Health
Does Weight Loss Surgery Outperform Popular Injections?
Health Points
- Bariatric surgery leads to significantly greater weight loss than GLP-1 medications over two years.
- Real-world results for weight loss injections often fall short of clinical trial data due to patient non-adherence.
- Choosing between surgery and medication depends on long-term goals, cost, and individual health conditions.
Weight loss medications like Wegovy and Zepbound have gained major attention for helping people shed pounds. But new research suggests that surgical options, such as sleeve gastrectomy and gastric bypass, are even more effective for those seeking lasting weight loss.
According to a recent study presented at the American Society for Metabolic and Bariatric Surgery, individuals who underwent bariatric procedures lost, on average, about five times more weight after two years compared to those receiving weekly injections of popular GLP-1 drugs.
Patients who had surgery dropped approximately 24% of their body weight — translating to an average of 58 pounds lost — while those using medication lost about 5%, or 12 pounds on average. Even people who stayed consistent with GLP-1 prescriptions for an entire year saw significantly less long-term weight reduction than those who chose 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.
The difference may be partly due to the way clinical trials are conducted. “What happens in a clinical trial might not actually be happening in the real world because people aren’t always compliant with medications,” noted Dr. Natalie Azar, NBC medical contributor, on the TODAY show.
Study co-author Dr. Karan Chhabra explains that patients in the real world may not have the same level of follow-up, and with more doctors — and even direct-to-consumer services — offering GLP-1 prescriptions, oversight may be lacking. “We have to take the prescribing of them much more seriously. I don’t think we can be giving them out like candy,” he emphasized.
Researchers analyzed over 38,000 people prescribed GLP-1 drugs and over 12,000 patients who had bariatric surgery. Findings showed that surgery offered “superior sustained, long term weight loss” for those eligible for both treatments. However, experts stress that GLP-1 medications remain a strong tool in the fight against obesity.
“We’ve never had such a good obesity medicine,” said Dr. Shauna Levy, an obesity expert and medical director at Tulane’s Bariatric and Weight Loss Center, who was not involved in the study. “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.”
GLP-1s mimic hormones to signal fullness, decrease appetite, and help some people lose weight — but usage must usually continue for life. “Since obesity is a chronic condition, patients must plan to take the medications for life to maintain their weight loss,” said Levy.
Yet, adherence is a major challenge. Up to 70% of people stop taking a GLP-1 drug within a year. Reasons include high costs, difficulty accessing ongoing prescriptions, loss of insurance coverage, and side effects. “Early discontinuation is a big part of why the medications are less effective in the real world,” said Chhabra.
Bariatric surgery, on the other hand, physically alters the digestive tract to reduce food intake. “Surgery is very, very effective and one and done,” Azar explained. Individuals can lose up to 50% of their weight post-surgery. “You have the tool with you always rather than going off or on, or having access or no access,” added Levy.
Cost over a lifetime can also be lower with surgery, Azar pointed out. Still, it’s not without risk — complications like bleeding, infection, and nutrient deficiencies may occur.
So, what’s the best approach for someone seeking lasting weight loss? Experts stress making the decision in partnership with your doctor, based on health goals and personal circumstances.
Levy suggests that patients ask themselves: “Do you want to take a medicine for the rest of your life?” Many people turn to surgery to stop needing daily medications. “If a patient wants a one-time treatment, surgery is the best approach because you get it once and the results last for at least a decade,” said Chhabra. However, there remains a risk for weight regain after surgery as well.
Desired weight loss amount also matters. Those hoping to lose more than 40-50 pounds may see greater results with surgery, while others may benefit from starting with medication. If someone does not want surgery or doesn’t qualify, GLP-1 drugs are a viable option.
Finally, pre-existing conditions should be factored in. As Levy notes, “If somebody has acid reflux, it may get worse with a GLP-1, while bariatric surgery could put it into remission.” Each method has unique pros and cons, and the right choice is deeply personal.
