Bariatric Weight Loss Surgery vs. Weight Loss Drugs

Buzz about injectable diabetes drugs for weight loss raises the question of which is better, bariatric weight loss surgery or these drugs. 

For patients who are overweight or obese, losing weight is important to improving health, quality of life and reducing mortality. Everyone’s weight loss journey is a personal decision, with many available tools. 

As specialists treating obesity, patients often ask us about how these popular weight-loss drug solutions compare with weight loss surgery. 

Injectable Weight Loss Drugs

Glucagon-like peptide 1 (GLP-1) agonists are diabetes drugs with semaglutide as the primary ingredient including Ozempic and Wegovy. These drugs have gained popularity. Patients lose about 15% to 20% of total body weight. 

The drugs work by mimicking the action of a hormone called glucagon-like peptide 1. This causes the body to produce more insulin to lower blood sugar levels. This helps control diabetes. For weight loss, they appear to curb hunger. They also slow the movement of food from the stomach into the small intestine. This causes people to feel full faster and longer, and thus, eat less. 

The Federal Drug Administration (FDA) has approved Wegovy for the treatment of obesity. It is likely the FDA will approve more of the GLP-1 agonists for this use. It is important to note that these medications and weight loss surgery are not for people who need to lose a few pounds. These interventions are only for people who need to lose significant weight. 

Comparing Bariatric Weight Loss Surgery and Weight Loss Drugs

Here are a few things we know about these drugs vs. weight loss surgery: 

  • The drugs are expensive, between $800 and $1,200 or more a month. In addition, the drugs are in short supply and currently not covered by insurance. Bariatric, or weight loss surgery, generally costs between $15,000 and $20,000. Medicare and most insurance covers weight loss surgery for people with Body Mass Index (BMI) of 40 or greater or with comorbidities. 
  • Use of the drugs can cause side effects in up to 75% of patients. These include mild rapid heart rate, infections, headaches, heartburn, dizziness, vomiting, constipation, diarrhea and nausea. Bariatric surgery risks can include acid reflux, nausea and vomiting, infection and stomach obstruction. However, doctors consider the risks low compared with the health benefits. 
  • Weight loss can be significant with the drugs. However, weight loss from bariatric surgery is two to three times more than with drugs.  
  • Use of the diabetes drugs for weight loss is new. Doctors do not yet know if the drug will stop working over time. They also do not know if it is safe to take long term at a high dose. Studies on the long-term safety of bariatric weight loss surgery go beyond 10 years.  
  • Beneficial metabolic changes occur only while taking the drugs. Bariatric weight loss surgery patients benefit from permanent metabolic changes. Also, bariatric procedures like gastric sleeve and gastric bypass are significantly more effective at triggering and maintaining weight loss. In part, this is because the surgical effect of increasing GLP-1 is higher than with injections. 
  • After stopping semaglutide drugs, patients often regain lost weight. Regaining weight is also a reality for some after bariatric surgery. About one-fifth of patients regain more than 15% of their weight five years after surgery. 

READ MORE: Support is the key to post bariatric surgery success

How to Choose Between Bariatric Weight Loss Surgery and Weight Loss Drugs

How patients embark on their weight loss journey is a personal decision. Bariatric weight loss surgery and GLP-1 agonists are just some of the tools available. The goal with weight loss is to support overall improvement in health and quality of life. 

Semaglutide may be a viable choice for someone who needs to lose significant weight but does not qualify for surgery. They can support bariatric weight loss before surgery or after surgery for an extra boost if someone is struggling. 

One thing is certain for all weight loss methods: permanent lifestyle changes keep the weight off. Resuming old eating habits and becoming sedentary after losing weight, both of which contributed to the original problem, will result in weight gain. 

The key to finding what works for you is partnering with an experienced physician who can create a plan that will work with your body, lifestyle and medical needs.