How does the newer weight loss medication, semaglutide, work to cause weight loss?
The latest hot trend in weight loss medications is the drug semaglutide, the active ingredient in Ozempic and Wegovy. This drug, which was developed to treat Type II Diabetes, mimics a metabolic hormone called GLP-1, which stimulates the body to produce more insulin when blood sugars rise after eating. It also slows the movement of food through the stomach thus curbing appetite. Semaglutide has been shown to be more effective than older weight loss medications, such as phentermine. Wegovy is a high-dose semaglutide and the only one FDA-approved for weight loss specifically. There are other newer diabetic medications, including Mounjaro (active ingredient is tirzepatide), which mimic two metabolic hormones (GLP-1 and GIP), affecting hunger and satiety and potentially producing somewhat more weight loss. These three drugs require weekly injections.
How does weight loss surgery work?
Bariatric surgeries, including the two most popular procedures, gastric sleeve, and gastric bypass, are powerful metabolic operations. Not only are there changes in anatomy by shrinking the stomach and/or rerouting the small intestine, but there are also profound changes in multiple metabolic hormones and pathways, making these operations very comprehensive in their effects. These metabolic changes curb hunger and increase satiety and are the most effective treatment for blood sugar management. Many bariatric patients come off their diabetic medications upon leaving the hospital and improve other related conditions, such as hypertension, high cholesterol, sleep apnea, soon after. Weight loss surgery produces proven mortality reduction and improved quality of life.
Does the weight loss resulting from each method compare?
Bariatric surgery is by far the most effective obesity treatment available today. The average weight loss with bariatric surgery is approximately two to three times that of semaglutide. Studies have shown that patients on semaglutide regain their weight after the medication is stopped. The metabolic changes from bariatric surgery can be effective for a lifetime, but there may be some weight recurrence after five to 10 years. Of course, either method must be accompanied by lifestyle changes for short or long-term success.
Are there differences in side effects and long-term safety?
The most common side effects from semaglutide are nausea, vomiting, diarrhea, and constipation. These can occur in approximately 74% of patients. There are no long-term safety studies greater than three years for high-dose semaglutide.
Bariatric surgery is typically performed with small incisions either robotically or laparoscopically. Patients do well and recover quickly. The GI side-effects are low but there is a risk of increased acid reflux of 15%-20% for sleeve patients. There are numerous long-term studies greater than 10 years. The mortality risk is almost zero and other serious complications are very low, especially with high quality programs and surgeons.
Is there a difference in cost?
Insurance coverage for weight loss medications is spotty, unfortunately, and Medicare does not cover Wegovy, so semaglutide for weight loss can run more than $1,000 to $1,300 per month. Since a patient needs to stay on the medication to be effective, these numbers can add up. Keeping the weight off for five years could exceed $60,000! Bariatric surgery may cost around $15,000 to $20,000. However, surgery is more commonly covered by commercial insurance and is universally covered by Medicare.
How do you choose between these options?
Bariatric surgery is less costly, safe with low side effects, results in significantly more weight loss, and is better for weight maintenance. The key to a successful and safe surgery is the highest quality multidisciplinary educational program, coupled with surgical excellence, a collaborative approach, and long-term follow-up.
However, the surgical and medical weight loss treatments can be complementary. Semaglutide may be used for patients who don’t qualify for surgery or who need to lose weight prior to surgery. It may be used after surgery if weight loss stagnates or if there is a concern for weight recurrence. A combination approach designed together with your surgeon may be the way to produce more dramatic, long-lasting results.
About the Expert:
Dr. Preeti Malladi is a board-certified, fellowship-trained leader in bariatrics as well as general surgery (acid reflux, hernias, and gallbladder issues). She founded Malladi Bariatrics and Advanced Surgery, a premier, award-winning surgical practice in Dallas and Plano in 2009. Dr. Malladi’s integrity and compassion for patients, paired with her extensive surgical expertise, have earned her a trusted reputation and outstanding outcomes. A Richardson native and JJ Pearce valedictorian, Dr. Malladi completed her bachelor’s degree in electrical engineering from Stanford University as a Presidential Scholar. First in her class at UT Southwestern Medical School, she continued her general surgery residency at UCLA and completed a two-year research fellowship in the field of tissue engineering at Stanford University which awarded her the McCormick Award for Women in Academic Medicine. She graduated from UCLA as the top chief resident in research. She honed her minimally invasive surgery skills during her fellowship at Northwestern University before establishing her practice in Dallas. Dr. Malladi has overseen multiple bariatric programs and is currently the medical director for bariatric surgery at Methodist Dallas Medical Center. She has authored numerous research papers and book chapters as well as presented throughout the U.S. Dr. Malladi has been named among D Magazine’s Best Doctors in bariatric surgery since 2012 in Dallas and Collin counties
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