For most of my career as a bariatric surgeon, I told patients that surgery was the most reliable tool we had for significant, sustained weight loss. That conversation has fundamentally changed.
In the past three years, GLP-1 receptor agonists, a class of medications originally developed for type 2 diabetes, have redefined what is medically achievable for patients with obesity. As someone who has performed hundreds of bariatric procedures and now helps patients navigate both surgical and non-surgical paths, I want to share what I believe every patient should understand about these medications in 2026.
What GLP-1 medications actually do
GLP-1 (glucagon-like peptide-1) receptor agonists work by mimicking a hormone your gut releases after eating. They slow gastric emptying, reduce appetite, and signal the brain that the body is satisfied. In clinical trials, semaglutide, sold as Wegovy for weight loss and Ozempic for diabetes, produced average weight reductions of 15 to 17 percent of total body weight. Tirzepatide (Zepbound) achieved over 20 percent in some trials. These are numbers we previously only associated with surgery.
The oral option is here
One of the most significant developments of the past year is the emergence of effective oral GLP-1 medications. Higher-dose oral semaglutide formulations are now in late-stage development, and several next-generation oral compounds including aleniglipron have shown absorption profiles comparable to injectables in early data.
This matters enormously for patients. Needle phobia, injection site discomfort, and the logistics of weekly injections are among the most common reasons patients either avoid starting or discontinue GLP-1 therapy. An effective oral option removes those barriers.
What patients often get wrong
In my clinical practice, I frequently encounter two misconceptions. The first is that these medications are a shortcut. They are not. GLP-1 medications are powerful pharmacological tools, but they work best when combined with meaningful lifestyle changes. Patients who use them as a replacement for dietary adjustment see less durable results.
The second misconception is that stopping the medication means keeping the weight off. Current evidence suggests that most patients regain significant weight after discontinuing GLP-1 therapy. These are likely chronic medications for many patients, similar to how we treat hypertension or high cholesterol. That framing matters for realistic expectation-setting.
Who is a good candidate?
Current Food and Drug Administration (FDA) approvals target adults with a body mass index (BMI) of 30 or higher, or a BMI of 27 with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or sleep apnea. Contraindications include personal or family history of medullary thyroid carcinoma and multiple endocrine neoplasia type 2 (MEN2) syndrome. A thorough evaluation by a physician, not a telehealth questionnaire alone, is appropriate before starting.
The surgical question
I am still performing bariatric surgery, and I still believe it is the right choice for certain patients, particularly those with a BMI above 40 or multiple comorbidities. But the lines are increasingly blurred. Some of my post-surgical patients now use GLP-1 medications to manage weight regain years after their procedure. Increasingly, these tools are complementary rather than competing.
A final word
The GLP-1 era is not a fad. It represents a genuine paradigm shift in how medicine treats obesity. For patients trying to understand their options, I encourage speaking with a physician experienced in both surgical and non-surgical approaches, and reviewing evidence-based resources rather than social media noise.
Quoc Dang is a bariatric surgeon.
