as is often the case, the best defense is a good offense! Thanksgiving is right around the corner, so read on to help yourself develop a plan to stay on track!

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