Are GLP-1 Drugs Putting an End to Bariatric Surgery?

In this video, Mikhail Varshavski, DO, who goes by “Dr. Mike” on YouTube, talks with Christine J. Ren-Fielding, MD, of NYU Langone Health in New York City, about the future of bariatric surgery.

Following is a partial transcript of the video (note that errors are possible):

Varshavski: If someone were to say to you what you just described, amputating 80% of the stomach, reconnecting the GI system in a way where it’s not the correct way, “Doesn’t that seem barbaric?” How would you respond?

Ren-Fielding: Yes, it appears barbaric. However, cutting out 80% of your stomach means very little if it’s going to extend your lifespan for over 10 years.

Varshavski: Today we are joined by the incredible Dr. Christine Ren-Fielding, a pioneer in bariatric, or fat loss, surgery. She is actually the chief of bariatric surgery at NYU Langone Health, where she has helped transform lives through innovative life-saving procedures and has been at the forefront of advancing surgical techniques for weight loss. We go into depth, covering what bariatric surgery is, who needs it, why insurance makes it so hard to get it, and, most importantly, if GLP-1 medications like Ozempic [semaglutide] are going to make fat loss surgery a thing of the past. Ren-Fielding does a phenomenal job with all these questions and I truly think you’ll benefit from this conversation, so let’s get started with “The Checkup” podcast.

I’m excited to chat because this is a topic that I have actually gotten a lot of hate on social media about and it kind of confused me because when I was in my training, bariatric surgery was something that we knew helped a lot of patients. But then with the way the media is and the way that headlines are often sensationalized and made to be very dramatic, people started getting angry about bariatric surgery and that fueled the rise of misinformation.

I’m excited that we get to talk with one of the leaders in bariatric surgery to tell us what’s what and to separate fact from fiction. I think a good place for us to start would be, what is bariatric surgery? Let’s define the terms, what procedures there are, and what options there are, so that if you’re the viewer you can kind of wrap your head around from the beginning what we’re talking about.

Ren-Fielding: Right. Thank you for the opportunity for letting me come and talk about this because as a person who is within the field of bariatric surgery, it’s been around since the 1960s, if not the 1950s, and yet there are so many people who don’t know about it or they fear it, or they don’t want to know about it.

Varshavski: What do you think created that? Why are people confused by it?

Ren-Fielding: Well, there is a judgment thing going on and it’s about, are you taking the easy way out, are you cheating, or you’re doing it the old-fashioned way? It is judging people who are obese or morbidly obese and saying, “Why aren’t you losing weight with diet and exercise?” It’s probably because that’s how many people maintain their weight.

But being a slender individual, like you and I, doing diet and exercise works in maintaining our weight. However, if you are my height and 250 lbs, you can’t do it. Diet and exercise is not statistically possible for you to lose 100 pounds and keep it off a long time. I think it’s not understanding why that is that makes people judgmental about if you’re 300 lbs, why can’t you diet and exercise your way down?

Varshavski: What is the answer to that?

Ren-Fielding: So, whoever figures that out is going to win the Nobel Peace Prize because there are many different hypotheses and thoughts about what the human body does when it gains a certain amount of weight. Our bodies have been exposed to famine, to disease, to war, and to starvation for the entirety of human beings being on Earth, except for the last 100 to 150 years. Now, all of a sudden our bodies are exposed to a plethora of calories, flavors, and tastes. I mean, sugar….

Varshavski: In most parts of the world.

Ren-Fielding: In most parts of the world.

Varshavski: Yeah. We want to be inclusive.

Ren-Fielding: Thank you. Thank you for clarifying that. But really, sugar never entered our vocabulary until the early to mid-1800s. There were three cases of type 2 diabetes in the scientific literature in 1847 …

Varshavski: Wow.

Ren-Fielding: And so all of a sudden, over the last century, the health epidemic of obesity and also type 2 diabetes has exploded. Going back to why are our bodies resistant to losing weight is because it’s never had to deal with that genetically or evolutionarily by having too many calories. It was always too few calories.

Varshavski: So the body is more prepped to be in storage mode rather than burnoff mode?

Ren-Fielding: That’s absolutely correct and there is no need to manage your weight. Our bodies can manage our blood pressure. It self-regulates temperature. It self-regulates heart rate. But it doesn’t know how to self-regulate weight, only if you’re exposed to starvation can it self-regulate. But when we have too many calories, it does not know how to burn off the excess, so it doesn’t know how to correct for excess calorie intake.

Varshavski: So the set point can only go up?

Ren-Fielding: That’s right, which brings me to the set point theory that the human body is set at a certain sort of weight. However, the set point will always go up; it will never go down. Because when it goes up, the body says, “Okay, your new normal is 250 lbs as a 5’5″ woman. That’s your new normal.” When you try to calorie restrict and lose weight, your body thinks it’s starving, that it’s pestilence. It doesn’t mean that you should eat more or eat six times a day, which used to be told to us in the 1980s and 1990s that you should eat more in order to lose weight. No, you should calorie restrict and stay at that calorie restriction.

Watch the video above for more.

Mike Varshavski, DO, is a board-certified family physician and social media influencer with more than 12 million subscribers.