But medication is not the only option for patients with obesity who need to lose weight to improve their health. Bariatric surgery has helped patients lose considerable weight—and keep it off—for decades.

“A significant benefit of surgery compared with medication management is that we expect the effect to endure decades into the future, if it’s accompanied by healthy lifestyle changes,” said bariatric surgeon Jeremy Korman, MD, medical director of the Cedars-Sinai Marina Weight Management Center.

Korman added that insurance typically covers surgery if a patient meets certain medical criteria. Pricey GLP-1s, sold under brand names like Ozempic and Wegovy, often are not covered by insurance for weight loss purposes and have become so popular they can be hard to find in pharmacies.

To better understand both of these powerful weight loss options, the Cedars-Sinai Newsroom spoke with Korman and Kulmeet Sandhu, MD, associate director of Minimally Invasive and Bariatric Surgery and associate professor in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai Medical Center.

Are there patients who would benefit from weight loss surgery rather than medications?

Sandhu: There are some patients who may benefit more from bariatric surgery, or weight loss surgery, rather than medical weight loss management, or taking medications for weight loss. Those include patients who have had side effects previously for medical weight loss, or who don't have effective results with medical weight loss. We also have some patients who have a much higher BMI [body mass index], which is where their weight is much higher, and they may not see as much effect from medications and may have better long-term benefits from surgery. We have also noticed that the most effective long-term weight loss solution is bariatric, or weight loss, surgery.

What are the most commonly performed types of weight loss surgery?

Korman: When we talk about bariatric, or weight loss, surgery, the two most popular options are sleeve gastrectomy and gastric bypass. The sleeve gastrectomy is an operation where we change the size and shape of the stomach only. The stomach is made narrower and more tube-shaped, looking almost like a banana. What's distinctive about sleeve gastrectomy, which is what makes it popular, is that we maintain the natural pathway from stomach to intestine without making new connections. This makes for slightly easier nutritional management for the patient.

For the gastric bypass, we are also changing the size and shape of the stomach, including making the stomach smaller. But we also create a new connection; we reroute the pathway from stomach into the intestine. This added, “malabsorptive,” element does make it a more powerful operation since we are short-circuiting some of the intestine. There is a drawback to altering the natural pathway since nutritional management becomes a bit more complex. There is then greater responsibility for vitamin supplementation and for monitoring in follow-up. However, for select patients this is a more effective option and therefore the appropriate choice.

What is a common misunderstanding about weight loss surgery?

Sandhu: One of the things I think holds people back from having surgery is concern about the risks of it. But the majority of my patients that have had surgery say the biggest regret they have is not having done it sooner. It's very effective, and it's also very safe. The long-term complications are quite minimal, and people do very well from surgery.

There also is a stigma around weight loss surgery that somebody has failed things like diet and exercise. But that's not the case. Patients may have the same diet as somebody else and not be able to lose weight because their biology is different. What surgery does, it just allows you to have another tool to be able to eat less and have more effective weight loss. And I think that's really important to realize.

What should patients know to help them achieve lasting results?

Korman: In addition to the treatments that we provide, the patients must change their lifestyle. That includes both nutritional and physical activity approaches to their lives. And with changing their lifestyle, they're absolutely going to be able to achieve their potential, the weight loss success that we expect. The odds of successful long-term weight loss increase to the 80% range. 

Sandhu: This is not a quick fix. It involves a long-term relationship with our patients. You know, when we become your doctors, we, as bariatric surgeons, say we become your doctors for life.

Read more from the Cedars-Sinai Blog: Bariatric Surgery Myths and Misconceptions

The study results, published in Annals of Internal Medicine, could help researchers evaluate how the prescription patterns of GLP-1RAs have changed over time, particularly for the use for treating Type 2 diabetes versus obesity.

GLP-1RA medications are a newer class of medications that were originally developed to treat patients with Type 2 diabetes. However, given their promising results, in 2021 the U.S. Food and Drug Administration approved the medications for chronic weight management in adults with obesity or those who are overweight with at least one weight-related condition, such as high blood pressure, prediabetes or blood vessel disease.

Since then, the demand for these drugs has skyrocketed, with a marked surge in GLP-1RA prescriptions for weight loss management. However, the steady swell in demand has also had downstream effects leading to nationwide drug shortage and issues with accessibility.

“Essentially, after the medication was approved for obesity, GLP-1RA use took off so quickly that we lost control and vision of how fast people were picking up these medications, and the trends of use are uncertain,” said the study’s co-first author Ali Rezaie, MD, medical director of the Cedars-Sinai GI Motility Program and director of bioinformatics at the Medically Associated Science and Technology (MAST) program at Cedars-Sinai. “While GLP1-RAs offer several benefits, they are also associated with various common and uncommon side effects, necessitating careful monitoring of their prescription patterns.”   

To gain insight into how GLP-1RAs have been prescribed and consumed over the years, Cedars-Sinai investigators used a real-world nationwide database containing medical records of about 45 million individuals with at least one outpatient or inpatient visit in the U.S. from 2011 through 2023.

During this timeline, the investigators found approximately 1 million new GLP-1RA users and classified them based on whether they had diabetes, obesity or other related conditions when they were prescribed the medication.

The researchers noted that between 2011 and 2023, semaglutide (a GLP-1RA) users were disproportionately female, non-Hispanic white and with a body mass index of 30 or greater. During the same period, the data also revealed that the proportion of new users with Type 2 diabetes decreased. “On the contrary, new GLP-1RA prescriptions among those with obesity or relevant comorbid conditions without Type 2 diabetes doubled, with a notable uptick in medication use especially since 2020,” Rezaie said.  

This noticeable shift and rising trend in GLP-1RA prescriptions for those with obesity, scientists say, is crucial.

“This data suggests that more healthcare providers are seeing the benefits of these medications for treating obesity, which is a significant public health shift,” said Yee Hui Yeo, MD, co-first author of the study and a clinical fellow in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai. “However, it also raises concerns about potential medication shortages and the need to ensure that patients with diabetes still have access to these treatments.”

The researchers believe that the study's findings can play a crucial role in developing strategies to address the growing popularity and demand for GLP-1RAs.

“We hope our findings will inform healthcare policies and promote equitable access to these essential treatments,” Yeo said.

Additional Cedars-Sinai authors involved in the study are Srinivas Gaddam, MD, MPH; Ghada Mohamed, MD; Rabindra Watson, MD. Additional authors include Kevin Sheng-Kai Ma, DDS; Tina Yi-Jin Hsieh, MD; Xiaoqin Hu, MD; Gin Yi Lee, MD; Pin-Chia Huang, MSc.

Read more on the Cedars-Sinai Blog: Weight-Loss Drugs – What to Know Now

Investigators found glucagon-like peptide-1 receptor agonists (GLP-1RAs)—medications like Ozempic and Wegovy that are used to treat diabetes and obesity—are associated with an increased risk of aspiration pneumonia following endoscopy. The large, population-based study is published in the leading peer-reviewed journal Gastroenterology. 

Aspiration pneumonia is caused by inhaling foreign materials—including food in the stomach, or secretions from the mouth and nose—into the lungs. Endoscopy is a medical procedure in which a physician puts a tube-like scope down a patient’s throat and into the body to look inside.

One way the new obesity medications work is by slowing digestion, so people feel full longer, causing them to eat less. This also means that food sits in the stomach longer. As a result, the stomach may not empty completely during the usual duration of fasting that is recommended ahead of a surgical procedure to decrease risk of aspiration, explained the study’s corresponding author, Ali Rezaie, MD, medical director of the GI Motility Program and director of bioinformatics at the MAST Program at Cedars-Sinai.

“Aspiration during or after endoscopy can be devastating,” Rezaie said. “If significant, it can lead to respiratory failure, ICU admission and even death. Even mild cases may require close monitoring, respiratory support and medications including antibiotics. It is important we take all possible precautions to prevent aspiration from occurring.” 

The study analyzed data from nearly 1 million de-identified U.S. patients who underwent upper or lower endoscopy procedures between January 2018 and December 2020. Patients who were prescribed GLP-1RA medications had a 33% higher chance of experiencing aspiration pneumonia than those who did not take these medications before the procedure. This comparison also considered other variables that could influence the outcome to ensure a fair comparison between the two groups.

“When we apply this risk to the more than 20 million endoscopies that are performed in the U.S. each year, there may actually be a large number of cases where aspiration could be avoided if the patient safely stops their GLP-1RA medication in advance,” Rezaie said.

“The results of this study could change clinical practice,” said Yee Hui Yeo, MD, first author of the study and a clinical fellow in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai. “Patients taking these medications who are scheduled to undergo a procedure should communicate with their healthcare team well in advance to avoid unnecessary and unwanted complications.”

Additional Cedars-Sinai authors involved in the study are Srinivas Gaddam, MD, MPH; Ruchi Mathur, MD; Rabindra Watson, MD; and Jamil Samaan, MD. Additional authors include Wee Han Ng; Pin-Chia Huang, BS; and Kevin Sheng-Kai Ma, DDS.

Read more from the Cedars-Sinai Blog: Weight-Loss Drugs – What to Know Now

Millions tuned in to the ABC prime-time event, An Oprah Special: Shame, Blame and the Weight Loss Revolution, as Velazquez, other medical experts and Winfrey discussed obesity as a chronic disease and addressed the life-changing impact as well as side effects of weight loss medications.

“A multipronged approach is the way it has to be,” Velazquez told Winfrey. “I think a lot of times people think that they can just pick up the medication and take it without any other counseling. The key, however, is that you’re working with a healthcare team that is multidisciplinary.”

Velazquez emphasized that obesity is a complex medical condition, and diet or exercise alone may not be enough for a person to lose weight, keep it off long term and prevent weight-related diseases.

In the special, Winfrey talked about her own experience of feeling weight shamed for 25 years.  

“It is a very personal topic for me and for the hundreds of millions of people impacted around the globe who have for years struggled with weight and obesity,” said Winfrey, who also revealed that she began taking a prescription weight loss medication in the past year.

Velazquez explained that anti-obesity medications approved by the U.S. Food and Drug Administration—such as semaglutide (Ozempic)—have been shown to be safe, if taken correctly and long term.

“We have good trials showing that when patients stop medication, the disease comes back,” Velazquez said.  

Velazquez also was included in media coverage of the special, including in The New York Times, Oprah Daily, and Time.  

Read more on the Cedars-Sinai Blog: Weight-Loss Drugs, What to Know Now.

Obesity is a chronic disease resulting in excessive or abnormal body fat. It can significantly increase an individual’s risk of developing serious health problems, such as cancer, diabetes, heart and vascular diseases, and stroke.

Velazquez told WebMD that “obesity is a very complex disease” and diet or exercise alone are not enough for most people to lose weight, keep it off long term and prevent weight-related diseases. She explained that newer anti-obesity medications approved by the U.S. Food and Drug Administration—such as semaglutide (Ozempic)—have been shown to be safe, if taken long term for weight loss and weight maintenance. But insurance coverage is “hit or miss.” 

“It’s best that you speak with your healthcare providers to find out which [anti-obesity medication] is best for you, in terms of costs,” Velazquez said.

She added that most insurers will cover bariatric surgery if a person meets the clinical criteria.

Even with these options, exercise is still key. Velazquez said strength training, which has many health benefits, is crucial for weight loss. Among other things, she said maintaining muscle mass helps improve the body’s metabolic rate—how fast the body turns food into energy.

“It can enhance your strength, better your balance, help you develop good bone health and more,” Velazquez told WebMD.

She compared a weight loss journey to a marathon and recommended support groups for motivation and apps such as MyFitnessPal, Noom and WeightWatchers for accountability.

Click here to read the complete article from WebMD.

The science is unclear on exactly why an increasingly popular new class of federally approved diabetes and obesity medications work, but they do know that they are effective at helping people lose weight. The medications are sold under brand names Ozempic, Wegovy and Mounjaro. 

A recent article in The New York Times, “We Know Where New Weight Loss Drugs Came From, but Not Why They Work,” explores the subject and says, “Researchers discovered by accident that exposing the brain to a natural hormone at levels never seen in nature elicited weight loss. They really don’t know why, or if the drugs may have any long-term side effects.”

Obesity is an epidemic in the United States, with 42% of adults having a BMI over 30 (which qualifies as overweight), according to the Centers for Disease Control and Prevention.  

Cedars-Sinai experts are available to share insight on these medications.

WHO:

Amanda Velazquez, MD, is an internal medicine physician and director of Obesity Medicine at Cedars-Sinai. Velazquez specializes in weight management and metabolic health and is available to discuss what patients should know if they are taking or considering taking weight loss medications.

**Velazquez is available for interviews in Spanish and English**

Martha Gulati, MD, MS is a cardiologist in the Barbra Streisand Women’s Heart Center at the Smidt Heart Institute at Cedars-Sinai, where she also serves as director of Preventive Cardiology. Gulati, president of the American Society of Preventive Cardiology, specializes in women’s heart health and is available to discuss how weight loss, including the use of medications, can protect against heart disease and heart attack. She can also discuss general risk factors and prevention of heart disease—the leading cause of death in the U.S. for men and women.

Cindy Wu, PharmD, BCPS, APh, is a clinical pharmacist at Cedars-Sinai and program coordinator in the Department of Pharmacy Services. Wu’s expertise includes specialty medications used to treat complex and chronic conditions that require special monitoring, administration and handling. Wu is available to discuss the importance of patients understanding their medications, taking them correctly and being monitored while taking them.

Velazquez, Gulati and Wu are available for media interviews and can answer questions like:

• Should patients who are taking these medications be concerned that medical science doesn’t know why they work?
• What should patients know about the side effects?
• How long should a patient stay on weight-management medications?
• If patients stop taking the medication, will they gain the weight back?
• What benefits do these medications provide, beyond weight loss?
• Should these medications be considered a preventive health measure and if so, for whom?
• What do patients need to know before taking these weight loss medications?
• How are patients monitored while taking weight loss medications?

WHY:

Obesity is an epidemic in the United States, with 42% of adults having a BMI over 30 (which qualifies as overweight), according to the Centers for Disease Control and Prevention. Obesity is a risk factor for diseases including hypertension, diabetes, heart disease, stroke, osteoarthritis, mental illness and many types of cancer. 

WHERE:

Cedars-Sinai can accommodate virtual interview formats via Zoom, FaceTime and Skype.

CONTACT:

Melissa Vizcarra | 719-502-5001 | Melissa.Vizcarra@cshs.org

Cara Martinez | 310‐562‐7821 | Cara.Martinez@cshs.org