I discuss the impact of GLP-1 medications on obesity treatment and highlight how bariatric surgeons have rapidly adopted these drugs as an additional tool and have shifted perceptions of obesity treatment within the medical field.
The Impact of GLP-1 Medications on Metabolic Surgery
- Wider Access to Treatment: GLP-1 medications have allowed many people to receive effective obesity treatment who may never have considered surgery to receive effective obesity treatment.
- Risk of Undermining Surgery: Some patients who might benefit from metabolic surgery are opting for medication instead rather than having a balanced discussion about all available treatments.
- Fundamental Shift in Obesity Understanding: These medications emphasise the biological nature of obesity, moving away from the outdated notion that it is solely a behavioural issue.
Demand for Metabolic Surgery – Public vs. Private Sector Trends
- Public Sector: No decrease in surgery demand; referrals are as high as ever, potentially due to patients transitioning from medication to surgery.
- Private Sector: A decline in demand, which Dr. Craven attributes to economic factors (e.g., rising interest rates affecting private health insurance) and the increasing popularity of GLP-1 drugs.
Surgery vs. Medication – Complementary or Competitive?
- Not a Threat, but an Aid: Dr. Craven does not view GLP-1 medications as a replacement for surgery but as a tool that helps high-risk patients lose weight pre-operatively and manage weight post-surgery.
- Surgery as a Permanent Solution: Unlike medications that require lifelong adherence, metabolic surgery offers long-term weight loss and a significant reduction in mortality.
- Risk of Medication Dependence: There is concern that people will rely on these drugs instead of seeking definitive surgical treatment, leading to suboptimal care.
The Game-Changing Nature of GLP-1 Drugs
- Shift in Disease Treatment: These medications act upstream on obesity-related diseases like diabetes, heart disease, and liver disease, making an “obesity-first” treatment approach more effective.
- Potential to Prevent Chronic Disease: If used early, GLP-1 drugs could prevent diseases such as type 2 diabetes, reducing long-term healthcare costs.
- Economic and Accessibility Concerns: The high cost of these drugs raises concerns about affordability and long-term healthcare budgeting, especially when considering their lifelong use.
Public Healthcare and Equity Concerns
- Limited Access to Public Healthcare: In Australia, only 3% of public hospitals offer metabolic surgery, which has led to an undertrained workforce unfamiliar with effective obesity treatment.
- Repeat of Past Mistakes? There is concern that governments may use the existence of GLP-1 drugs as an excuse to avoid expanding access to metabolic surgery despite its proven effectiveness.
Long-Term Implications and the Need for a Balanced Approach
- Combination Therapy is Ideal: Dr. Craven advocates for a holistic approach, using GLP-1 medications and surgery to achieve the best patient outcomes.
- Changing Stigma Around Obesity: The introduction of these medications is helping to shift the conversation around obesity from personal failure to a legitimate medical condition requiring appropriate treatment.
I am optimistic about the role of GLP-1 medications in obesity treatment but stress that they should not replace metabolic surgery. Instead, a multifaceted treatment approach—where medications, surgery, and lifestyle interventions work together—will provide the best outcomes. I urge policymakers to ensure that drugs and surgical treatments remain accessible to prevent further inequalities in obesity care.
