Are GLP-1 Drugs an Alternative to Bariatric Surgery?

The answer is no. Bariatric surgery holds a significant place in the weight loss continuum as the most effective long-term solution for patients with morbid obesity. While GLP-1 drugs can be an excellent option for patients with lower BMIs or used alongside bariatric surgery, there comes a point where they may not deliver enough weight loss or disease improvement on their own.

BMI Limits

While every patient is unique, GLP-1 drugs eventually reach a point of diminishing return. Once a patient reaches a BMI of about 40, bariatric surgery is generally more effective than medication alone.

Consider a 6’0” tall patient weighing 295 pounds with a BMI of 40. Their goal weight is 200 pounds and the ideal weight is closer to 180. Even at the upper limit of losing 25% of their body weight on tirzepatide (which was achieved by roughly one in four patients in Zepbound trials), he would lose 74 pounds, landing at 221 pounds, still above his target.

By contrast, with a Duodenal Switch, patients can lose up to 90% of excess body weight. In this case, that would equal a 108-pound reduction, putting him at 187 pounds, surpassing his goal and coming within seven pounds of his ideal weight.

The difference becomes more striking at higher BMIs.

To be sure, we must take BMI calculations with a grain of salt. They do not take into account the patient’s gender, body frame, or musculature. These nuances are always considered during consultation, but the numbers highlight why surgery often provides a more powerful outcome in higher-BMI patients.

Costs

There’s also the consideration of finances. While the cost of GLP-1 drugs has dropped over time, the simple fact is that patients will have to take them for as long as they wish to lose or maintain their weight. The cost of drugs can add up significantly over the years and often exceeds the cost of surgery, which has more lasting results (though no less hard work in the diet and exercise realm).

For example, if you pay cash for Wegovy, you might spend about $350 per month. Over time, the cost adds up: roughly $4,200 after one year, $12,600 after three years, and $21,000 after five years. Depending on the type of bariatric procedure, the cumulative cost of long-term injections can become comparable to, or greater than, the one-time cost of surgery.

To that end, patients should fully understand their costs and speak to our team about what makes the most sense for them.

The future of GLP ones and medical weight loss

As you have probably already seen, the future of medical weight loss is bright. GLP-1 drugs will continue to evolve, with refinements in dosing and delivery. Oral GLP-1 medications are on the horizon, offering added convenience even if they may deliver slightly less weight loss than injectable options. However, as we look ahead to the future, there are two significant things that patients must understand.

No matter how effective a drug or surgery may be, there is no substitute for lifestyle changes. Patients must prioritize improving their diet and exercise, regardless of the weight loss modality they ultimately decide upon.

Significant and rapid weight loss requires careful and comprehensive oversight by a qualified medical professional. There are risks associated with any weight loss modality, and GLP–1 medications are no exception. From gastrointestinal upset to the risk of osteoporosis in the future (due to potential muscle and bone mass loss), patients must have a clinical partner in their long-term weight loss program.

We look forward to your visit and hope to help you on your journey toward long-term weight loss and improved health.