喵咪社区

A 喵咪社区 bariatric surgeon and obesity medicine specialist shares why multimodal obesity care should be the new standard. 

The premise that GLP-1 receptor agonists are replacing bariatric surgery for weight management is not just oversimplified; it鈥檚 wrong.  

What these medications have actually done is forced a long-overdue shift in how obesity care is approached. The old model 鈥� diet and exercise, then maybe medication, then surgery as a last resort 鈥� is being replaced by something far more aligned with the biology of the disease: multimodal, individualized and long-term treatment. 

鈥淧eople think this is a question of medication versus surgery,鈥� says Harry J. Wong, MD, MS, a bariatric surgeon and obesity medicine specialist who focuses on gastrointestinal conditions with 喵咪社区 Surgery and the 喵咪社区 Digestive Health Institute, part of 喵咪社区. 鈥淭hat鈥檚 not how we practice anymore. We use all the tools in our toolbox.鈥� 

Oral GLP-1s are poised to expand obesity treatment even further by providing another route for patients who cannot or do not want to use injections. More than in the United States filled a prescription for oral semaglutide in just the first six weeks after the pill was approved by the Food and Drug Administration (FDA) in December 2025.  

While this new tool is certainly exciting for practitioners treating obesity, Wong cautions nuance.  

鈥淧eople hear 鈥榩ill鈥� and think it鈥檚 simpler,鈥� he says. 鈥淏ut the semaglutide (Wegovy) pill actually has to be taken in a very specific way.鈥� Daily dosing, strict fasting requirements and absorption variability make oral formulations less straightforward than they appear. But having more options to treat obesity is never a bad thing, he says.  

鈥淭his is just another tool, and for some patients 鈥� especially those who can鈥檛 or won鈥檛 inject 鈥� it鈥檚 a great option,鈥� he adds. 

More recently, , a small-molecule (nonpeptide) oral GLP-1 receptor agonist that can be taken once daily without fasting or water restrictions, addressing one of the key adherence challenges of earlier oral formulations. 鈥淔or patients who struggled with the strict dosing requirements of oral semaglutide, this represents a meaningful step forward in real-world usability,鈥� Wong says. 鈥淭hat said, oral agents as a class still produce somewhat less weight loss than their injectable counterparts, which is why patient selection and shared decision-making remain central to good obesity care.鈥� 

The real impact of GLP-1s: Patients are finally showing up  

If GLP-1s have disrupted anything, it鈥檚 patient behavior. For decades, bariatric surgery has been dramatically underutilized. Less than 1% of eligible patients ever undergo surgery. Meanwhile, in just a few years, GLP-1 medications have reached a staggering portion of the population. 

鈥淣ow you have one in eight Americans who鈥檝e tried a GLP-1,鈥� Wong says. 鈥淚f anything, the popularity of GLP-1s has helped patients realize they can actually get treatment for their obesity.鈥� 

And that shift matters. Many patients who would never have considered surgery are now entering the health care system seeking help with weight management and weight-related comorbidities. As the stigma around weight management and obesity lessens 鈥� though it is still present 鈥� more patients are recognizing that obesity is a complex, chronic condition and needs to be treated as such, rather than a personal moral failing. For physicians, this represents an opportunity, not a threat. 

While hybrid treatment is great, surgery is still essential for some patients 

At multidisciplinary obesity treatment centers like the 喵咪社区 Digestive Health Institute鈥檚, medications are already being used in a multidisciplinary fashion. They are being used before surgery to help reduce complications and make surgery safer. In some cases, they can take the place of surgery. And after surgery, they can be used to help further optimize weight loss, reduce 鈥渇ood noise鈥�, and prevent weight gain recurrence in the long-term. 

鈥淲e use GLP-1s to optimize patients before surgery,鈥� Wong explains. 鈥淚f someone has a very high BMI, preoperative weight loss reduces operative risk and improves outcomes.鈥� 

Although GLP-1s are effective, they do have limits. 鈥淵ou鈥檙e looking at roughly 10% to 20% total body weight loss on average with the current GLP-1 medications,鈥� Wong says. 鈥淔or a patient starting at a BMI of 60, that’s clinically meaningful progress, but it may not get them to a healthy range.鈥� For those patients, surgery remains essential. That鈥檚 why obesity care requires multiple options for treatment.  

鈥淚f you鈥檙e a hammer, everything looks like a nail. And it鈥檚 the same with obesity treatment. If you only know how to do one thing, that鈥檚 all you will ever do,鈥� Wong says. 鈥淏ut patients are different. Their goals are different.鈥� That鈥檚 why discussion of these new therapies and how they work for patients is so important. If patients have only ever been told that the only way to lose weight is with diet and exercise, that鈥檚 all they will ever try.  

鈥淚 still have patients who are told, 鈥榊ou don鈥檛 need medication. You don鈥檛 need surgery. Just do it yourself,鈥欌�� Wong says. But that advice ignores the underlying physiology of obesity. 

鈥淵ou鈥檙e fighting against your body,鈥� he says. 鈥淎nd when you鈥檙e fighting physiology with willpower, physiology almost always wins.鈥� 

Until that mindset shifts 鈥� among both patients and providers 鈥� many individuals will continue to go untreated. Increasingly, however, conversations happening around peoples鈥� successes with GLP-1s will bring more patients into their doctors鈥� offices.  

鈥淟earning about these new tools puts us in a better place to counsel patients,鈥� Wong says. 鈥淭his isn鈥檛 about picking one treatment. It鈥檚 about using the right combination for the right patient.鈥� 

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Mollie Barnes

Mollie Barnes is a digital editor and writer at 喵咪社区.

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