It's always wise to use glp-1 and gip first and see how it goes before offering bariatric surgery, the implications of bariatric surgery and costs far exceed the cost of GLP1s even if it's out of pocket.

Most insurances are penny wise dollar foolish. My use of glp-1/gip has gone up significcantly.

It would change it more if insurance coverage was better. Most insurance companies will cover bariatric surgery but not the GIP/GLP-1 or GLP-1 medications. The dual GIP/GLP-1 medication has great results however if insurance doesn't cover the medications, most people are only willing to pay out of pocket for GLP-1s because it is cheaper. I continue to discuss nutrition and exercise along with the medications.

Offering patients dual GIP/GLP-1 opportunity before bariatric surgery referral. Discussion of maintaining weight loss regardless of avenue taken with dietary & portion size change and light exercise.

I try to preferentially use tirzepatide in patients with a BMI over 40. I also emphasize the goal of slow long term weight loss.

Dual GIP/GLP-1 therapy is changing my approach by making medication a much more effective option for severe obesity, with weight loss approaching what we historically saw mainly with bariatric surgery. I’m increasingly considering it earlier, while still using surgery for appropriate patients. I also counsel patients that this is likely a long-term, potentially lifelong treatment—similar to treating other chronic diseases—because stopping therapy can lead to weight regain. The focus is therefore on sustained treatment, lifestyle support, monitoring, and choosing the approach the patient can maintain long term

More and earlier nutritional counseling is key with the caveat of increased protein intake to avoid sarcopenia

Earlier intervention with medications, more nutritional counseling, patients eventually put on lowest effective dose for them of glp for maintenance. Stress increase protein and weight bearing exercises to prevent loss of muscle mass.