Your choices: Exploring weight-loss medication vs surgery

The debate on medical weight loss versus surgical weight loss has escalated as weight loss medication reaches the mainstream in Australia and abroad. Patients are often confused as to which one is more effective. However, it's not always a matter of one over the other: it's important to find the right treatment for the right patient.

Here, we'll discuss the factors that you and your doctor should consider when assessing your options.

From the evidence at hand, through to the long-term effectiveness and side effects, we'll guide you through the key considerations.

No time to read it all? Here's a speedy summary:

• The decision to pursue weight loss treatment should be made with your doctor.
• While the evidence base for bariatric surgery is larger, drug companies and research bodies are investing significantly in weight loss medication research to fill the gap.
• Regardless of your treatment option, you may regain the weight. However, preliminary studies tend to reveal that this may be a more rapid process with weight loss medications than with surgery.
• Both surgery and medication come with a risk profile that will need to be considered in consultation with your doctor.

What are weight loss drugs?

You've likely heard of "Ozempic", "Mounjaro", or GLP-1s, but not everyone knows exactly how they work. This class of drugs works by suppressing your appetite and slowing the emptying of your stomach. You feel less hungry, and, as a result, tend to consume less food.

What is weight loss surgery?

Bariatric surgery also reduces appetite in its effect on the “hunger hormone”, ghrelin. With weight loss surgeries, there are a number of procedure types available. This means it can be tailored to the individual's needs. However, a general understanding of the procedure is reducing the stomach's capacity in order to limit an individual's ability to consume a higher volume of food.

The Evidence

Ozempic for weight loss has only been studied for a handful of years, whereas weight loss surgery (sleeve gastrectomy and gastric bypass) has been extensively studied and performed for over 20 years. The long-term effects of Ozempic are unknown. Meanwhile, weight loss surgery has been repeatedly shown to be the only intervention that achieves an impact on long-term health. Large cohort studies in the USA and Sweden have shown a life-extending result for obese patients who have undergone bariatric surgery.

Ozempic is designed to be taken long-term under the supervision of a healthcare professional if it is well-tolerated, though the recommended length of time has not been established and would likely be different for each patient. Personalised care is vital in both the case of weight-loss surgery and medication.

Side Effects

All medications and surgeries come with side effects, and the side effects of procedures and treatments are sometimes not known for years or decades down the line.

There are far-ranging and serious side effects associated with the use of Ozempic, many of which are clearly outlined on their website under Important Safety Information. These range from nausea and vomiting to kidney failure, tumours and cancer. These drugs are also not recommended if you suffer from mental health issues such as depression and suicidal thoughts. It's also possible for these drugs to be ineffective: some surveys reveal that they are ineffective for up to 1 in 4 patients. One of the main issues with Ozempic is that in order to increase your weight loss, the dosage must be increased, which in turn increases the side effects. For some patients, this can make daily life near unbearable (e.g. persistent nausea and diarrhoea). For that reason, many patients cease taking it long before they see any real results.

Many of the risks of bariatric surgery are the same risks associated with the majority of surgeries performed under general anaesthesia. However, the most common long-term side effects are vitamin and mineral deficiencies, eating disorders, and reflux.

These should not be unstated – they will form an important part of your discussions with your medical team and surgeon.

Treatment Duration

Bariatric surgery is intended to be a permanent tool to assist with weight management. Much of the uncertainty around Ozempic and weight loss medications comes from a lack of information about sustained results. Studies are proliferating at a rapid rate, with a common conclusion becoming apparent: discontinuing weight loss medications results in regaining the weight lost. This can be up to two-thirds of the weight, up to a year post-treatment.

Although weight regain after bariatric surgery is not uncommon, this tends to be around 15 to 25 per cent, and tends to be less for patients who adhere to regular check-ins with their health practitioners.

Extent of Weight Loss

The weight loss results for bariatric surgery are about 2 – 3 times higher over the same period of time. On the average dose of Ozempic, patients are likely to lose about 7% of their total body weight over 18 months, compared with losing 50 – 70% of their excess weight over the same period, having had bariatric surgery. So, for example, a patient weighing 130kg may only lose around 9.1kg on Ozempic over 18 months versus losing around 35kg with surgery in the same amount of time.

Costs of treatment

Granted, weight loss surgery is not cheap, especially if you don’t have private health insurance, but the cost of using weight loss medication is an ongoing cost. For weight loss, one month’s supply in Australia can cost between $150-$350 depending on dosage and this doesn’t include the ongoing GP visits in between. Considering that the expected weight loss from Ozempic can be slower, this might make it a less appealing option for patients looking to lose large amounts of weight.

The Verdict

There's only one way to find out which weight loss treatment option is right for you, and it's to speak with your primary healthcare physician. It's also important to consider that weight loss isn't necessarily beneficial to your health, and many of the reasons people are opting for weight loss medications have to do with aesthetic concerns. The first step is to speak with your doctor: they can explain your options to you in a way that's tailored to your unique situation.

And, of course, no treatment for any health condition stands alone without appropriate nutrition and mental health support. Food choices tailored to your own needs, regular exercise, and regular check-ins with your healthcare team are the best way to ensure a happy, healthy life.

*Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252.

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