Weight loss drugs are everywhere these days—on the news, TikTok and even in celebrity endorsements. With so many options available, it’s no surprise that more and more people are curious about these medications.
And for good reason: according to the latest statistics, over 40% of Americans aged 20 and older suffer from obesity. Many adults with obesity are at greater risk for heart disease, high blood pressure and type 2 diabetes.
But while weight loss medications are gaining popularity, bariatric surgery has long been a trusted method for significant and sustained weight loss. If you’re trying to lose weight and finding it difficult, you might wonder which option is the best for you.
With the help of David Podkameni, MD, a bariatric surgeon with Banner Health, we take a closer look at weight loss drugs and bariatric surgery to help you make the best decision.
What to know about weight loss medications
Prescription weight loss medications – such as Zepbound and Wegovy among others – have made quite a name for themselves. But what do these drugs really do?
Most weight loss drugs, or anti-obesity medications (AOMs), help suppress appetite, making you feel fuller sooner. Some affect how your body absorbs fat or how effectively your body uses fat deposits (storage) for energy.
“Weight loss medications do this by affecting certain chemicals in your brain or slowing down how quickly your stomach empties,” said Dr. Podkameni. “One of the newer and more effective types of these drugs is tirzepatide, a GLP-1 (glucagon-like peptide receptor agonist).”
GLP-1s work in the brain and other parts of the body (like the pancreas and heart) to help reduce appetite and slow digestion, making you feel full longer. They are most often injected into the fatty tissue just under your skin.
More AOMs will most likely be approved by the U.S. Food and Drug Administration (FDA) in the next few years, but some of the most popular ones available now include:
- Tirzepatide (Mounjaro, Zepbound)
- Orlistat (Alli, Xenical)
- Phentermine-topiramate (Qysmia)
- Semaglutide (Wegovy, Ozempic)
- Liraglutide (Saxenda, Victoza)
How effective are weight loss drugs?
“The newest medications have 15% to 20% total weight loss (TWL), which is comparable to the 20% to 25% TWL seen with sleeve gastrectomy, a popular bariatric surgery,” said Dr. Podkameni.
This similarity in effectiveness makes AOMs an attractive option for many people. However, it’s important to understand that these medications often need to be continued long-term.
“Obesity is a chronic disease, just like high blood pressure,” Dr. Podkameni said. “If someone responds well to medications for high blood pressure, we don’t think, ‘When can this be stopped?’ For people who benefit from AOMs and don’t have side effects, these medications may be taken for life.”
Beyond weight loss, AOMs can also improve health conditions like high blood pressure, diabetes, high cholesterol, sleep apnea and more.
“This improvement is partly due to the reduction of adipose (fatty) tissue,” Dr. Podkameni said. “This body fat affects hormones in the body, and reducing fat can help with many health issues.”
What are the side effects or drawbacks of weight loss drugs?
While AOMs are non-surgical and easy to use, insurance does not cover many of these medications. In contrast, bariatric surgery is often covered by insurance. Some AOMs can range from $800 to $1,300 per month without insurance coverage.
Like other medicines, AOMs can also cause side effects. “The main effects are nausea, constipation and, in rare cases, some serious issues like intestinal paralysis and inflammation of the pancreas,” Dr. Podkameni said.
Is it safe to buy weight loss drugs online or from a medical spa?
Buying weight loss drugs online, at medical spas (med spas) or at similar places carries several risks. These drugs might not be approved by the FDA, may be counterfeit or could contain harmful ingredients.
“When weight loss drugs are prescribed by a health care provider who specializes in obesity treatment, they are monitored for effectiveness and safety,” Dr. Podkameni said. “They can prescribe FDA-approved medications and guide you on their use.”
For your safety, talk to your health care provider who can guide you to safe and effective medications.
Also, learn more about taking weight loss supplements.
A closer look at bariatric surgery
Bariatric or weight loss surgery changes your digestive system to help you lose weight. This can include making your stomach smaller or bypassing part of your intestines.
“As a result of the surgical changes, there is a shift in gut hormonal release as well as metabolic release that help or contribute to the weight loss experienced after bariatric procedures,” Dr. Podkameni said.
Bariatric surgeries include gastric bypass, sleeve gastrectomy and biliopancreatic diversion with duodenal switch. Another surgical procedure, an adjustable gastric band (Lap-Band), is rarely performed today.
These surgeries are prescribed for people with a body mass index (BMI) of 35 or higher or a BMI of 30 or higher with health issues related to weight. Certain individual (like those of Asian descent with diabetes) with a BMI of 27.5 or higher may also qualify for medical treatment or may be eligible for surgery.
How effective is bariatric surgery?
Bariatric surgery typically results in greater weight loss than medication alone. Research has shown that weight loss surgery can help you lose as much as 60% of excess weight in six months and 77% as early as 12 months after surgery.
“Like AOMs, bariatric surgery can also help with conditions like high blood pressure, diabetes, sleep apnea, arthritis, infertility and more,” Dr. Podkameni said. “But its success depends on a commitment to lifestyle changes and regular check-ups.”
What are the side effects or drawbacks of bariatric surgery?
Bariatric surgery, like any surgical procedure, carries risks.
“Complications with weight loss surgery are linked to the type of surgery that was done, but side effects from any surgery may include infection, bleeding, nausea and vomiting,” Dr. Podkameni said. “Long-term side effects are often due to not taking multivitamins, calcium or iron, which are needed to prevent nutritional deficiencies caused by the surgery.”
Making the right choice: Weight loss drugs or bariatric surgery
When it comes to choosing between the two, Dr. Podkameni said it shouldn’t be an either/or approach.
“You and your care team should view treatments as part of a continuous process,” he said. “Initially, focus on diet and exercise. Even though these might not be effective for weight loss on their own, it’s important to understand healthy food intake and the benefit of exercise for cardiovascular health.”
Then, your care team should review current medications that may cause weight gain and consider adding AOMs. While using AOMs, you can discuss the possibility of surgery, especially if weight loss is insufficient or the medication isn’t tolerated. Bariatric surgery might also be used alongside AOMs to prevent weight gain or boost weight loss.
“Unfortunately, some providers aren’t including surgery in the discussion, which limits treatment options,” Dr. Podkameni said. “For patients who might be severely obese even after losing 15% to 20% of their weight, surgery is extremely effective to reach higher weight loss goals.”
Bariatric surgery should be considered for those who don’t respond or can’t tolerate AOMs, need more weight loss beyond what medication can provide, or don’t have access to or prefer not to use AOMs permanently.
Learn more about bariatric surgery and see if you are a candidate.
Final thoughts
Starting treatment with weight loss drugs and bariatric surgery is a personal decision that depends on many factors, including your health, weight loss goals and financial situation. It’s important to talk to your health care provider to discuss all available options and develop a treatment plan that fits your needs.
Remember, obesity is a chronic condition that requires ongoing management. Both medications and surgery offer solutions for weight loss and improving overall health. Schedule an appointment with your provider or a Banner Health specialist who can help you make the best decision.
If you are considering weight loss surgery, start your journey here.
Related blogs:
- Celebrating Non-Scale Victories: A Journey Beyond Weight Loss
- The Dangers of Fad Diets and Losing Weight Too Quickly
- How to Get Over Your Weight-Loss Plateau
Original article was published September 3, 2024.
