Weight Loss
More than one third of Americans are overweight; experts estimate that number will grow to more than half of the U.S. population by 2030.
When changes to eating and physical activity habits are not enough on their own to help with weight loss, some people look for other options. Over the last few years, two options have grown in popularity: bariatric surgery and GLP-1 drugs.
Approximately 256,000 people undergo bariatric procedures each year in the United States, according to the American Society for Metabolic and Bariatric Surgery. A recent survey from the Pew Research Center suggests nearly 2 million people are taking semaglutide medications such as Ozempic and Wegovy.
So is there one option that is better than the other? We asked Dilendra Weerasinghe, MD, Director of Bariatrics Surgery at Rochester Regional Health, to explain how these two weight loss methods work, and what people might not think of when they make a choice.
Before considering additional approaches to treating obesity treatments, patients should first focus on committing to eating a well-balanced diet, regularly exercising, and making lifestyle changes to live their life at a weight that is healthy. If this is not yielding the results that the patient needs, then they can begin exploring other treatment options with a weight management specialist.
For bariatric surgery, several procedures can be performed – including gastric bypass, laparoscopic duodenal switch, and gastric sleeve. Most procedures are done through a small incision (laparoscopic) instead of opening the abdomen with a large incision. Some will create a smaller stomach using different techniques, while others change the small intestine so food and drink can still be absorbed through the digestive system.
Semaglutide drugs like Ozempic and Wegovy imitate a hormone in the stomach and intestines called glucagon-like peptide 1 (GLP-1). GLP-1 hormones influence parts of the brain that control appetite and food consumption by lowering glucose production from the liver and increasing the release of insulin from the pancreas.
If you are looking for an answer of which treatment is better than the other, the truth is more complicated. The answer is it depends on several factors for each patient.
Clinical trial data shows patients who use semaglutide medications like Ozempic lose 5-10 percent of their body weight by doing regular injections. However, if a person has a very high body mass index (BMI) – 40 or greater, the amount of weight they might lose by only using medications would not be enough to get them to a BMI that is considered healthy.
Other factors taken into consideration by weight management providers when screening for weight loss include:
In some cases, a semaglutide medication might be prescribed as a first step to initial weight loss, followed by bariatric surgery. Dr. Weerasinghe suggests people with lower BMIs and limited co-morbidities are better candidates for these drugs. The bottom line: the right methods need to be prescribed for the right patient.
“Ozempic and similar GLP-1 drugs are not a cure-all treatment, but should be used a tool in someone’s weight loss journey,” Dr. Weerasinghe said. “It’s about using the right tool for the right person so they can have long lasting success rather than giving them something they can use when they feel like it. I would prescribe this tool by looking at it in a holistic patient-centric way.”
Semaglutide drugs are a lifelong commitment and can be expensive – costing anywhere from $400 to $1,500 each month out of pocket. Because these drugs are relatively new, researchers also have yet to determine how effective they are in the long term – and what their side effects might be long term.
One trial showed an increased number of patients who used GLP-1 drugs for years began to stop using them altogether as time went on. Some cited common side effects, including nausea, vomiting, diarrhea, stomach pain, and constipation. There is also an increased risk of pancreatitis and a slight increased risk of hypoglycemia if used together with other diabetes drugs. In very rare cases, some patients developed blindness or gastroparesis.
Patients who undergo bariatric surgery are likely to have significantly lower risk of advanced liver disease and lower risk of significant cardiovascular events such as heart attacks or heart failure. Beyond these effects, bariatric surgery also reduces the risks of other conditions, including:
Regardless of how a person ends up going about getting help for weight loss, Dr. Weerasinghe said these conversations about weight loss medication and bariatric surgery are raising awareness of obesity as a disease.
“For a long time, people have been ashamed to seek treatment for weight loss,” Dr. Weerasinghe said. “Because of the popularization of these drugs, the stigma is breaking down. If it’s becoming more widely accepted to achieve weight loss by taking a medication, then having surgery for the same purpose becomes less taboo.”
