“With the GLP-1 base, if we can intervene prior to surgery, we can help control those medical conditions related to their obesity in a way that potentially makes the surgery safer,” he said. “A big one would be if they have diabetes; getting their A1Cs down to a safer range.”
For some patients, medication and surgery can also work together as part of a longer-term approach to obesity treatment. GLP-1s may help patients to lose weight and improve obesity-related conditions before surgery, while continued medical therapy after surgery may support long-term weight management. Rather than treating surgery as the finish line, continued support can be the key to managing obesity. Sustaining that weight loss, after all, can be just as important as achieving it in the first place.
For Cornier, the significance of the newer medications goes beyond how much weight patients can lose. He believes they may also help to change how people understand obesity itself.
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“There is so much stigma and bias toward obesity. I think that medicines legitimize this as a disease more and raise more awareness,” Cornier said. “This is a true disease caused by neurometabolic changes in the brain and in the body that put people at risk in the right environment, which we live in.”
But the medications are neither appropriate nor accessible for everyone. Cost and insurance coverage can limit access, and some patients cannot tolerate the medications or experience side effects that prevent them from continuing treatment. For those patients, treatment does not necessarily stop there; it may simply require a different approach.
Cornier also emphasized that patients taking GLP-1s require appropriate medical monitoring, particularly as the medications produce levels of weight loss that previously were more commonly associated with bariatric surgery.
“You can’t just throw people on them. With surgery, where we see 30% weight loss on average, we monitor those patients very closely for dehydration, excessive weight loss and mineral deficiencies. With these new medications, we’re losing similar amounts of weight, yet we’re not giving patients the same close monitoring.”
Perhaps nowhere is that change more tangible than for patients whose weight has stood between them and another treatment they need. “In the past, we used to get referrals, such as, ‘This patient needs to lose 50 pounds before they can get hip or knee replacement.’ Or many kidney or lung transplants, because of their obesity, they’re not good candidates.”
Previously, helping patients to lose enough weight to become eligible for surgery could take considerable time. Newer medications are changing that, Cornier said. Drugs such as Wegovy (semaglutide) and Zepbound (tirzepatide) target hormonal pathways involved in appetite and food intake, helping some patients to achieve levels of weight loss that were previously more commonly associated with bariatric surgery. That can shorten the path to the treatment they need.
“In the past, we would put people on liquid diets and this and that, and yes, we could get people down, but it took a while. Now with these newer treatments, it’s easier, more effective, faster weight loss so we can get these patients their treatments quicker.”
For Cornier, that ability to help patients to receive the other treatments they need underscores a larger shift in obesity care: treating obesity as a biological disease – and treating it effectively – can improve health far beyond the number on a scale. And for patients who have struggled to lose the weight they need to lose, that shift can mean something even more personal: another chance to move forward with their lives.
