In recent years, glucagon-like peptide-1 receptor agonists, known as GLP-1s, have gained attention as weight-loss tools. For some patients, taking these medications is an effective option. Patients who take GLP-1s typically can lose 20 to 30 pounds if they use the medication properly and follow a healthy diet. 

GLP-1s can also have unpleasant side effects such as pancreatitis, vomiting and fatigue. And patients run the risk of weight regain if they stop taking them.

Surgery, on the other hand, has proven effective for significant weight loss, helping patients for whom GLP-1s are not effective shed 60%–70% of their excess body weight. Most patients keep the weight off, says Katherine Lamond, medical director of the Johns Hopkins Center for Bariatric Surgery at Sibley Memorial Hospital and a fellowship-trained minimally invasive surgeon.

A review and meta-analysis of 18 studies, published in PLOS Medicine in 2020, finds that bariatric surgeries are associated with reductions in all-cause mortality and significantly fewer incidences of obesity-related diseases, including type 2 diabetes, hypertension and ischemic heart disease. The surgery can also cure gastroesophageal reflux disease.

Lamond spends time with patients educating them about weight loss options.

Expert Bariatric Surgical Care in Washington, D.C., and Baltimore

Johns Hopkins Center for Bariatric Surgery at Sibley Memorial Hospital has an expert team dedicated to helping patients throughout their weight-loss journey. “We take care of the whole patient,” says Lamond.

In addition to Lamond and another fellowship-trained minimally invasive foregut and bariatric surgeon, Brett Parker, the Sibley Memorial Hospital site is staffed with nurse practitioners, nutritionists and psychologists.

The clinical team works closely with each patient to discuss treatment options; schedule appointments as required for insurance approvals; and organize pre-operative screenings with cardiologists, endocrinologists and others.

A combination of medication and surgery can be an effective option for helping patients meet their weight loss goals, Lamond says, noting that patients may go on a GLP-1 to lose weight before bariatric surgery, or to help them continue losing weight if they hit a plateau after the surgery.

Johns Hopkins experts perform several surgical options for weight loss to meet patients’ needs. The two main surgical choices are laparoscopic sleeve gastrectomy, which removes 60% to 70% of the stomach, using a stapling device to create a smaller reservoir the size and shape of a banana; and laparoscopic gastric bypass, which reroutes a portion of the intestines to create an even smaller stomach. Both surgeries reduce levels of ghrelin, a hormone that stimulates appetite. 

While both are effective, with patients losing and keeping off about 70% of their excess weight, there are reasons for choosing one over the other, including patient preference and comorbidities. Clinicians take into account whether patients have conditions such as gastroesophageal reflux disease — those patients see better outcomes with gastric bypass.