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While obesity continues to be an area of concern in our society, the good news is that we have many available tools to address the issue:

• Medications such as appetite suppressants and GLP-1 analogs, with success dependent on continued use

• More permanent surgical procedures

• Lifestyle, dietary and behavioral modifications, which are important in all treatment choices and for overall health

Many factors contribute to an individual’s decision as to which therapy is best — medicinal or surgical — based on individual patient circumstances, such as the degree of obesity, presence of comorbid conditions, risk tolerance, availability, and cost.

Medications

A new class of medications called glucagon-like peptide-1 (GLP-1) agonists, initially designed to treat diabetes, has become popular for their secondary effects of weight loss. Examples include semaglutide (Wegovy and Ozempic) and tirzepitide (Mounjaro and Zepbound).

While they produce results very quickly, they can often cause drastic changes in appearance and patients will frequently regain most of their weight, sometimes more, after stopping the medication. There are not yet good studies demonstrating results or complication rates when these medications are used long-term.

Surgical Options

Bariatric surgery (gastric banding (Lap-band), sleeve gastrectomy, gastric bypass, duodenal switch) is generally much more effective than medical treatment for long-term weight loss as most surgical patients maintain significant weight loss many years after surgery. The general guidelines include a body mass index (BMI) > 40, or a BMI > 35 with an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea. Resolution of comorbid conditions can occur more rapidly following surgery due to the larger amount of weight loss. In fact, the American Diabetes Association has recommended referral for surgery for diabetics with a BMI > 35 since 2009.

Potential Complications

As mentioned previously, these weight loss medications are new and have not been well studied for long-term side effects, but common side effects already known include nausea, vomiting, diarrhea and constipation. Serious risks include pancreatitis and possible thyroid tumors.

Safety is a concern for many patients undergoing surgical procedures of any type and while serious complications of bariatric procedures are quite rare, usually less than 0.1%, they can include bleeding, infection, blood clots, internal leakage, and even death with long-term problems such as nutritional deficiencies, dumping syndrome, and need for further procedures.

Cost Factor

Cost is another important variable when choosing between surgical and medical treatment. These new drugs were developed for diabetic care, not just weight loss, so insurance coverage is not consistent and can frequently cost patients more than $1000/month. Since they are meant to be continued indefinitely to maintain weight loss, it can quickly become cost-prohibitive.

Bariatric surgery is frequently covered by health insurance. And while surgery has a higher up-front cost if not covered ($10,000–$15,000), it can still be a more cost-effective and permanent solution in the long run compared to only a year’s supply of a GLP-1 agonist that can be just as expensive and only temporary.

So, what is the answer?

While everyone must make their own healthcare choices, it is always advisable to become as informed as possible, understanding your options and how they affect your long-term health, as well as your pocketbook. Talk to your insurance provider as well as your doctor and don’t be afraid to seek a second opinion. Our team here at South Texas Surgeons is always available to meet with you and answer any questions you might have about your options for permanent weight loss surgery.