Health
Weighing Weight Loss: Surgery Or Medication Results
Health Points
- Bariatric surgery leads to more significant, lasting weight loss than GLP-1 medications in real-world use
- GLP-1 drugs remain a valuable, less-invasive treatment option for obesity
- Personal health goals and medical factors should guide treatment decisions
Bariatric surgery may still be the gold standard for weight loss, according to new findings comparing it with popular GLP-1 medications such as Wegovy and Zepbound. Adults who had a sleeve gastrectomy or gastric bypass experienced nearly five times more weight loss over two years than those on weekly GLP-1 injections.
On average, those opting for surgery lost about 24% of their body weight, which is close to 58 pounds. In contrast, patients using GLP-1 medications for at least six months lost just 5% of their body weight, roughly 12 pounds. Even with consistent use for a year, GLP-1 drug users trailed behind the results seen with surgery.
“Clinical trials show weight loss between 15-21% for GLP-1s, but this study suggests that weight loss in the real world is considerably lower,” said Dr. Avery Brown, the study’s lead author and a surgical resident at NYU Langone Health. Dr. Natalie Azar, an NBC medical contributor, shared a similar perspective, emphasizing the gap between ideal clinical settings and actual patient experiences. “What happens in a clinical trial might not actually be happening in the real world because people aren’t always compliant with medications.”
Dr. Karan Chhabra, a bariatric surgeon and senior author of the study, pointed out that as GLP-1 drugs become more accessible—even direct-to-consumer—oversight becomes crucial. “We have to take the prescribing of them much more seriously. I don’t think we can be giving them out like candy.”
The research included over 38,000 people taking GLP-1 drugs and about 12,500 who chose surgery. Overall, the analysis showed surgery provided “superior sustained, long term weight loss” among patients eligible for both options.
Still, for many, GLP-1 medications offer an important alternative. Dr. Shauna Levy, an obesity medicine specialist, noted: “We’ve never had such a good obesity medicine. There are plenty of people that would benefit from GLP-1s, and they’re still the best category of medication we have on the market to treat this disease.”
Comparing GLP-1 Drugs and Surgery
GLP-1 medications mimic gut hormones that help people feel fuller, reducing appetite. Unlike surgery, patients need to stay on these medications long term to maintain weight loss, but rates of early discontinuation are high. According to Dr. Brown, up to 70% of patients stop GLP-1 treatment within a year.
“A big part of why these medications are less effective in the real world is that many people don’t stick with them,” explained Dr. Chhabra. High price, insurance limitations, and belief that the drugs are unnecessary after reaching weight goals all play a role, alongside side effects that can make the medications challenging for some to tolerate.
Bariatric surgery can be a one-time, highly effective intervention because it changes the digestive system to reduce how much food a person can eat. Patients typically lose 20-50% of their body weight. “You have the tool with you always rather than going off or on, or having access or no access,” Dr. Levy said. In some cases, Azar suggested, surgery may even prove more cost-effective over time than lifelong medication.
However, surgery comes with risks: “The downside of surgery is that it’s invasive and comes with potential complications and side effects like bleeding, infection and nutritional deficiencies,” physicians confirmed.
Personalizing the Right Choice
Experts recommend discussing the options with your doctor, considering your health needs and preferences.
“A lot of people, when they get bariatric surgery, are doing it because they want to come off medicines. They want to stop taking their blood pressure medicine or their cholesterol medicine,” said Dr. Levy. “So then taking a GLP-1 for the rest of their life may not be something that they want to do.” Surgery offers a lasting solution for many, but some may experience weight regain in the years after the operation.
The amount of expected weight loss also shapes the decision. On GLP-1 medications, most people lose 40-50 pounds; there’s greater potential with bariatric surgery. “If you’re interested in losing more weight, then bariatric surgery might be the right answer for you,” Dr. Levy said. Those who don’t qualify for or want surgery may find medications a suitable path, Dr. Chhabra added.
Pre-existing health issues may influence treatment. For instance, acid reflux could worsen with a GLP-1 drug but improve after surgery, according to Dr. Levy.
The bottom line for those over 40: Talk with your doctor to weigh the risks, benefits, and personal preferences. Both treatments can be effective when matched to your specific health goals, and expert guidance ensures the safest path to better long-term health.
