Are GLP-1 medications or bariatric surgery better for weight loss?
Catherine Boulay, MD, is a bariatric surgeon at Salem Health. Dr. Boulay said these days, one question she often gets from patients is, “Do we need bariatric surgery now that there are effective GLP-1 medications such as Ozempic and Zepbound?”
GLP-1 medications versus weight loss surgery
“Some patients, especially lower BMI patients (less than 35) with diabetes, would likely get more benefit out of a GLP-1 than surgery,” she said. “From a BMI of 35 to 45, there are some patients who could benefit from a trial of medication to determine if their weight really will respond dramatically in the long term. However, at a BMI of 45 and higher, it is really difficult to keep off the same amount of weight with medication for life.”
Dr. Boulay said a patient who is 5 foot 4 is expected to lose about 85 pounds with gastric bypass, which most patients could not achieve with medication alone.
“Not everyone loses weight on a GLP-1 medication, and sadly, most patients do not have access to them in the long term, from a combination of insurance restrictions and side effects,” she said.
That’s when it might be time to consider surgery.
Types of bariatric surgery
Patients are considered for bariatric surgery if their body mass index is at least 40, or at least 35 if accompanied by conditions such as diabetes or hypertension.
The two main types of bariatric surgery are gastric bypass surgery and a sleeve gastrectomy.
With gastric bypass, the stomach is divided, with a small pouch created to hold food. This pouch is only about one ounce, or roughly the size of an egg.
A piece of intestine is connected to the pouch to create a new pathway for food. This creates a feeling of fullness much faster for people, and because part of the intestine is “bypassed,” not all calories of the food get absorbed.
A sleeve gastrectomy involves removing the majority of the stomach, creating a tube shape that is about the size of a banana.
Both weight loss surgeries can be performed laparoscopically, or with small incisions.
Dr. Boulay said to help patients, both medication and surgery are valuable tools.
“I look forward to the day when the world is so healthy that we no longer need bariatric surgery,” she said. “But it remains the most effective way to treat obesity. “