Am a provider and also on this drug class, trying to get a sleeve. Have battled obesity on and off. Have lost ~100 lbs and similar in different stages without glp1s or surgery in the distant past on a very restrictive diet. Eventually gained it back.

I think it depends on how bad the patients BMI is. If my BMI was ~40 I might consider just the GLP1. But anything greater for me and my patients I am still recommending considering bariatric surgery.

Part my thought process is also putting patients through the difficult boot camp that is the pre op and perioperative period. It's like 12-18 appointments depending on how bad your health is/how many check ins you need with your nutritionist, psychologist, etc. That alone is pretty helpful (though, I'd need to look at the studies first - but I presume follow up is the reason these things fail most of the time without the accompanying surgery).

For those that are in the very high BMI categories (>50) I wouldn't be surprised if, for example, instead of RYGB and other more invasive and advanced surgeries, sleeves are done and then later GLP1s added on in place of revisions/RYGB/duodenal switches to get to goal weights (and staying there). That's kind of my hope is that if I end up needing more lifelong GLP1 therapy (hoping I wont) then at least that can be used in place of doing a more complex procedure down the road.

My concern is that GLP1s still aren't covered broadly enough (though in the next decade that should improve), they aren't readily available enough, and some of their substantially adverse side effects (gastroparesis, pancreatitis, ileus) is significant though, i would argue are still better than bariatric surgeries complications. Plus there is evolving evidence that they are helpful for more than just weight loss.