Recent reports indicate a surge in rapid weight loss attempts using glucagon-like peptide-1 (GLP-1) obesity treatment injections like Mounjaro and Wegovy. This trend has led to more than doubling of gallstone disease cases in South Korea over the past decade. The use of these obesity treatment injections for weight loss may increase the risk of gallstones.
According to medical experts on Wednesday, gallstone disease occurs when bile components, primarily cholesterol, crystallize and harden, accumulating in the gallbladder and causing pain and inflammation. Bile stasis is identified as a major cause, which happens when cholesterol excretion increases or the gallbladder’s contraction function declines.
Spread of GLP-1 obesity treatments increases gallstone risk with rapid weight loss
GLP-1 receptor agonist injections have become widely adopted as an obesity treatment. These medications mimic the hormone GLP-1, which is released during food intake. They enhance feelings of fullness, suppress appetite, and slow digestion to promote weight loss.
During rapid weight loss, the liver excretes more cholesterol into bile. However, reduced food intake leads to fewer gallbladder contractions, causing bile to stagnate and crystallize. This process concentrates and solidifies bile, accelerating gallstone formation. The risk is particularly high with extremely low-calorie diets or fasting-like regimens that drastically limit food intake.
A recent study in an international journal confirmed that GLP-1 receptor agonists are associated with an increased risk of gallbladder and bile duct diseases. In clinical trials for weight loss, the incidence of these conditions was about 2.3 times higher than in control groups.
Gallstone cases double in a decade; half are younger adults in their 30s and 50s
Health Insurance Review and Assessment Service statistics show that gallstone cases in South Korea jumped from 136,774 in 2015 to 277,988 in 2024, a 103% increase over ten years.
Cholecystectomies, the definitive treatment for gallstones, have also risen. In South Korea, these surgeries increased from 57,553 in 2015 to 91,172 in 2024, a 58% rise over the past decade. Notably, over half (52%) of cholecystectomy patients in 2024 were between 30 and 50 years old, indicating a significant prevalence among younger adults.
Gallstone disease often goes unnoticed but can cause sudden pain in the upper abdomen or right upper quadrant after fatty meals. While easily mistaken for indigestion, pain lasting several hours or accompanied by fever may indicate acute cholecystitis, requiring immediate medical attention.
Dr. Lee Kyung-joo, a gastroenterology professor at Hallym University Dongtan Sacred Heart Hospital, advises that if you experience recurrent discomfort or pain in the upper abdomen during rapid weight loss, it’s crucial to get an abdominal ultrasound to check for gallstones and ensure timely treatment.
Acute Cholecystitis May Require Surgery; Avoid Extreme Low-Calorie Diets During Weight Loss
Treatment for gallstones varies based on their location, symptoms, and presence of inflammation. While asymptomatic gallstones are often monitored, active treatment becomes necessary for recurrent upper abdominal pain or progression to acute cholecystitis.
Acute cholecystitis occurs when gallstones block the gallbladder duct, preventing bile flow and causing inflammation. This condition typically presents with persistent pain and fever. Treatment usually involves fasting, intravenous therapy (IV) fluids, pain relief, and antibiotics, followed by cholecystectomy as standard care.
Dr. Lee emphasizes that during weight loss treatment, it’s crucial to avoid extreme weight loss or very low-calorie diets. Instead, work with healthcare professionals to develop a gradual weight loss plan that supports gallstone prevention and gallbladder health.
