Does the Success of Weight Loss Medications Like Wegovy Mean I Don’t Need Bariatric Surgery?
By now, anyone looking to lose weight has read up on a relatively new crop of weight loss drugs like Wegovy/semaglutide, which have shown excellent effectiveness in overweight and obese patients. By some accounts, weight loss in the range of 15-20% of total body weight loss has been achieved. This is incredibly impressive for a minimally invasive injection, and the results are consistent across a significant population of patients. Does that mean, however, that bariatric surgery is now obsolete?
Bariatric Surgery’s Role
Medications play a role in weight loss and diabetes management, giving hope to patients who have otherwise given up on diet and exercise. However, these drugs may not be as helpful in very obese patients. For the sake of this article, we can take a patient with a BMI of 40 at 5’4” inches tall. If this person is of average build, they are around 233 pounds, and the upper limit of a healthy weight is about 145 pounds. The limit between overweight and obesity is 174 pounds.
If they lose 20% of their body weight, they lose approximately 46 pounds, which puts them at about 187 pounds, squarely in the obese category. This means that even if they achieve the very best results from the weight loss medication, they are still obese and may risk illness and early death.
On the other hand, that same person could lose between 70 and 90% of their excess body weight with any of several bariatric surgeries. This roughly translates to between 60 and 79 pounds. We have many patients who, with exceptional dedication, have even lost 100% of their excess body weight. This is because bariatric surgery generally offers both a hormonal and mechanical function versus the hormone-only mechanism of medication.
This is not to say that medication is bad or should be avoided. Quite the opposite. Evidence shows that medication can reduce cardiovascular risk and lower the risk of metabolic diseases like fatty liver disease in well-selected patients. All of us in the field of weight loss are excited by the prospect of these medications. However, we see the most significant benefit as a combination therapy with bariatric surgery.
For one, these drugs can be used before surgery to lose some weight and reduce the liver’s size, making the surgery safer and allowing us a more straightforward operation with less risk. On the other hand, these medications are to be used to maintain weight loss during plateaus or later when the chance of regaining weight is highest. Ultimately, it is yet another arrow in the quiver in the fight against excess weight and should be embraced.
No solution, not even bariatric surgery, is without risk, however. Patients need to educate themselves on the possible downside of their medications. Patients who do not consume enough protein or perform regular weight-bearing exercises risk losing bone density and muscle mass. Many patients will also experience stomach pain, diarrhea, constipation, and more. Serious risks can include pancreatitis, gallbladder problems, obstruction of the small bowel, and Gastroparesis, which paralyzes the stomach and slows food movement into the small intestine. These risks and considerations may lead to stopping medical therapy for some patients, at which point they may wish to consider bariatric surgery as a more permanent alternative.
Lastly, the cost of the medication should be understood as well. For most, these medications are not covered by insurance and cost upwards of $800-$1000 per month. On the other hand, Dr. Tsuda and VIPSurg have an exceptionally low-cost cash-pay gastric sleeve currently available. That may make financial sense when compared to long-term medical therapy.
Most importantly, you are ready to do something about your excess weight, and we applaud that. Speaking to a weight loss specialist like Dr. Tsuda can offer the perspective you need to make the best decision for your circumstances. We encourage you to schedule a consultation with us.