Diet Pills after Bariatric Surgery

Well, shots actually. We professionals prefer the term “anti-obesity medications” but I’m using diet pills because that’s what patients managing regain after bariatric surgery are searching for on Google!

Everyone is talking about the new diet pills…

I asked my family doctor at my annual visit recently “so are you getting asked about Ozempic much?”

“Two to three times a day minimum.”

Woah.

In my family text thread, my sister asked “what is the deal with Ozempic? Some of these celebrities are looking way too thin.”

Jimmy Kimmel cracked a joke at the Oscars “I can’t help but look around the room and wonder, is Ozempic right for me?”

No doubt the buzz be STRONG. But let’s cut through the noise and get to the meat and vegetables of these new weight loss drugs.

Also, I had an email this week from someone asking about the new fat buster drugs. Diet pills, fat buster drugs…any other names you can think of? Comment below if you’ve got one!

These FDA approved medications are not your average plant pill (sorry to dis on GOLO again but here a link to that blog).

In this diet pills after bariatric surgery article we will:

Paint a picture of the weight loss medications on the market (tiny history lesson here)
Discuss side effects, weight loss expectations and when docs consider these meds for post-op bariatric patients
Chat about insurance, cost and supply with the current information we have available to us!

History of FDA Approved Weight Loss Meds

Without getting terribly boring, let’s do a quick history lesson to orient ourselves to options for FDA approved weight loss drugs through the years.

I think this will show us just how quickly things are moving in the world of diet pills after bariatric surgery…

1959 – FDA approves Phentermine, the oldest weight loss medication still FDA approved today

2012 – FDA approves Qsymia (combo of phentermine and topiramate)

2014 – FDA approves Contrave

2014– FDA approves Saxenda

2021 – FDA approves semaglutide (Wegovy) for chronic weight management

​2022 – FDA granted a fast-tracked designation for Mounjaro to be approved for weight loss and expected to have FDA approval in 2023. It is currently approved for diabetes management.

I became a Registered Dietitian in 2009. I remember well when Contrave was set to come out. It was mind blowing. Before then, when patients asked about a medication we kinda brushed it off and said “get back to basics and use your surgical tool!”

I’m not saying that is untrue. Not at all. But what I have witnessed unfolding before my eyes is more help. In the span of one decade we’ve seen four (almost five) medications come to the stage after more than 50 years since Phentermine. Amazing.

By the way, Leptin was only just discovered in 1994.  A powerful hormone that signals our brains when we are satisfied.  Maybe I’m just in denial but that was NOT that long ago! We’re talking the year of Forrest Gump and the world’s first smartphone.

Even though the obesity charts are getting more concerning, things ARE happening in the fight against this disease. The first Gastric Sleeve was performed in 1990 and the first done laparoscopically  was 1999.

Now let’s dig deeper, what are these diet pills and how do they work after bariatric surgery?

We can get super technical very quickly – honestly not my style. I ask my brainier Dietitian friends for things like that! Ha! Then I translate into everyday language I can remember…and share with you.

For this article I am focusing on the newer medications that are GLP-1 Agonists. My After the Honeymoon course will teach students about all the FDA approved medications on the market!

GLP-1 stands for Glucagon-like Peptide-1 Receptor Agonists. They stimulate insulin secretion in response to food or blood sugar. No there will not be a quiz later ; )

These medications set out to improve blood sugars for diabetes management, but showed promising for weight loss.

Saxenda (Victoza) was the first injection medication to get FDA approval. It is injected daily, suppresses appetite and cravings and provides longer fullness after eating.

Wegovy (semaglutide) is the same drug as Ozempic. Ozempic is FDA approved for diabetes and Wegovy is a higher dose for weight-management. It is also an injection but is just weekly instead of daily. #insertapplause

Mounjaro (tirzepatide) is the latest and greatest but is not yet FDA approved for weight loss. The website states it is not a weight loss drug…because it is still under FDA review.

The drug is intended for diabetes management but people are taking it off label for weight loss. (Off label = taking the medication for something other than what it’s approved for.) It is also a once weekly injection like Wegovy, but it also adds an incretin effect (gut hormones) so it is a dual-targeted treatment for blood sugar control.

Weight loss expectations, side effects and when docs consider these meds for post-op bariatric patients

My hope is that we’ve created a bit of a picture of the weight loss medications on the market…without getting too lost in the weeds or overwhelming.

Let’s add another layer and talk about what percentages of weight loss these drugs have shown us in research. You’ll quickly see why these drugs are in such high demand!

These percentages are how much starting weight is lost. For example, if you weight 200 pounds and lose 25 pounds you lost 12. 5% (25/200 x 100). The numbers vary based on dosage, this is a birds-eye view.

Saxenda 5% in the first 8 weeks, 9% after one year

Wegovy averages 15-18% weight loss

Mounjaro (not approved for weight loss) but studies show 20% weight loss over a 56 week time frame

Putting that into numbers, that patient who was 200 pounds might weight 160 pounds after a year of utilizing Mounjaro.

Nausea, dizziness, diarrhea, oh my

We haven’t gotten to the price and availability yet but hold tight. First let’s talk about how people are feeling with these medications.

Moujaro has shown to cause a lot of nausea in patients. Same as Ozempic and Saxenda since they use a similar mechanism. Some patients find they can’t handle the queasy feeling all day. For some it caused them to vomit. Others have said the symptoms did improve but would come back when the dose increased.

Patients on social media report needing to stick it out at first but the payoff was worth it. I’ve heard patients call it surgery in a bottle because it took them back to their early post-op portion sizes.

Others have reported headaches, diarrhea, constipation and fatigue.

If you’ve tried any of these three drugs Ozempic, Saxenda or Moujaro let us know in the comments how you’ve felt!

When do docs consider adding a weight loss med to your treatment plan after surgery?

Times have changed and as well all know, that can take a moment to spiderweb out into the real world.

Like I mentioned in my flashback, we used to brush off requests for medications.

But now we have a broader toolbox to manage the disease of obesity.

Programs and doctors differ but a common practice is for a patient to be past that first year/honeymoon phase before introducing a medication. There may be times it is prescribed sooner if someone is not responding how they’d hoped after surgery despite following their plan.

The medication is in addition to bariatric eating recommendations, and hopefully makes it easier to stick with.

New weight loss meds (diet pills) insurance, cost and supply

Come on in and have a seat as we try to sort through the piles of confusion here.

First up is Mounjaro. Since it’s not FDA approved for weight loss, it is not covered by insurance for weight loss.
The list price is $1,023.04 per fill.
When there is a diagnosis for type 2 diabetes and insurance doesn’t cover Mounjaro, a patient might be able to get their savings card and pay as little as $25 per month.

The interesting thing here, is that when it does become approved for weight-loss, the coupon will stop working.

There are online companies that offer virtual doctors to prescribe off-label mounjaro. You’ll go to your local lab for labwork and pay their monthly fee instead of using insurance to pay. Pricing differs but a quick Google search showed me one option around $140 per month.

Supply was an issue for a little bit with Mounjaro but has been reportedly back in stock since February 2023. The company filled all their backorders and is supplying on an ongoing basis.

Next up Wegovy….and really all the others.

I’ve asked colleagues what they are hearing from patients and commonly weight loss medications are not getting covered.

Employers decide prescription benefits for their employees. If your company plan doesn’t include medicine to treat obesity, you can try submitting a request for coverage. Ask your doctor for a letter of medical necessity.

I once got my son’s infant helmet covered when insurance denied it. He had a skull surgery and a surgeon said he needed a helmet…I did not quit that fight!

The other option is to look for coupons or savings options online. My doc joked that she saw a Groupon for semaglitude, but wasn’t sure if it could get filled.

The Wegovy website has an area you can check to see if you have coverage.

While there is a shortage on Ozempic, which is said to be resolved soon, Wegovy is now available. It had been on shortage due to increased demand.

By the way…while most people don’t pay the list price, Wegovy and Saxenda prices start at $1,365.76 for each fill.

And something to keep in mind as you consider cost is the timeline. These medications are meant for chronic weight management. That means they are intended for long-term use.

Obesity is a chronic condition and these medications are a treatment for chronic weight management. Stopping the med understandably means appetite comes back and likely weight relapse.

One final thought here, keep your eye on when the patents for these drugs expire. When a patent expires, off-brands are able to be created.

Wegovy has 5 patents protecting their drug. Based on more Googling, it may be 2031 for the earliest date for generic entry. Not exactly around the corner but it’s something.

When the money, the symptoms or the access mean you can’t take a diet pill after surgery…

I don’t want to end this long chat without encouraging you!

Even when the bariatric surgery honeymoon is over, you have a wonderful tool that can be tapped into to improve your appetite and cravings.

The benefits of surgery don’t fully fade away. They may not be as strong as the early months, but they are available to you. You don’t HAVE to have bariatric surgery in a bottle to feel back on track.

Are these medications really promising? YES.

Will supply and pricing and coverage improve?? I sure hope so.

Will getting back to basics help? Does getting support and community make a difference?

You betta believe it. Your body will respond to healthy inputs all the time. These medications help to suppress appetite, but so does water and protein. Is it harder without a medicine? Yes. Is it impossible? No way.

If insurance doesn’t cover it and even with coupons you cannot afford it, you can STILL manage your hunger and appetite. That’s why I wanted to make a course about regain to cover all the angles (medications and not).