GLP-1 Meds Before And After Bariatric Surgery

Weight regain after bariatric surgery can feel like a personal failure, but it’s often a predictable collision of biology, appetite signaling, and changing metabolism. We walk through one of the most common questions we get as obesity medicine physicians: when GLP-1 agonists fit before or after metabolic and bariatric surgery, and how to use them in a way that protects your health.

We start with the pre-op side, where GLP-1 medications may help people with class 3 obesity or very high BMI reduce surgical risk and improve conditions like type 2 diabetes, insulin resistance, sleep apnea, and fatty liver disease. We also cover practical perioperative considerations, including why many surgical teams ask patients to stop GLP-1s about a week before anesthesia to reduce aspiration risk.

Then we move into post-op strategy. Because bariatric surgery already changes your GI system and appetite, we explain why many clinicians wait 1 to 2 years before restarting a GLP-1, and what needs to be true first: stable recovery, thoughtful evaluation, and optimized nutrition. We dig into micronutrient labs, bariatric supplements, and why slow titration matters so much after sleeve gastrectomy or gastric bypass. We also break down medication absorption differences between injectable vs oral options and when non-GLP-1 weight loss medications may be a better fit.

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Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

Who Qualifies After Bariatric Surgery

Dr. Lindsay Ogle, MD 0:44

Do you qualify for a GLP1 agonist if you've had metabolic and bariatric surgery or if you're planning one in the future? We're gonna talk about that today. And this is something that has come up quite a bit in my practice for individuals who come for support after they've regained weight after having a metabolic and bariatric surgery in the past, or maybe they are considering which option is best for them. Should they pursue surgery or pursue an obesity management medication? Or maybe they are considering a combination approach, or that might be what my recommendation is for them. And we're going to talk about why that those cases might be and what are some of the things to watch out for and be aware of when pursuing these treatment

Using GLP-1 Before Surgery

Dr. Lindsay Ogle, MD 1:36

options. So first we'll talk about using a GLP1 medication prior to metabolic and bariatric surgery. This could be a great option for somebody who has an elevated BMI in the class 3 category. So it's a BMI of 40 or greater, and specifically individuals with an even higher BMI of maybe 50 or greater. And especially if they have a lot of metabolic comorbidities, maybe diabetes or insulin resistance, obstructive sleep apnea, potentially some you know cardiovascular disease, if they have metabolic dysfunction associated steatotic liver disease or fatty liver disease, what is commonly called, these individuals would likely benefit from optimization prior to their surgery. So utilizing a GLP1 medication to help get some weight off as well as control of their weight-related conditions and metabolic conditions. And the GLP1 medication can help achieve that. But for most people with that elevated BMI, they are not going to reach their ultimate goals, whether that's personal goals or health goals, with a GLP1 medication alone. And so once they are optimized on their GLP1, or maybe prior, you know, prior even to that, then they are a safer candidate for metabolic and bariatric surgery and have less perioperative surgical risk. So the surgery is safer for them and more likely to have a positive outcome. So that's a great option for those individuals. The thing to note with utilizing a GLP-1 around the time of a planned surgery is that most surgeons and anesthesiologists will want you to hold your GLP1 about a week prior to that surgery, and that's to decrease the risk of aspiration when you are under anesthesia. So that's pretty common. And if you're having a different surgery, you could start immediately after your surgery if you're feeling well, but of course, talk to your doctor about that, what timing might be best for you.

When To Restart After Surgery

Dr. Lindsay Ogle, MD 3:59

But for metabolic and bariatric surgery, because of the significant changes to the GI system, it is typically not going to be something that you restart right away. This is something that is being studied, and there may be certain patient populations where this may be recommended either now or in the future, but I think most clinicians would recommend holding off on a GLP1 after metabolic and bariatric surgery for at least a year or two as the body is recovering. That's usually when we see the most weight loss related to the surgery, and then we can see where things kind of settle out in the body, both from a weight standpoint and then hunger signal and metabolic standpoint, and we can make a more informed and safer decision on if that individual would need or benefit from a GLP1 agonist after their metabolic and bariatric surgery. If the decision is to start a GLP1 medication after surgery, again, we'll wait for the vast majority of people, about a year or two, to have that evaluation.

Micronutrients And Lab Monitoring

Dr. Lindsay Ogle, MD 5:17

Prior to starting, we want to make sure that your nutrition and your micronutrient levels are optimized. You should already be on your bariatric supplement and potentially other supplements depending on the surgery and your baseline labs, but this is something that needs to be checked before starting a GLP1 agonist or any obesity management medication. This is something that anybody with metabolic and bariatric surgery should be having checked at least annually. It's very important to have these labs done because it could do quite a bit of damage if these micronutrients are not at the recommended levels. So this needs to be monitored prior to starting a medication and periodically while on the medication. Again, at least once a year, maybe more frequent in that combination of surgery and medication population.

Bariatric Supplements And ProCare Discount

Dr. Lindsay Ogle, MD 6:19

There is a wonderful supplement company that I have been working with and getting to know. They're called ProCare. This is an independent supplement company. They are third-party tested, meaning that there is a different company that tests their product to ensure that it has what it says that it has in its products. And they also consult other health professionals and scientists. So they consult doctors and registered dietitians and scientists to make sure that they are having quality products that they are recommending to their customers. And because I believe in them as a company and trust their products, I have decided to accept their offer for a discount code. So anybody who uses the code Metabolic Health will get a 10% discount on their products, and I'll have that linked below so you can check it out and see if it's something that you would want to incorporate. Whether you've had a metabolic and bariatric surgery, that's their specialty, but they also are supporting individuals who are on GLP1 agonists, and there's other products that really anybody could benefit

Absorption Differences Oral Vs Injectable

Dr. Lindsay Ogle, MD 7:33

from. But going back to starting a GLP1 after surgery, there when choosing a GLP1, there is something really important to consider. It is the absorption of that medication. And because the GI tract is altered during metabolic and bariatric surgery, it is recommended to utilize the subcutaneous injectable GLP1s because that's not going to affect your absorption of the medication. If you've had surgery, then we really need to closely monitor how you're responding. If you do choose an oral option, if we're thinking about oral weak OB, that's absorbed in the stomach. And so for anybody who had a surgery that makes the stomach smaller, so that is truly all of the surgeries. So sleep gastrectomy and bypass are the most common. Again, injectable weak OV, same effectiveness, same absorption, oral weak OV. If that's the only option you have, you could always try it. It's not harmful. You just may not have optimal absorption. So you really want to closely monitor your response to that medication. And then our other option, Oral Fondeo, this medication is absorbed in the small intestines. So anybody who had the sleeve gastrectomy or gastric sleeve, this you'll probably absorb this just like anybody else. But if you've had gastric bypass or a Sadie is another surgery that decreases the absorption, then you may want to reconsider Oral Fondeo. Again, if it's your only option, you could absolutely try it. But again, closely monitor your response to the medication. And if you're not seeing any of those benefits when you get to the higher doses, then you're probably not absorbing it and it's probably not the best medication for

Slow Titration And Nutrition Protection

Dr. Lindsay Ogle, MD 9:48

you. If you did choose a GLP1 medication and you're starting it about a year or so after your surgery, it is so important that you titrate slowly. And I always recommend and I'm an advocate for slow titration of GLP1s. I just see that patients tolerate it better, have better long-term outcomes, and are able to reach their goals at lower doses overall. But especially in anyone who has had a bariatric surgery, we need to go slow with these medications to avoid the side effects and to prevent excessive appetite suppression and excessive satiation with meals, that excessive fullness that would really make it difficult to reach adequate nutrition when you're combining the metabolic and bariatric surgery with a GLP1. Both of them commonly have GI side effects, and both of them make you feel really full on less food, which could put you with that combination, could put you at risk for severe side effects and poor nutrition, which could lead to many complications like muscle mass loss, fatigue, micronutrient deficiencies, hair loss. The list goes on and on. So we don't want that for anybody. We never want to, you know, give up our health for a smaller body. That is not the goal of obesity medicine. The goal of obesity medicine is to manage weight, to improve weight-related health conditions, and to improve quality of life and longevity of life. And you're not going to get that if you're not nourishing your body adequately. And that brings us back to the importance of monitoring micronutrients and dietary intake. So utilizing a registered dietitian is a great idea in this population, and they're great for anyone who has had metabolic oberatic surgery or is utilizing an obesity management medication, but definitely beneficial when you're combining those two. If you don't have access to a dietitian, sharing your nutrition patterns and the things that you're eating with your prescriber is very important so they know if you are reaching your protein, fiber, and just overall caloric goals. And then you need to have your labs checked regularly. I'm saying this again because it is so important. And I don't think that a lot of the massive telehealth companies that prescribe GLP1 medications are really monitoring this. So this is something that you may have to advocate for or specifically seek out the support of an obesity medicine physician.

Non GLP-1 Options And Closing

Dr. Lindsay Ogle, MD 12:49

And last, I do want to remind us all of the non-GLP 1 obesity management medications, our first generation medications. I recently did a talk about these that I will link here. But these may be a better choice for individuals who have had metabolic and bariatric surgery because they work more at the brain level and helping control appetite and cravings, but they do not impact the slowing of the stomach. And that's positive in this population because it can limit the GI side effects and it can limit the excessive fullness that the combination of surgery and GLP1 medications can induce. So that's something to consider potentially trying first, or if you had tried a GLP1 and it was too strong of an effect along with your surgical history. So I hope you found this helpful. I hope it highlights the fact that treatment should truly be individualized to what is best for you because you have unique risk factors, you have unique conditions and other medications that we need to consider, and we are getting more and more options available for treatments to really continue to individualize. And many people do need a combination treatment, and that does not mean that there is anything wrong with you or you're doing anything wrong. It's how we manage most of the chronic medical conditions that we treat, especially in primary care and in the medical field in general. If you think this would help anybody that you love, please share it with them. And I can't wait to see you next week for our next topic. Thank you for listening and loving how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.