Bariatric surgery, weight-loss medication, or both? Navigating your options
September 5, 2024
Most of our patients have had a lifelong struggle managing their weight. They’ve tried dozens of diet and exercise plans, including “miracle” medications that failed to produce results. Today, patients can access a range of effective options, from bariatric surgery to anti-obesity medications known as glucagon-like peptide-1 receptor agonists (GLP-1RAs). You probably know them by their brand names: Wegovy, Zepbound, or Saxenda.
But one question remains: Is bariatric surgery or an anti-obesity medication the best option for sustainable weight-loss success?
For a growing number of patients, the answer is a combined approach.
To safely have bariatric surgery, patients are advised to first reach an optimal pre-operative weight or body mass index (BMI). Anti-obesity medications can help patients lose up to 20% of their body weight and qualify for surgery. Some continue to take the medication after surgery to help reach their ideal weight. For others, taking an anti-obesity medication as part of a healthy lifestyle can be an effective alternative to weight-loss surgery.
At UT Southwestern, patients get the full support of our Weight Wellness team to achieve their goals. Bariatric surgeons partner with endocrinologists, registered dietitians, psychologists, and primary care providers to create personalized, sustainable treatment plans for each patient, with wraparound health and nutrition guidance.
More than 41% of people in the U.S. have obesity, and many also have adjacent conditions such as heart disease, high blood pressure, and diabetes. While there’s no magic pill or procedure to cure obesity, our specialists can tailor and combine treatment options to support long-term success.
Some obesity-related health conditions
Bariatric surgery fast facts
How it works: Bariatric surgery makes permanent changes to your anatomy to help you lose weight and sustain weight loss over time. UT Southwestern bariatric surgeons have performed more than 4,000 minimally invasive procedures, including:
- Laparoscopic sleeve gastrectomy: Removes about 90% of the stomach, leaving a much smaller “sleeve” to hold and digest food.
- Laparoscopic Roux-en-Y gastric bypass: Makes the stomach smaller and bypasses part of the small intestine.
- Laparoscopic adjustable gastric banding (Lap-Band): Places an inflatable balloon-type device around the stomach.
More than half of the patients we see for bariatric surgery have tried at least one anti-obesity medication without success. In some cases, the side effects were intolerable, so they stopped taking the medication. For others, the idea of taking an expensive medication long term was intimidating – some patients prefer the more permanent solution that surgery can provide. In general, candidates for bariatric surgery have a BMI of 35 or more and an obesity-related condition.
What to expect: The process of preparing for bariatric surgery takes several months of personal commitment. Patients must quit smoking, achieve their pre-surgery goal weight, and visit with a nutrition expert and mental health professional prior to surgery.
After surgery, patients must be mindful of what, how much, and when they eat to avoid gastrointestinal distress and unintended weight gain. Excess weight will steadily come off over one to two years with healthy lifestyle choices and follow-up care from an obesity specialist.
For many, the work is worth it. Bariatric surgery can put Type 2 diabetes, obstructive sleep apnea, and cardiovascular disease into remission. People who have bariatric surgery can lose 77% of excess weight within one year after surgery, and the average patient can maintain 50% of excess weight loss over five years.
Cost: Most insurance providers, including Medicare, cover bariatric surgery. Without coverage, the cost can range from $10,000 to $20,000.
Related reading: Bariatric Surgery FAQ
Possible side effects
* Nausea and vomiting
* Diarrhea
* Indigestion
* Loss of appetite
* Headache
* Dizziness
About anti-obesity medications
How they work: Anti-obesity medications mimic the effects of bariatric surgery, making patients feel less hungry and feel full sooner and longer after eating. Though most are injectable medications, the U.S. Food and Drug Administration approved the first GLP-1RA pill, Rybelsus, for Type 2 diabetes treatment (not specifically for weight loss) in 2019.
What to expect: The amount of weight loss depends on a patient’s unique physiology and how well they can maintain lifestyle changes. While every person is different, GLP-1RAs have been shown to help reduce weight by an average of 15%. If the dose is started too high or increased too quickly, some patients have disruptive gastrointestinal symptoms.
Cost: Most insurance providers cover GLP-1RA medications for diabetes, and some cover these drugs for weight loss. Out-of-pocket costs to get the medication without coverage can be $1,000 or more a month. For many people, bariatric surgery is a more cost-effective option in the long term.
Related reading: Weight-loss medications: The 5 most-asked questions
How can anti-obesity drugs help before, after bariatric surgery?
Before: Anti-obesity medications can help patients reach their pre-surgery weight goal quicker than with diet and exercise alone. Researchers are building a base of knowledge for long-term success – GLP-1RAs are still relatively new as a weight-loss treatment.
Though GLP-1RAs were originally designed to treat Type 2 diabetes, research shows that these medications can prevent diabetes and decrease the risk of heart attack and stroke in patients who are at high risk with no diabetes history.
After: In 2023, UTSW endocrinologist and obesity specialist Jamie Almandoz, M.D., led a study to understand the effectiveness of anti-obesity medications in helping patients manage their weight after bariatric surgery. The 207 patients in the study were, on average, eight years out from bariatric surgery and had regained more than 40% of the weight they had lost. After taking an anti-obesity medication for at least three months, patients had lost an average of 8.8% of their body weight on liraglutide (Saxenda) and 12.9% on semaglutide (Wegovy).
Whether patients choose medication, surgery, or both, the lifestyle changes required are similar. Dietary recommendations are clearly spelled out for patients who have bariatric surgery, with plans customized to each patient’s needs.
Nutritional guidelines do not currently exist for anti-obesity medications, but UTSW is leading the charge to give patients sustainable dietary recommendations. In 2024, Dr. Almandoz, Director of UTSW's Weight Wellness Center, co-authored a first-of-its-kind review to inform future nutritional guidelines for patients who take weight-loss medications. While eating less of the average American diet can lead to weight loss, doing so can increase the risk of malnutrition, heart disease, and diabetes due to a possible deficit of certain nutrients.
Working together for your best health
Weight management is a lifelong process, regardless of the initial path to weight loss. No one should have to take that journey alone. For the best chance at sustainable success, partner with an obesity specialist to create a comprehensive, individualized plan. Together, we can help you find the right balance of strategies and treatments to achieve your long-term health goals.
To talk with an obesity specialist, call 214-645-8300 or request an appointment online.
