Is Surgery or Medication Better for Long-Term Weight Loss?

If you’ve ever struggled to maintain a healthy body weight, you’re far from alone. Most Americans are overweight or obese, and for some of us, that excess weight can have adverse effects on our physical health and wellness. But a number on the scale doesn’t tell us why it might be easier for some people to lose weight through diet and exercise alone than others. Factors such as diabetes or insulin resistance, genetic predispositions and other health conditions (known as “comorbidities”) may mean that common advice like “eat healthy and work out” is not enough by itself to reach a normal body weight. You may be hearing a lot these days about weight-loss medications, like Ozempic® or Wegovy®, as a new avenue for weight loss. Before these medications became popular, another common suggestion for treating obesity was bariatric surgery—and it’s still a widely used tool for weight loss today.So, which approach is preferable for long-term weight loss: medication or surgery?

Bariatric surgery is a type of surgery that changes how the digestive system works to help people lose weight and improve their metabolic health. These surgeries are mainly done to treat obesity, a condition where someone has too much body fat, but bariatric surgery can also improve other comorbidities like diabetes, high blood pressure and high cholesterol. There are different types of bariatric surgery:

• Sleeve gastrectomy, which reduces the size of your stomach by about 70% and makes it more tubular or banana shaped.
• Gastric bypass, which creates a small egg-sized stomach and then divides your small bowel to bypass digestion.
• Duodenal switch, which is typically used for those with more severe obesity. This combines the sleeve with an intestinal bypass much further downstream than from where the traditional gastric bypass is performed.

In most cases, health insurance covers bariatric surgery when a person has a BMI (body mass index) of 40 or higher with no other health problems. Some insurance plans may cover the surgery if the patient’s BMI is 35 or higher, but only if they also have comorbidities like diabetes, sleep apnea, high blood pressure or high cholesterol. Always check with your insurance provider to confirm coverage.

Some medicines can help people lose weight and improve their overall health. One group of medications, GLP-1 receptor agonists, has recently grown in popularity. It includes drugs like semaglutide (known by brand names such as Ozempic® and Wegovy®), tirzepatide (Zepbound®) and liraglutide (Saxenda®). These medicines work by causing food to leave the stomach more slowly, which helps reduce appetite and makes people feel full.Providers recommend these medications for people with a BMI of 27 or higher, especially if they also have health problems like diabetes. They are also recommended for people with a BMI of 30 or higher without comorbidities who still need help with weight loss. For people with overweight or obese BMIs in the lower range, these medications are often tried first before thinking about surgery.Unlike bariatric surgery patients, not all patients on GLP-1s are necessarily overweight, either. Some diabetic patients can be prescribed GLP-1 even if they don't have weight issues because it helps manage blood sugar levels.

Your BMI is the main determining factor when your care team recommends medication or surgery. People with a higher BMI often have better results with bariatric surgery, but it is a more drastic intervention than medication and with a more complicated recovery. For younger people or those with less severe obesity, providers might choose medication first, especially if they have not had much success with diet and exercise alone. After trying many ways to lose weight and still struggling, you may choose surgery because it can give you more lasting results. Ultimately, in collaboration with your care team, the decision should be based on what is best for your health, preferences and weight loss goals.

It’s important to remember that whether you choose medication or surgery, both options require a long-term commitment to a healthy diet and regular exercise. Neither option is a quick fix. In both cases, the goal is not just to lose weight but to improve overall health and metabolism for a lifetime of health benefits. We are still learning more about the long-term effects of GLP-1s for weight loss, and this is why sticking with a healthy diet and exercise is so important while taking a GLP-1. If you go off your medication, for example, some weight may stay off, but you may regain about half to two-thirds of the weight within a year. Working with your provider on a plan to keep the weight off and adjust your medication is vital to your long-term success.

If you are thinking about bariatric surgery or medications like GLP-1s, the first step is to talk to your primary care provider. They can help you decide what’s right for you based on your health and weight loss goals. You can also join a free online seminar offered by ChristianaCare to give you more information about what bariatric surgery involves, how weight-loss medications work and the changes you must make to your diet, regardless of which option you choose.We also offer support groups at ChristianaCare to connect patients who have already had bariatric surgery. These groups provide encouragement and motivation when recovering from surgery and adjusting to the lifestyle changes needed afterward for long-term health.Working with your provider and their care team to make the best decision for your health is essential. Weight loss programs that include a team of experts often lead to the most lasting success for patients hoping to lose weight and keep it off.