Palisades 
Share
One of the realities of any significant weight loss program, including bariatric surgery, is that the peak benefits of the procedure—whether restrictive, malabsorptive, hormonal, or a combination of all three—eventually begin to taper off.
This does not mean the benefit goes away completely. However, as our bodies become accustomed to our new lifestyle and anatomical changes, our metabolic rate can adapt. We may gradually start eating more or exercising less. Furthermore, while the primary hunger hormone, ghrelin, is drastically reduced immediately after stomach surgery, the body can adapt over time. Small amounts of ghrelin are still produced in the small intestine and other organs. Years after surgery, these hormone levels can fluctuate and gradually increase our physical hunger for the foods we should be avoiding.
Preparing for the Bumps in the Road
While it is great to think we will always immediately identify when we veer off the proper path, that isn’t realistic. We have to be prepared for when we fall off the wagon. This is especially important at the 3-, 5-, or even 10-year mark after bariatric surgery. During these later years, our guard is often at its lowest, and we may allow ourselves indulgences that eventually add up to a big difference in our weight, our shape, and how we feel.
Where Do GLP-1 Medications Fit into This Continuum?
The short answer is that they absolutely can fit into your long-term plan, but they should be used strategically.
Why is that? While highly effective, GLP-1 medications can cause gastrointestinal side effects, be a financial burden, and may not be as effective as expected if we don’t also address our foundational habits. Ideally, we don’t want to rely solely on a medication if we haven’t first evaluated our diet, exercise, and behavioral options.
However, the beauty of GLP-1 medications lies in their profound hormonal effects on our bodies. Not only do we feel less physical hunger, but we also think less about food. The constant “food noise” that many patients fear returning—and rightly so—tends to quiet down significantly when on a GLP-1. This can be an incredibly useful tool for a post-bariatric patient who is having a hard time regaining control of their weight.
Does a Maintenance Dose Make Sense for You?
The most important step is to talk to your bariatric surgeon or obesity medicine specialist about these medications. They are absolutely not for everyone, and considerations include:
- Cost and Accessibility: These medications can be very expensive, and insurance coverage varies.
- Long-Term Dependence: If you use them without making lifestyle changes, you may find yourself dependent on higher doses to maintain your weight, and stopping the medication often leads to rapid regain.
- Alternative Support Systems: If you are having a difficult time staying on your diet or exercise program, consider psychotherapy (talk therapy) as part of your “back on track” program.
Working with a therapist or a registered dietitian is often covered by insurance and allows you to address the underlying psychological, emotional, and behavioral concerns associated with your weight regain. Medication is a fantastic tool, but it works best when combined with a strong, supportive foundation.
