Losing weight is one thing. Knowing what comes next is another.

Losing weight on GLP-1 medication can be a huge success — but it doesn’t always mean the treatment conversation is over.

You have worked so hard to lose a meaningful amount of weight on GLP-1 medications. You are proud and feel so much better in terms of mobility, blood sugar, and fitting into clothes. So why would you still want to or need to have bariatric surgery if the medication worked?

The answer to this question basically comes to this: Every single person and every single case is different. In some cases, a sufficient amount of weight loss while on GLP-1 medication can be enough to ensure long-term weight loss and overall health. However, for others, weight loss may come to a halt, the patient’s metabolic health may not improve as expected. Also, for a variety of other reasons, the patient may not be able to continue using weight loss medication.

When Good Results Are Not the Same as the Final Result

Prof. Dr. Ali Solmaz, general, obesity and metabolic surgeon at Erdem Hospital, emphasizes that the decision for bariatric surgery should be taken based on the patient’s general health status, not the number on the scale. “If the patient has lost weight with the help of medication, that is not a failure that needs to be corrected. That is useful information for us. We look at what has improved, what has not improved and what the patient still needs from treatment,” he says.

However, even with a good amount of weight loss, patients may not necessarily be at their final goal. There are many patients who have lost 10% to 20% of their body weight on GLP-1 medications, but still have poorly controlled type 2 diabetes, sleep apnea, severe gastroesophageal reflux disease, and/or mobility problems. Some may continue to be severely obese and at increased risk for developing chronic diseases.

“Weight loss is only one part of the conversation,” Prof. Dr. Solmaz says. “We also take into consideration the changes in blood sugar, blood pressure, sleep, mobility, liver health, etc. In some cases, the patient has lost a lot of weight on medication, but has not reached all their health goals.”

Medication and Surgery Do Not Have to Compete

In brief, it seems like an increasing number of patients are switching between treatments in order to reach their health goals. This does not mean to say that the treatment is not working. It simply means that there are other treatments available that could help in the long run.

Research also shows why long-term planning matters. Studies have shown that although GLP-1 medications can lead to significant weight loss, the weight loss may not be permanent. Some patients who were no longer on semaglutide regain a considerable amount of the weight that they lost within 12 months after the end of the treatment period. Similarly, some patients who discontinued tirzepatide went on to gain the weight back, whereas the patients who continued on tirzepatide went on to either maintain their weight loss or to extend it.

“Before the surgery, we want to know this: Why is the patient asking for surgery?” Solmaz underlines. “Is the concern weight regain? Is diabetes still difficult to control? Is long-term medication becoming difficult? Or does the patient simply want a treatment option that feels more sustainable for their situation?”

The Value of Follow-Up

Erdem Hospital’s General Surgery, Obesity and Metabolic Surgery department conducts evaluations for bariatric surgery candidates in a nutrition framework. After the surgery, the follow-up of the patients in the hospital is crucial and is conducted with respect to patients’ dietary habits, vitamin and mineral needs, weight loss and other health conditions.

“Weight loss is only one part of the conversation,” Prof. Dr. Ali Solmaz says. “At Erdem Hospital, we are focused on the overall quality of the patient’s life, so we also want to know what happened to blood sugar, blood pressure levels, sleep, mobility and liver health.”

The hospital staff emphasize that medication may have been part of that journey already, and it may still be relevant later. However, if the health goals have not been completely met, it may be necessary to consult with them to discuss further measures. The important thing is to choose the right tool at the right time.