Is it safe to take Wegovy after bariatric surgery?

In this article:

• Can you take Wegovy after gastric bypass surgery?
• Can you take Wegovy after gastric sleeve surgery?
• Wegovy vs. bariatric surgery: Which is better?

In this article

• Can you take Wegovy after gastric bypass surgery?
• Can you take Wegovy after gastric sleeve surgery?
• Wegovy vs. bariatric surgery: Which is better?

Until recently, there weren’t many medical treatments that could safely provide dramatic weight loss results for people with obesity, especially if you didn’t want or couldn’t qualify for bariatric surgery. “Even after trying bariatric surgery, some people don’t lose the weight they hoped to or gain some or all of it back after several years,” says J. Omatseye Jr., MD, aesthetic and regenerative medicine provider at Signature Rejuvenation MD in Florida. However, the introduction of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists like Wegovy (semaglutide) has changed that landscape.

Made with the same active ingredient as Ozempic, semaglutide, Wegovy is approved by the Food and Drug Administration (FDA) for weight management in adults and adolescents 12 years and older with obesity and adults who are overweight with a weight-related health condition, such as high blood pressure or diabetes. And, it was recently FDA approved to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and obesity or overweight.

Wegovy is emerging as a potentially effective way for people to continue to manage their weight post-surgery. Here’s what to know about taking Wegovy after gastric bypass or gastric sleeve surgery, including who may want to use it and how well it works for continued weight loss. 

Can you take Wegovy after gastric bypass surgery?

Gastric bypass surgery, sometimes also called Roux-en-Y gastric bypass surgery, is a bariatric procedure where a surgeon sections off a small portion of your stomach and connects it to a part of your small intestine called the jejunum. This reduces the amount of food your stomach can hold and allows the food to bypass a large part of your small intestine, absorbing fewer calories. 

This leads to substantial weight loss; most people who receive gastric bypass surgery will lose 50% to 80% of their excess weight in the first 12 to 18 months.

According to Christine Ren-Fielding, MD, director of NYU’s Langone Weight Management Program and the chief of the Division of Bariatric Surgery, gastric bypass surgery is the “gold standard” of bariatric operations for weight loss. It helps people lose weight and keep it off for the longest period of time and is highly effective at putting Type 2 diabetes and other health conditions into remission.

However, nothing is 100% effective or can guarantee weight loss forever, Dr. Ren-Fielding adds, because of the number of factors that contribute to obesity, like your physiology, hunger cues, genetics, sensitivity to sugar, and even your emotional response to food. In other words, obesity is a complex disease—and it often requires a complex approach, such as combining surgery with medication, like Wegovy. 

“Gastric bypass is effective in increasing fullness and decreasing hunger,” Dr. Ren-Fielding says, “but people who have it will typically regain about 10% to 20% of what they lost—and 10 years after gastric bypass surgery, about 20% to 30% of people have regained most or all of the weight.”

When Wegovy is added to the equation, people who had gastric bypass may be able to lose some of that regained weight. For example, a study published in 2022 found that most post-surgical people taking semaglutide for six months experienced some amount of weight loss. Of the participants, 85% lost at least 5% of their excess body weight, 45% lost at least 10%, and 5% lost 15% or more. In this study, there was no meaningful difference in the amount of weight lost based on the type of bariatric surgery that had been performed.

Dr. Ren-Fielding says prescribing Wegovy to post-surgical patients is as safe as it is for everyone else. The starting dosage of 0.25 milligrams is the same, and people can slowly increase their dose over time without experiencing any abnormal side effects.

Can you take Wegovy after gastric sleeve surgery?

Gastric sleeve surgery is a type of bariatric surgery that shrinks the size of your stomach, reducing how much food you can eat. Bariatric surgeons make the stomach smaller by removing a large part of it and leaving behind a “tube-shaped” structure, like a sleeve. 

Most people who get gastric sleeve surgery will lose about 60% to 70% of their excess body weight in the first 12 to 18 months after surgery. However, while gastric sleeve surgery has similar outcomes to bypass surgery and is typically successful in causing weight loss and improving other health outcomes, there’s a substantial chance of weight regain. Some studies suggest that as many as 75% of people will regain some of their original weight lost about six years after surgery.

Just like with gastric bypass surgery, this is where Wegovy can potentially play a role. According to Dr. Omatseye, Wegovy is safe for most people after gastric sleeve surgery and can help them continue to lose weight. He points to a recent study of people who had undergone bariatric surgery about eight years ago and had regained more than 40% of the initial weight they lost. In that study, the people taking semaglutide were more likely to lose weight than the people taking liraglutide. And, in contrast to some other study results, the people who had undergone gastric sleeve surgery—as opposed to other types of bariatric surgery—were even more likely to see significant weight loss. 

“Like with gastric bypass surgery, people taking Wegovy after gastric sleeve surgery can start at the normal lowest dose of 0.25 milligrams,” says Dr. Omatseye. They can then gradually increase their dose as needed until they’ve found the lowest effective dose that’s right for them.

Wegovy vs. bariatric surgery: Which is better?

The question of which intervention is better, Wegovy or bariatric surgery, doesn’t have a straightforward answer. Dr. Omatseye says multiple studies show that bariatric surgery results in greater weight loss than medication, but surgery isn’t without risks (and some people can lose substantial amounts of weight on semaglutide).

Dr. Ren-Fielding agrees, explaining that there are pros and cons to both options and, in order to figure out which intervention is better for you, you need to work with your healthcare provider to answer a few key questions, including:

• Which interventions do you have access to? If your insurance doesn’t cover semaglutide and you need to lose a significant amount of weight to improve health conditions like Type 2 diabetes, you may want to opt for surgery.
• How much weight do you need to lose? Medications like Wegovy are effective up to a point, helping you lose an average of 20% of your body weight. But, bariatric surgery can help you lose 50% or more of your excess body weight.

• Can you combine medication and surgery? Dr. Ren-Fielding also says that sometimes the choice isn’t “either/or” but which intervention to try first. While drugs like Wegovy can help people continue to lose weight or lose weight they regained years after their operation, she notes that it may be useful for some people to take Wegovy first because it can lower their overall surgical risks and make them more likely to qualify for weight loss surgery.

However you choose to move forward, it’s important to work with a healthcare provider to discuss your options, the potential advantages and disadvantages of any intervention, and what you can expect in terms of short- and long-term weight loss and improvement to your health.