Weight loss medications vs. weight loss surgery: Which is right for you?

In the last few years, new injectable weight loss medications have dramatically increased in popularity. The new drugs are an important advance for treating obesity-but that doesn’t mean they’re the best option for everyone.

"Some treatments work better for one person than another, and the more tools we have available-including medications and surgical options-the better," says bariatric (weight loss) surgeon Timothy Snow, D.O., a surgeon at the Sentara Comprehensive Weight Loss Solutions at Sentara Martha Jefferson Hospital. Dr. Snow specializes in bariatric and minimally-invasive surgeries.

He explains the pros and cons of weight loss surgery versus medications and what you should know if you’re seeking help managing your weight.

Obesity: A disease in need of treatment

The introduction of injectable weight loss medications such as semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) has helped change the conversation about obesity. That’s a good thing, Dr. Snow says. "One of the great things about these new medications is that they’re helping more people recognize obesity as a chronic disease," he adds.

Experts now understand that obesity isn’t caused by a lack of willpower or simply eating too much. Rather, it’s a complex disease affecting your metabolism and the hormones that regulate hunger and cravings. Factors like genetics and medications can also affect body weight. "We’ve been trained to think that if you eat better, you’ll lose weight and be healthier, but it’s not that simple," Dr. Snow says.

Because obesity is a chronic disease, it requires long-term treatment. Medications and weight loss surgery can play different roles in that treatment journey, Dr. Snow explains.

Medical and surgical weight loss

Here’s how medical and surgical weight loss work:

• Injectable weight loss medications regulate hormones, so you feel less hungry and experience fewer cravings. They also slow digestion, helping you feel full longer.
• Weight loss surgery (bariatric surgery) reduces the size of the stomach, so you eat fewer calories. The procedure also removes hormone receptors in the stomach, so you experience fewer cravings after surgery and have positive changes to your metabolism.

How much weight can you expect to lose?

• Weight loss medications: In clinical trials, people lost about 15-20 percent of their body weight. In the real world, Dr. Snow says, people can probably expect to lose 8-14 percent of their total body weight.
• Bariatric surgery: Patients can expect to lose 25-45 percent of their body weight, depending on which type of surgery they have-meaning weight loss surgery can be two to three times as effective as medications, Dr. Snow notes.

In people with more severe obesity, medications may not be enough to help them reach a healthy weight. A person who weighs 350 pounds, for instance, might expect to lose about 50 pounds with the help of medications. Yet, they would still have obesity and be at risk for the diseases that often go along with it, such as Type 2 diabetes and heart disease. For those reasons, Dr. Snow says, surgery is often more effective for people with a body mass index (BMI) of 40 or higher.

Long-term outcomes of bariatric surgery and weight loss medications

There are other drawbacks to medications. People often experience side effects like nausea, diarrhea or constipation.

Patients should also consider the long-term picture, Dr. Snow says. People who stop taking the medications typically regain the weight they lost. Plus, not everyone wants to stay on a drug for the rest of their lives-and not everyone can afford to. The drugs are expensive, and insurance doesn’t always cover the cost.

Most insurance companies do, however, pay for bariatric surgery, Dr. Snow says. After surgery, patients usually have dramatic weight loss in the first one and a half to two years, then hit a new "steady-state" weight. A small subset of people regains the weight in the following years. But the majority stay near their new steady-state weight indefinitely.

Bariatric surgery safety

Weight loss surgery has been around for decades, and it’s only gotten better over time, according to Dr. Snow. "The technology and training have improved a lot over the last 20 or 30 years," he says.

He uses minimally-invasive procedures to perform several types of bariatric surgery. The procedures use small incisions, resulting in less pain and faster healing than traditional surgery. "While there are risks with any surgery, the risks of bariatric surgery are low-similar to the risks of other common procedures, such as appendix or gallbladder removal," he adds.

Surgery isn’t right for everyone, though. Patients with health problems like severe congestive heart failure or advanced lung disease are at higher risk of surgical complications. For them, medication may be a safer choice.

A combination weight loss approach

Sometimes, medications and surgery can work together. Patients with a very high BMI, for example, may have an increased risk of complications from surgery. Medications could help them lose some initial weight to reduce their risk before they undergo an operation.

And in the very small subset of patients who gain back some weight in the years after surgery, medication could help them return to a healthier weight. "As with other chronic diseases, such as diabetes or heart disease, some patients with obesity need multiple treatments," Dr. Snow says.

Finding the right weight loss solution for you

Neither surgery nor medications are a magic cure for obesity. "There is no easy fix," Dr. Snow says. Both weight loss surgery and medications must be combined with healthy eating, physical activity and lifestyle changes for long-term success.

He encourages patients not to rule out any options before they get the facts. "For a long time, there’s been a taboo against weight loss surgery. But that’s changing as more people recognize that obesity is a disease that can be treated," Dr. Snow says. "For the right patient, bariatric surgery offers long-term, effective weight loss-and better health."

Dr. Snow is a fellow of the American College of Surgeons and the American Society for Metabolic & Bariatric Surgery. He practices at the Sentara Comprehensive Weight Loss Solutions, where our team of bariatric surgeons, nurses, dietitians and clinic staff are with you from preparation to recovery and beyond. To learn more or schedule an appointment with Dr. Snow, call 434-654-5260.