Weight loss options: Understanding GLP-1 medications and bariatric surgery

When GLP-1 medications such as Ozempic, Wegovy, and Zepbound entered the mainstream, they transformed the way people think about obesity treatment.

For many patients, the medications offered something they had never experienced before: meaningful weight loss through a treatment that recognized obesity as a chronic disease rather than a failure of willpower. The medications have helped countless people lose weight and improve their health, changing the conversation around obesity care.

At University of Iowa Health Care, bariatric surgeons say that shift has been overwhelmingly positive. But while GLP-1 medications have expanded treatment options, they have not eliminated the need for bariatric surgery.

"Obesity is a complex disease. There isn't one treatment that works for every person."

Jessica K. Smith, MD, MPH, FACS, FASMBS, bariatric surgery program director and clinical associate professor of surgery in gastrointestinal surgery at UI Health Care, says increased awareness about obesity as a medical condition has helped more patients seek treatment.

"I think there's more understanding now that obesity is a medical diagnosis and a chronic medical problem," Smith says. "It's not about willpower or character."

The rise of GLP-1 medications has changed who walks through the doors of bariatric surgery clinics.

Smith says many patients now considering surgery have already spent months or years trying weight-loss medications. Some experienced side effects. Others lost insurance coverage or access to treatment. Many discovered how difficult it can be to maintain weight loss after stopping medication.

"We are seeing a lot of patients who've tried GLP-1 medications. Some of them would not have considered surgery before trying the medications."

Nau says the medications have created new opportunities for conversations about long-term obesity treatment.

"I think it's important that patients are informed on both options," he says. "People should understand the risks, benefits, and long-term outcomes of medications and surgery so they can make the choice that's right for them."