Zepbound after Bariatric Surgery
Have you wondered about Zepbound after bariatric surgery? Short answer, yes! It’s safe and effective! Long answer? Keep reading.
Tirzepatide, the active ingredient in Mounjaro for diabetes, is also approved for obesity treatment in the medication Zepbound. This newest medication to receive FDA approval is a GLP-1 receptor agonist along with Saxenda and Wegovy. The very popular Ozempic is a GLP 1 medication for Diabetes, but is not the only one. Find out about all 7 FDA approved medications for Obesity here!
There is a lot of information to overwhelm yourself with regarding medication management. Instead, stick with me and I will tell you what you need to know about medications like Zepbound, even after bariatric surgery.
If you’re looking for help managing weight after bariatric surgery, you’re in the right place! Grab my free 10 Day Habit Refresh tracker and the corresponding blog posts!
What is Zepbound?
The active ingredient in Zepbound is Tirzepatide. This is the same ingredient in the medication Mounjaro. Previous to November 2023, patients used Mounjaro “off label” before it was FDA approved for Obesity treatment because of how effective it is for appetite control and weight control.
Tirzepatide is a GLP-1 receptor agonist, like Wegovy or Ozempic, but it introduces another mechanism. It is also a GIP receptor agonist (glucose-dependent insulinotropic polypeptide). Those are super long words to say it’s a GIP and GLP-1 medication. Those two together increase the results compared to Wegovy. More on that in a moment.
When or why use a medication like Zepbound after bariatric surgery?
Bariatric surgery continues to be the most effective treatment to the disease of obesity. It’s super exciting that we also have a medication option to add to the toolbox because we know weight reoccurrence after the first year post-op is likely to occur. What we don’t know is how much. Everyone is different.
A medication like Zepbound after bariatric surgery is safe and effective and can help continue to manage Obesity and Obesity-related diseases in the long run.
Post-op patients also have the benefit of already undertaking major lifestyle changes so the learning curve to introduce a medication is likely not as steep!
Side effects and contraindications of taking Zepbound
Like any of the GLP-1 receptor agonists, nausea is the most common side effect. The symptom is most present when the medication is first started or anytime the dose is increased. For many patients, it will improve but for some, they will give up on the struggle. No one wants to live nauseous and in fact, it’s not recommended to ignore nausea for too long.
Other symptoms to manage include gas, bloating, belching, GERD, constipation, diarrhea, or headaches. Many symptoms are a result of delayed gastric emptying (and something I coach patients through often!)
Here who Zepbound is NOT for. Anyone with a history of thyroid cancer or pancreatitis, or is pregnant. Other GI issues like inflammatory bowel disease or a history of kidney or liver disease may also not be a good candidate.
Cost and supply issues
Many people will qualify for Zepbound using the metrics of BMI. The medication is for anyone with a BMI over 30 (or BMI over 27 with a weight-related co-morbidity) or for those experiencing a weight plateau or weight reoccurrence after bariatric surgery.
Though many qualify, can you afford it and can you fill the prescription are the next big hurdles.
Some patients may get coverage for a GLP-1 if they have diabetes and can get Mounjaro for treatment. Many obesity medications are not covered and are quite expensive. You can look for savings cards or coupons, although it may be over $500 a month even with the savings. Some patients can afford it at first but struggle to afford it long term.
It’s possible (I’m hopeful!) that coverage may increase with time but until then, patients may look at all the options to see what fits their budget.
If supply is the issue, you might have to call around all the pharmacies in your area and ask if they have it in stock. Be specific with the dosage of pen you need and I’ve heard patients have more luck at smaller pharmacies.
Where to go for Zepbound prescription and monitoring?
This is a sticky area, especially in light of cost and supply. When it comes to healthcare, you do want to make sure you are working with qualified experts. Compounding pharmacies have been found to use salt forms of drug ingredients that are not FDA-approved. You’ll find warnings from the FDA online about using compounded versions of GLP-1 medications.
I recommend contacting your surgical team to ask if they are offering medical management of obesity. If you don’t have access to your team, visit obesitymedicine.org and use the Find a Provider option. These are obesity medicine experts who know medications and the disease very well.
What happens when you stop taking Zepbound?
I get this question all the time. I’ve even been asked by other dietitians what happens when someone stops taking the medication. How do we teach them to maintain the weight loss?
The short answer is that we don’t. This is a medication treating a chronic disease. It’s not about teaching someone to keep weight off. While some patients may be able to maintain weight when the medication is titrated down, the vast majority will experience weight relapse when the medication isn’t present.
That’s a hard pill to swallow (or injection to take). The medications are indicated for long-term use which means cost and management are long-term.
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