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Weight Loss Surgery vs. GLP-1 Weight Loss Drugs: Which Is Right For Me?

Before and After BMI

September 29, 2022

Weight Loss Surgery vs. GLP-1 Weight Loss Drugs: Which Is Right For Me?

There are more ways than ever to improve your life, health, and happiness by losing excess weight. In addition to highly effective, safe, and accessible weight loss surgeries, powerful new GLP-1 medicines like Ozempic and Wegovy have entered the market in recent years that can trigger create substantial weight loss.

Semaglutide (sold as Wegovy and Ozempic) and liraglutide (sold as Saxenda and Victoza) make up a new generation of type 2 diabetes medications that are making waves for their powerful weight loss effects. Some studies on these drugs show an impressive 15% bodyweight loss over six months, while studies on a newer drug called irzepatide (sold as Mounjaro) show an astounding 22% weight loss over 6 months. Astonishingly, even more powerful medications are in development, and will likely become available in the next few years.

Those weight loss numbers are significant. For context, we know that losing just 5% of bodyweight has a tremendous metabolic benefit for high BMI individuals. Achieving triple or quadruple those results via these new medications has profoundly positive implications for that person’s health.

Picture of drug vialsHow Do Weight Loss Drugs Like Ozempic and Wegovy Work?

What do these new drugs have in common? They all stimulate the production of Glucagon-like peptide-1, or GLP-1, a hormone made in the gut to help signal that you’re full, along with other weight loss benefits (fewer excess calories stored, slower movement of food through the GI tract).   They can also create gastroparesis:  a condition where your stomach does not empty efficiently.

We know from bariatric surgery that this hormone increases post-surgery. In effect, these new medicines are cloning the hormonal effects of bariatric surgery, allowing patients to absorb this hormone exogenously (via injections) for the first time.

What Is More Successful: Weight Loss Surgery or Weight Loss Drugs like Ozempic and Wegovy?

Due to the effectiveness of these drugs, bariatric surgeons, weight loss experts, and prospective patients are asking the question: Should I try weight loss medication instead of weight loss surgery?

It’s worth noting that at this time, bariatric procedures like gastric sleeve, gastric bypass, and the duodenal switch are significantly more effective at triggering and maintaining weight loss. In part, this is because the surgical effect of increasing GLP-1 is logarithmically higher than it is with exogenous injections. Weight loss surgery is also a permanent solution — provided the patient sustains the necessary lifestyle changes — which is very different than needing weekly intravenous injections indefinitely.  Generally speaking, when patients stop the medications they will gain some (or perhaps all) of their weight back.

But there is another, bigger downside to these medications: many of our patients report that they are only available at extremely high cost. In fact, these drugs can sometimes cost a patient over $1,000 per month — for many people in need of a weight loss intervention, this is simply unaffordable.

Because demand for these drugs vastly exceeds supply — even at their high price, Big Pharma can’t get them on shelves fast enough — it is unlikely that these drugs will come down in price any time soon.

Consider this: after ten months of exogenous treatment via these weight loss drugs, the patient or their insurance company has paid for the equivalent of a gastric sleeve procedure, with the results from the surgery being notably better and longer-lasting.

Wegovy vs. Bariatric Surgery, Gastric Sleeve, and Gastric Bypass

Wegovy, another GLP-1 receptor agonist, has entered the spotlight for its weight loss benefits. Similar to Ozempic, Wegovy stimulates feelings of fullness, reduces appetite, and can lead to substantial weight loss. When comparing Wegovy to bariatric surgery, including gastric sleeve and gastric bypass, patients should consider the longevity and magnitude of weight loss. While Wegovy offers a significant advance in medical weight loss treatments and may be preferred for its non-invasiveness, bariatric surgery provides a more permanent solution with the potential for greater weight loss and improvement in obesity-related conditions. The choice between Wegovy and surgery should be made in consultation with healthcare professionals, considering the patient’s medical history, preferences, and lifestyle.

Am I Eligible for Wegovy?

Determining eligibility for Wegovy is an essential step for individuals considering this medication as part of their weight loss journey. Wegovy is specifically approved for adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related condition such as hypertension, type 2 diabetes, or high cholesterol. However, eligibility also depends on a thorough evaluation by a healthcare provider, who will consider your overall health, weight loss history, and any potential contraindications. Patients with a personal or family history of certain thyroid cancers, a rare condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or those who are pregnant, should not take Wegovy. A discussion with your healthcare provider can help determine if Wegovy is a suitable option for you.

Ozempic vs. Bariatric Surgery, Gastric Sleeve, and Gastric Bypass

Comparing Ozempic to bariatric surgery options such as gastric sleeve and gastric bypass is crucial for patients exploring weight loss solutions. Ozempic, a GLP-1 agonist, has shown promising results in weight management by mimicking the hormonal effects typically seen after bariatric procedures. While Ozempic offers a non-surgical alternative with significant weight loss outcomes, it’s essential to recognize that bariatric surgery often results in more substantial and longer-lasting weight loss. Bariatric surgery modifies the digestive system to support weight loss, leading to more significant metabolic changes compared to medication. However, Ozempic can be an attractive option for those seeking less invasive methods or for whom surgery is not recommended. Deciding between Ozempic and surgical options depends on individual health profiles, weight loss goals, and a thorough discussion with healthcare providers.

Who Is Eligible for Ozempic?

Ozempic’s eligibility criteria are similar to those of Wegovy, with some specific considerations. Originally approved for the management of type 2 diabetes, Ozempic has also demonstrated significant weight loss benefits, making it a dual-purpose medication for eligible patients. Adults with type 2 diabetes who are also looking to manage their weight may consider Ozempic, especially if they have a BMI that classifies them as overweight or obese and have at least one weight-related health issue. Like Wegovy, Ozempic is not suitable for everyone. It is not recommended for individuals with a history of certain thyroid cancers, MEN 2, or women who are pregnant or planning to become pregnant. As with any medication, a comprehensive assessment by a healthcare provider is crucial to determine if Ozempic is an appropriate treatment option for your specific health needs and goals.

Weight Loss Surgery vs Wegovy or Ozempic: Our Recommendation

Combo Therapy: A Win-Win

At BMI, we don’t view weight loss surgery and weight loss drugs as either-or options. Instead, we believe that whenever possible, the best therapy is combo therapy: weight loss surgery and GLP-1 drug treatment.

For instance, if a patient begins with weight loss surgery, and six months later, begins taking Ozempic drug, they can augment their overall weight loss results substantially — a significant advantage in the battle against obesity.

It’s worth noting that these drugs like Ozempic and Wegovy were developed using research conducted on weight loss surgery patients. In other words, they are proven to work effectively together.

How Long Does Wegovy Stay in Your System?

Understanding the duration Wegovy remains in the system is important for patients considering this treatment option. Wegovy’s active ingredient, semaglutide, has a half-life of approximately one week, meaning it takes about a week for the drug’s concentration in the bloodstream to reduce by half. Typically, it may take around 5 to 6 weeks for Wegovy to be fully eliminated from your system. This extended presence supports its once-weekly injection schedule, allowing for steady medication levels and consistent weight loss benefits over time.

Every Effective Solution Counts

GLP-1 drugs like Wegovy, Ozempic, Saxenda and Victoza represent an incredibly exciting breakthrough in bariatric science. With well over two-thirds of the country suffering from being overweight or obese — not all of whom are eligible for bariatric surgery — it is unquestionably good to have more safe, effective weight loss solutions to combat obesity, no matter the financial cost. 

That’s why we believe that choosing weight loss medication vs surgery is usually the wrong question: whenever possible, they should be combined together to maximize results. 

Put another way: when suffering from obesity, nothing is more important than safeguarding your health by making changes now. The only wrong choice is sticking with the status quo: the lifestyle choices that have not been working for you in reaching your weight loss goals.

Do you know if you qualify for weight loss surgery? Take the Quiz