While GLP-1 drugs have become a game-changer for people trying to lose weight, bariatric surgery remains excellent when it comes to total and sustained weight loss, a new study found.
Patients who underwent sleeve gastrectomy or gastric bypass lost about five times the weight two years later than those who received weekly injections of semaglutide or tilzepatide (active ingredients for anti-obesity drugs and Zepbound, respectively) reported Tuesday, June 17th at the American Society Conference for Metabric and Viaatrik Surgery.
This was converted to bariatric surgery patients who lost 24% of their body weight compared to average 58 pounds or average 12 pounds (average 58 pounds) for patients who had a GLP-1 prescription for at least 6 months.
Even those who took GLP-1 medications continuously for a year were significantly reduced than those who underwent surgery.
“While clinical trials show a weight loss of 15-21% in GLP-1, this study suggests that weight loss in the real world is significantly lower,” said Dr. Avery Brown, the lead research author and surgical resident at Nyu Langone Health, in a statement.
“People don’t always follow drugs, so they may not actually happen in the real world,” said Dr. Natalie Hazard, a medical contributor at NBC, on June 18th.
This may be because clinical trials often take place in idealized settings with experienced physicians and very close follow-ups, says Dr. Karan Chhabra, senior research author at the NYU School of Medicine, a bariatric surgeon and assistant professor.
“As more and more doctors enter the business of GLP-1 prescriptions, there are these consumer options to get GLP-1 medications. I think a lot of people are given without careful monitoring,” Chhabra tells Today.com.
“We have to take those formulas more seriously. We don’t think we can give them like candy.”
The new study included 38,545 people taking GLP-1 medications and 12,540 people who underwent one of the bariatric surgical procedures.
The findings show that bariatric surgery is associated with “super persistent and long-term weight loss” compared to GLP-1 in patients eligible for both options, the authors write.
However, GLP-1 drugs remain an important tool for treating obesity, says Chhabra.
Dr. Shauna Levy, an obesity medicine physician and medical director of the Center for Obesity and Weight Loss at Tulaine, agreed.
“We’ve never had a better obesity pill,” Levy tells Today.com. She has not been involved in new research and has been consulting for Novo Nordisk, the pharmaceutical company that manufactures Ozempic and Wegovy.
“There are many people who benefit from GLP-1, but they are still the best medication we have on the market to treat this disease.”
This is what you need to know about Semaglutide, a drug commonly sold as Wegovy and Ozempic.
Weight loss injection vs. surgery
GLP-1 drugs mimic at least one hormone produced by the intestine, signaling swelling and reducing appetite.
Because obesity is a chronic condition, patients must plan to take medication for their lives to maintain weight loss, Levy says.
However, Brown noted that up to 70% of people receiving GLP-1 drug termination treatment within a year. Early cancellations are a “big part” of why drugs are ineffective in the real world, says Chhabra.
The reasons why people may stop taking them include the high cost of weekly injections and the realization that they don’t need drugs after their weight goals have been met, experts say. Patients may lose coverage from their insurance, Hazard noted.
Because drugs also have side effects, some people wonder whether GLP-1 drugs like Ozempic are safe for weight loss in the long term.
Doctors have known for a long time that bariatric surgery has a higher potential for weight loss. This is because it permanently changes the digestive system by reducing the stomach and limiting the amount of food a person can eat.
The surgery was “very, very effective” and “one and completed,” Azar pointed out.
Patients lose 20-50% of their weight, Levy says.
“You’re not off, on, or you have access or you don’t have access, you always have the tools with you,” says Levy.
Surgery may be more cost-effective for a patient’s lifetime than taking medications throughout his lifetime, Azar added.
The drawback of the surgery is that it is invasive and has potential complications and side effects such as bleeding, infection, and malnutrition.
Which is better: GLP-1 or bariatric surgery?
It’s a conversation you have with your doctor, experts say.
Levy raises these questions to patients:
Do you want to take medicine for the rest of your life?
“A lot of people do that when they have bariatric surgery because they want to take their medicine off. They want to stop taking blood pressure or cholesterol medication,” says Levy.
“So taking GLP-1 for the rest of their lives may not be what they want to do.”
If a patient wants a one-off treatment, the surgery is the best approach, as it gets it once and the outcome lasts for at least 10 years, adds Chhabra.
However, surgery could also lead to relapse of weight, Levy points out.
How much weight do you want to lose?
On average, people lose 40-50 pounds on GLP-1 drugs, but surgery has increased the likelihood of losing weight, says Levy.
“If you’re interested in losing more weight, bariatric surgery might be the right answer for you,” she says.
However, if the patient is not eligible for surgery or does not want invasiveness, the medication is a good option, says Chhabra.
What is your existing state?
If someone has acid reflux, it can get worse with GLP-1, but bariatric surgery can make it into remission, says Levy.
This story first appeared on Today.com. More from today:
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