Improving Brain Health: Weight Loss Surgery, Medications, and Lifestyle Changes

The connection between obesity and various health complications is widely acknowledged, and recent studies indicate that obesity might also negatively impact brain health.

Consequently, weight loss, whether attained via surgery, therapeutic drugs like Ozempic and Wegovy, or lifestyle modifications may help obese individuals improve their cognitive abilities.

According to a study published in JAMA Network Open in February, significant cognitive improvements were observed in 40% of adults who underwent bariatic surgery. Similarly, an August research publication highlighted the capacity of an anti-obesity medication called liraglutide to restore adaptive learning abilities in obese individuals.

Obesity medicine physician and Vice President of Clinical Development at Calibrate, Kristin Baier, MD, asserts that brain and metabolic health are closely intertwined. As weight loss contributes to the reversal of metabolic syndrome and a decrease in inflammation levels, brain metabolism and mitochondrial function would subsequently improve.

The connection between obesity and brain health seems to be centered on inflammation. Excess fat tissue has the potential to release molecules that instigate inflammation in the entire body, the brain included. This neuroinflammation can lead to changes in the gray and white matter of the brain, with loss of gray matter being associated with disorders like dementia and depression.

Metabolic syndrome, characterized by a large waist circumference, high cholesterol and blood sugar, hypertension, and low HDL cholesterol, is another condition associated with obesity, and research shows a connection between it, inflammation, and a decline in cognitive function. Thus, weight loss might be an effective way to enhance brain health.

Baier cites clinical studies that indicate the potential of diet and exercise to manage symptoms of depression and anxiety, and even prevent or mitigate neurodegenerative diseases such as Alzheimer’s and Parkinson’s. As weight loss surgery, medication, and lifestyle changes can facilitate weight loss, these can also influence brain health.

A recent study published in JAMA Network Open revealed a connection between weight loss surgery and improved cognition. It focused on 133 Dutch adults with severe obesity who underwent bariatric surgery and showed that roughly 43% of these participants had improved cognition two years post-surgery. Alongside this, lower inflammation markers and fewer depressive symptoms were observed.

While weight loss surgery can have significant health benefits, consult your physician before proceeding due to potential risks such as bleeding, blood clots, infection, diarrhea, and more.

Baier also notes that drugs such as Ozempic and Wegovy may enhance metabolic health, and consequently, brain health. However, experts are in the process of determining how these glucagon-like peptide-1 (GLP-1) drugs interact with the brain. A type of diabetes medication called gliptins has been observed to enhance GLP-1 levels and improve cognitive decline in people with type 2 diabetes. This suggests the potential of Ozempic, a GLP-1 mimetic, to yield similar results. A clinical trial is in progress to examine whether the medication could have a favorable effect on early Alzheimer's disease. Other similar weight loss drugs have also been associated with improved brain health.

An August 2023 study found associative learning impairments caused by obesity can be restored with liraglutide, an anti-obesity medication also known as Saxenda or Victoza. After just one dose, researchers said participants with obesity showed no impairment compared to a group of healthy-weight participants.

However, it’s imperative to be cautious when using these medications, said Chris Allen, MD, pediatric neurologist and sleep medicine physician at Covenant Healthcare and senior science advisor at Aeroflow Sleep.

GLP-1 drugs can lead to gastrointestinal side effects such as nausea and vomiting, while Ozempic and Wegovy, in particular, have been linked to more severe side effects such as pancreatitis.

And though more recent studies have not found any connection between these medications and suicidal ideation, it’s important to ensure the drugs don’t make brain health worse in any way.

“Potential side effects and long-term impacts on neurological functions should be thoroughly evaluated,” Allen told Health. “Consultation with a healthcare professional is crucial before considering these drugs.”

While surgery can provide the most dramatic weight loss results, lifestyle changes are also very beneficial.

Implementing a well-balanced diet, exercising regularly, focusing on quality sleep hygiene, and eliminating stress have been shown to cause weight loss. And these types of lifestyle changes have been associated with inflammation reduction, and therefore, with a lower risk of developing neurodegenerative and other diseases. In particular, exercise might be able to improve blood flow in the brain, boosting cognition.

Though lifestyle changes tend to come with fewer risks, you should check with your doctor before starting any new weight loss program. This is especially true if you’re currently being treated for any neurological or psychological disease.

Though research suggests weight loss could contribute to cognitive improvements, it’s certainly not a guarantee.

“Cognitive function is influenced by a multitude of factors, including genetics, lifestyle, and overall health,” said Allen.

Even among factors that are in your control, weight management is just one way to protect against cognitive decline. Others include keeping your mind active, engaging with friends and social activities, and lowering stress.

And if a person is interested in losing weight to try to improve their brain health, that too isn’t “one-size-fits-all,” Baier said. Factors such as medical and family history, age, gender, or personal goals can all influence which method of weight loss is best for you, she added.

“Weight loss should be viewed as part of a holistic approach to enhancing cognitive well-being, complemented by other healthy habits and practices,” said Allen.