Many clients have struggled for years with successful long-term weight loss. GLP-1 medications like Ozempic are seen as a miracle drug for many individuals who have struggled with weight. Many now question what is more effective: weight loss surgery or Ozempic?
However, recent research finds that GLP-1s are not “top dog” for weight loss. Recent research conducted at New York University and other sites found that those undergoing bariatric surgery lost an average of 58 pounds, compared to 12 pounds for GLP-1s. But bariatric surgery patients were also more likely to maintain weight loss over long-term periods.
So, why? Don’t so many patients swear by the effects of GLP-1s? First, many patients do not take GLP-1 medications for as long as surgical effects usually last. Many stop taking these medications after 1 year. Second, GLP-1s provide limited effects in some cases. For example those with history of emotional eating, in particular, research finds these medications are not as effective in the first place.
Second, so much of successful weight loss involves behavior change. Very, very difficult behavior change. Behavior change for weight loss often comes down to in-the-moment self-regulation. Things like internal cravings, stress, and social or family pressures can make it difficult to enact healthy eating behaviors. For example, not eating past the point of fullness. GLP-1s’ ability decrease cravings and create a sense of fullness now make it easy to not engage in such behaviors.
These medications do help, but we’ve heard this story before with so many medications. Like many psych medications, the effects of GLP-1s cease after an individual stops taking them. Cravings return and the body processes food the way it did prior to taking the medication. Many individuals left back at “square one” with their self-regulation struggles.
On the other hand, bariatric surgery “forces” long-term behavior change. First, the way the stomach restricts food-intake immediately following the procedure forces individuals to change how they eat in the long term. Some surgery patients “drift” back to old habits and eventually counteract the effects of surgery, but many effectively sustain their new behaviors.
Many bariatric practices have integrated behavioral services in addition to the preoperative psychological evaluation traditionally required by insurance. These services allow surgeons to require patients learn behavioral tools and strategies when maladaptive behaviors get in the way of weight loss goals.
Pre-operative counseling for emotional eating or bored-eating is a common example of this. Patients learn many behavioral skills geared for weight loss that provide in-the-moment strategies as alternatives to eating. CBT or behavioral activation are exampes of effective self-regulation and coping skills.
Like other psychological tools, patients have these skills forever once they’re learned. Learned methods help prevent future weight loss that may occur from behaviors that once thwarted their efforts.
Mental health professionals therefore play a key role in long-term success for weight loss surgery! Like other approaches, professionals help foster skills that can last for life. Many of these skills are applied to emotional eating and other difficulties to help weight loss patients reach long-term success.
