Navigating weight loss: The role of GLP-1 medications and bariatric surgery

How we approach weight and its impact on health is changing, and that’s good news.

"Obesity is a disease, not a lack of willpower or motivation," says Anjali Gresens, M.D. and bariatric surgeon with Sentara Comprehensive Weight Loss Solutions in Norfolk, Va.

This is why the way we describe weight is changing, with doctors shifting to terms like “having obesity.” This new language helps change the narrative of struggling with weight loss from one of “guilt” and “failure” to an understanding that weight loss and maintenance is about much more than just “eating less.”

Recognizing obesity as a chronic disease requiring medical care also helps addresses the many factors that contribute to weight struggles, including genetics, environmental conditions and socioeconomic factors.

With the rise of GLP-1 medications and the continued success of bariatric surgery, patients today have more options to improve their health.

What are GLP-1 medications?

GLP-1 medications, which have been on the market for about 20 years to treat diabetes, are now being prescribed for weight loss after a series of approvals from the Food and Drug Administration. These medications work in several ways, including helping to regulate appetite by slowing gastric emptying and reducing hunger signals to the brain.

Kristina Kratovil, M.D., a board-certified obesity medicine physician with Sentara Comprehensive Weight Loss Solutions, explains that GLP-1s also provide benefits beyond weight loss.

“We’ve found that in addition to improving glycemic control and helping with weight loss, these medications reduce cardiovascular risks, reverse fatty liver disease and help manage conditions like sleep apnea,” Dr. Kratovil says.

How effective are GLP-1s for weight loss?

While people who use GLP-1s typically see significant weight loss, there are limitations. Dr. Gresens stresses that these medications should not be considered a stand-alone solution.

“The medication isn’t magic — it’s a tool that needs the foundation of nutrition, exercise, and lifestyle changes,” she says.

As with any weight loss tool, GLP-1 patients see more long-term success when receiving medical guidance and support.

Why guidance is key when taking GLP-1s for weight loss

As GLP-1s gain popularity, the rise of commercial, unregulated weight loss solutions has become a concern. Side effects like nausea and gastrointestinal discomfort can make long-term use difficult for some. More concerning, without proper supervision, patients may face serious risks beyond common gastrointestinal side effects, including mood disorders, skin issues and nutritional deficiencies.

“People should go to their doctor or a comprehensive center for guidance,” warns Dr. Kratovil.

Patients using GLP-1s without proper medical guidance may face risks such as muscle atrophy if they do not maintain adequate protein intake and physical activity. Additionally, stopping the medication can lead to weight regain if dietary and lifestyle habits are not well established.

Studies have shown that patients who receive medical oversight and lifestyle interventions have significantly better long-term success than those who rely on medications alone.

“Appropriate nutrition guidance means you’ll see better results, avoid complications and maintain muscle mass while losing weight,” says Dr. Kratovil.

The dangers of unregulated weight loss solutions

Dr. Kratovil warns about the current market for often unregulated weight loss solutions. Many unapproved weight loss compounds are marketed online or in certain clinics. They are risky for patients because they do not undergo FDA review for safety, effectiveness and quality.

These unregulated compounds may have issues of efficacy and dosing. The FDA received reports of adverse events related to dosing errors resulting from patients measuring and self-administering incorrect drug doses.

Dr. Kratovil emphasizes the importance of medical supervision when taking GLP1s, as this is the best way to ensure safe weight loss with FDA-tested medications as well as receive support for things like dosing adjustments and side effects of the medication.

When is bariatric surgery the right choice?

Bariatric surgery remains one of the most effective long-term weight loss solutions for individuals with a BMI over 35 or a BMI over 30 with diabetes, metabolic syndrome or who have not seen substantial weight loss through other attempts. Surgery provides more sustained results than GLP-1 medications, as it physically alters how the body processes food and regulates hunger hormones.

Dr. Gresens says patients who don’t tolerate GLP-1s or do not want to commit long-term for financial or other reasons are often good candidates for bariatric surgery.

Getting started with support from Sentara Comprehensive Weight Loss Solutions

Sentara Comprehensive Weight Loss Solutions is an accredited bariatric surgery center and one of the first centers in the state to be accredited in obesity medicine by the American College of Surgeons. This distinction is awarded to programs dedicated to the highest standards of safety and quality of care for weight loss patients.

When new patients start their weight loss journey in partnership with Sentara Comprehensive Weight Loss Solutions, the referral coordinator they speak with will discuss their interest in medical or surgical weight loss support. Factors that can influence the decision include insurance coverage, costs associated with each option, and the patient’s BMI and other health conditions.

No matter the treatment option, treating obesity effectively requires more than medication or surgery — it demands a full-spectrum approach. Sentara offers exercise specialists, dietitians, mental health support, and even an in-house gym to address the disease from all angles.

When combining medical and surgical approaches is helpful

Some patients who commit to bariatric surgery start taking a GLP-1 before surgery to lose weight, which makes the procedure safer and improves outcomes.

“Surgical and medical weight loss used to be very separate. We’re trying to find those shades of gray to provide the best outcomes,” explains Dr. Gresens.

Some patients may also start with medication and choose surgery later in their weight loss journey. One benefit of the services offered at Sentara Comprehensive Weight Loss Solutions is that the doctors are well-versed in both medical and surgical weight loss.

A judgment-free approach to weight loss

When we frame having obesity as being similar to having heart disease or other serious conditions, we better understand why it’s not a failure to seek medication or surgery to treat it, says Dr. Gresens.

For those considering weight loss options, Sentara Comprehensive Weight Loss Solutions provides a judgment-free environment where patients can explore surgical and medical solutions tailored to their individual goals. Whether through GLP-1 medications, bariatric surgery, or a combination of both, one thing remains clear: weight loss is not about willpower but about finding the right treatment plan for long-term success.

Ready to take the next step on your weight loss journey?

Learn more about Sentara Comprehensive Weight Loss Solutions and schedule an appointment.