Weight Loss Medication Versus Bariatric Surgery

With the sensational headlines over the past several months about diabetes and weight loss drug shortages like Ozempic and Wegovy, respectively, it’s no wonder we have received a flood of inquiries about getting started on a weight loss medication regimen. Many patients see these weight loss medications as their best chance to lose weight after years or even decades of trying. Some even see it as a way to avoid bariatric surgery.

Are These Weight Loss Drugs Effective?

Ultimately, the weight loss drugs you see on the market are exceptionally effective, allowing patients to lose over 15% of their body weight. This largely follows the results from clinical trials conducted before their approval. Qualifying patients will likely benefit from these medications from a health and wellness standpoint. As production ramps up on these injected drugs, and a similar class of weight loss drugs in pill form are released, more and more patients will have access to these life-changing medications.

Have These Medications Made Bariatric Surgery a Thing of the Past?

Most bariatric surgeons consider weight loss medications essential to the overall treatment continuum for excess weight and obesity. It’s one of the reasons we have a comprehensive medical weight loss program here at MIIS. However, this does not change the fact that bariatric surgery may be the best option for many patients. Why?

First, there are circumstances in which patients will not lose significant weight even with these medications. As with almost any drug, some patients don’t respond, while others find the side effect profile problematic.

Second, there is the question of how much weight needs to be lost. Patients with very high BMIs – those above 40 or 45 – will have difficulty losing enough weight on medication alone versus bariatric surgery, which can offer significantly more significant potential weight loss. Sometimes, these high BMI patients must lose over 50% of their body weight to hit a healthy number.

Can Weight Loss Medication and Bariatric Surgery Work Together?

The short answer is yes, and this is an exciting next step in bariatric patients’ pre-and post-op care. As you likely know, excess weight is a significant risk factor in complications during and after any surgery, including bariatric surgery. The higher the BMI, the greater these risks are. Weight loss medications like GLP-1 agonists (Semaglutides) that we see on the market now may offer higher BMI patients the possibility of losing significant weight before the procedure, thus shrinking their livers, reducing their surgical risk, and getting them started on the right foot for their bariatric journey.

There may also be a place for these weight-loss medications after the procedure. While most bariatric patients follow their post-op diet and exercise plan closely, these drugs can be a potential backstop if patients begin to experience weight regain, which usually happens to a small degree in the few years after bariatric surgery.

An Important Note

Importantly, these GLP-1 agonist drugs are not effective if they are not being taken. In other words, as soon as the patient stops taking these medications, they will likely regain weight if they have not made long-term, lasting dietary and lifestyle changes. This is important because many people believe these medications are an easy way to lose weight. Sure, losing weight with this kind of help is easier than traditional diet and exercise, but insurance guidelines typically will not cover these medications indefinitely, and cash payment for these medications can be rather steep. Consider it a temporary, effective way to get you started on the path to long-term weight loss.

The Next Steps

We are excited that these highly effective weight loss medications are part of the discussion on excess weight and obesity. With proper management, millions of patients that otherwise would be living with excess weight can now lose significant weight with what seems like a reasonably safe side effect profile. However, it’s important to visit a comprehensive weight loss center like ours to understand more about the pros and cons of these weight loss medications and see if other weight loss modalities up to and including bariatric surgery may make sense for you.