An obese patient trying to decide between taking a medication like Ozempic or undergoing bariatric surgery should consider a few things first.
The two treatment modalities affect the body in similar ways, says Brandon Fadner, MD, FACS, a bariatric surgeon and medical director of the Center for Metabolic & Bariatric Surgery at St. Luke’s Health - Sugar Land Hospital. The prescription medicines Ozempic and Wegovy belong to a new class of drugs known as GLP-1 agonists. Ozempic is used to treat type 2 diabetes and Wegovy is prescribed to treat obesity. Both medications are the same drug, semaglutide.
Q: How can a diabetes medication cause weight loss?
"Obesity is a chronic medical condition that results from dysregulation of the body’s metabolic hormones. Bariatric surgery leads to a normalization of the majority of these metabolic hormones. By contrast, the medications target one specific metabolic hormone, Glucagon-like peptide-1 (GLP-1) which sensitizes the body to insulin which lowers one's blood glucose, and discourages the storing of fat tissue." Dr. Fadner said, “Both bariatric surgery and GLP-1 medications, like semaglutide, are effective because they address the underlying problem. Surgery offers a more comprehensive solution...with fewer needle sticks.”
Q: Who is a candidate for bariatric surgery versus GLP-1 medication?
There are many candidates for obesity treatment. Unfortunately, insurance coverage of treatment costs is not guaranteed. “Private insurance companies and government-funded health plans will only extend bariatric surgery coverage to patients with a BMI of 35 or greater. However, a BMI between 30 and 35 is still considered obese.” Dr. Fadner says. “Wegovy has a broader BMI coverage range of 27 and above. For a patient that has insurance coverage and a BMI between 27 and 35, Wegovy is a great option. If the patient does not have insurance coverage, the weekly injected medications can cost up to $1,300 a month.”
Q: Is the weight loss permanent?
"Every patient that walks through my door is educated on the fact that obesity is a chronic medical condition. I would be remiss if I said we could cure obesity." Dr. Fadner insists. "The metabolic effects of bariatric surgery are permanent. That said, between 5 and 10 years post-surgery, there is often an expected amount of weight regain. However, it is rare for a patient to regain all of their preoperative weight following a successful bariatric surgery. The medications don’t provide that same permanence and patients risk regaining most, if not all, of their weight once they stop taking the medications and do not adopt better nutritional and exercise habits."
Nonetheless, a second generation of GLP-1 medications is coming to market. The first drug of the second generation combines GLP-1 with a second metabolic hormone, GIP. "A newer drug, trade name Mounjaro, is just one more step in a very positive direction for the non-surgical treatment of obesity because it is affecting more metabolic hormones which in turn leads to better weight loss." Dr. Fadner says, offering additional options for patients with a BMI between 30 and 35.
These medications require close medical management and they should never be considered a mere weight loss drug or for patients whose BMI is below 30.
"People who are not obese should not take these drugs," he cautions. "If you're not obese then you're not going to benefit from these medications which cause a hormonal surge.”
For patients whose BMI is over 35, bariatric surgery is still a patient’s best option, says Dr. Fadner.
Q: What if an obese patient chooses neither option?
“Obesity is a real threat to a patient’s overall health, quality of life and life expectancy,” he insists. “The list of health issues that are exacerbated by morbid obesity are too numerous to mention but begins with high blood pressure, diabetes, and arthritis. I have seen patients regain their health following bariatric procedures like the gastric sleeve or the gastric bypass. My patients feel so much better and their health starts improving almost immediately,” he said.
Obesity is a complex disease process. As such, the treatment of obesity requires a multimodal approach with close, life-long, management. Obese patients who are considering treatment should consult with a qualified bariatric surgeon or obesity specialist to explore their options.