Life After GLP-1s or Weight Loss Surgery: Maintaining Weight Loss After Medical Intervention

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For those interested in seeking medical treatment for obesity, the two main effective strategies for lifelong weight management are bariatric surgery and medication.

Bariatric surgery includes several types of surgeries that reduce how much food you can eat or absorb. The most effective medication alternative, glucagon-like peptide-1 (GLP-1) receptor agonists, help you think about food less, not feel hungry as often, and digest food more slowly.

Both of these treatments can be a part of a sustainable weight management program for people who have obesity, but their long-term effects differ. If you’re considering either, here’s what you need to know about maintaining weight loss after medical intervention.

Long-Term Effects of Weight Loss Surgery

There are different types of bariatric surgery, including the adjustable gastric band, the gastric sleeve, and gastric bypass surgery. How much weight people lose depends on the surgery type, their biology, and their diet after surgery.

Bariatric surgery is usually a long-term intervention that allows many people to keep weight off over the long term. It can be a permanent solution to weight loss for those who eat a healthy diet and get regular exercise to maintain the weight loss long-term.

But if you don’t eat a healthy diet and engage in regular physical activity, you’re at higher risk of regaining weight after bariatric surgery. Studies have shown that about half of the people who have bariatric surgery regain some of the weight they lost afterward. Those who undergo gastric bypass surgery are most likely to regain weight.

“Each individual’s weight loss journey after bariatric surgery is different.  Although surgery is a powerful tool, several factors play a role in how much weight is lost,” said Sara Wagner, CRNP, UPMC Central PA Weight Management. “The type of surgery that is performed, your age, genetics, your health before surgery, and your habits after surgery can all impact how much weight you lose.”

According to one study, younger people have a higher risk of regaining weight. It found that you may also regain weight lost from bariatric surgery if you have:

• A vein disease called venous edema with ulcerations.
• Difficulty with daily physical activities, such as bathing, dressing, and walking.
• Symptoms of depression.

Certain behaviors were also linked to a reduced risk of regaining weight after bariatric surgery. These behaviors include:

• Addressing unhealthy eating behaviors, such as eating nonstop, eating when you feel full, and binge eating.
• Avoiding fast food.
• Spending less time sitting down.
• Weighing yourself at least once a week.
• “Ongoing follow-ups with your bariatric provider and dietician are necessary to help maintain weight loss and can help provide psychological and behavioral support along the way,” said Ms. Wagner. “Follow up is also important to detect and prevent nutritional deficiencies, monitor and manage comorbid conditions, and screen for surgical complications.”

Long-Term Effects of Medications for Obesity

People lose an estimated 10% to 20% of body weight when taking a GLP-1. The three GLP-1 drugs approved to treat obesity are:

• Liraglutide
• Semaglutide
• Tirzepatide
• “GLP-1 and GIP are natural hormones that the body makes in the gut after eating and are sometimes called ‘incretin hormones,’ said Ms. Wagner. “Medications like semaglutide, tirzepatide, and liraglutide are designed to mimic our bodies natural hormones, but they last much longer in the body. These hormones help control appetite by acting on the hunger centers in the brain, slowing digestion. This results in feeling less hungry, feeling full faster, feeling satisfied longer after meals, and even having fewer cravings.”

GLP-1 medications also offer people continuous support for weight loss maintenance after they reach their ideal weight. But what happens when you stop taking semaglutide for weight loss, or any of the other GLP-1s? Maintaining the same amount of weight loss after stopping these medications is possible, but it isn’t always easy or common.

When you stop taking GLP-1 drugs, the effects of the drug start to wear off until they stop completely. Then, your appetite and thoughts about food will return, and you’ll want to eat more than you did when taking the drug. Your stomach will also begin digesting food faster, so you’ll become hungry sooner after meals.

Once the drug’s effects have fully worn off, most people begin eating more than they did while taking the medication. Therefore, they regain some of the weight they lost while taking GLP-1s.

“Obesity is a chronic disease that will likely relapse when treatment is stopped. These medications are meant for long term use,” said Ms. Wagner. “Just as blood pressure often rises when blood pressure medication is stopped, stopping weight loss medications often leads to weight regain.”

In clinical trials of people taking these drugs, those who stopped them eventually regained about two-thirds of the weight they lost. Some studies showed that the risk of obesity complications, including heart disease and stroke, also increased post-GLP-1s.

How to Maintain Weight Loss Long Term

Effective strategies for lifelong weight management are similar after bariatric surgery or taking a GLP-1. The key is to eat a healthy, balanced diet and to get regular physical activity.

The biggest difference: How much people eat a day after each treatment.

If you undergo bariatric surgery, you usually can’t eat very much at each meal because your stomach is smaller. But if you stop taking GLP-1 drugs, you’re able to eat more food — and you’ll also feel hungrier. You may need support from a dietitian, a doctor, or an app to help you know how much to eat each day.

Healthy Habits for Long-Term Weight Maintenance

Many people find it a challenge to maintain weight loss after stopping GLP-1 medications. But there are strategies you can follow to feel less hungry and eat less after stopping GLP-1s. These strategies also help maintain weight loss after bariatric surgery.

Here are tips you can follow to maintain weight loss:

• Avoid fast food, eating out, and takeout — Restaurant meals tend to have larger portions and include more sugar, sodium, and fat than meals made at home. If you do eat out, look for meals heavy in vegetables and lean protein. You can also split the serving in half before you begin eating and save the other half for another meal.
• Eat food with lots of fiber — Fiber makes you feel fuller for longer, so you won’t feel hungry as soon. Foods with lots of fiber include vegetables, fruits, and whole grains.
• Eat foods with lots of protein — Protein helps build muscle, and muscle increases your metabolism so that you burn calories faster. Healthy foods rich in protein include poultry, fish, nuts, beans, and legumes.
• Reduce the amount of sugar and simple carbohydrates in your diet — Your body digests these foods faster than others, making you feel hungrier sooner.
• Maintain a high level of physical activity — Include at least 150 minutes of moderate activity or 75 minutes of vigorous activity weekly. Studies have shown that people who maintain regular exercise gain less weight after stopping GLP-1s.
• Develop a weight training routine — Regularly engaging in weight training helps build and maintain muscle, keeping your metabolism strong so you burn calories efficiently.
• Drink water instead of sugary drinks — Opt for water over soft drinks or drinks with sugar. Also, reduce the amount of alcohol you drink because the body converts alcohol into sugar.
• Check in with your providers — Maintain regular follow ups with your bariatric surgeon and/or medical weight management provider.  They can provide support to prevent further weight regain, and provide additional treatments and support if needed.

Even if you follow these tips, you might regain weight after stopping GLP-1s. But a healthy diet and regular exercise help keep your heart healthy, regardless of what the scale says. They also reduce your risk of other diseases, like diabetes and cancer.