Bariatric Surgery or Weight-Loss Medication

Which weight-loss treatment is best depends on your age, health and goals

Are you trying to get healthier by losing weight — but hitting barriers to your goals? If you’re cycling through workout programs and cleaner diets, but still aren’t shedding the extra pounds you need to become the healthiest version of yourself, it may be time to consider other options.

“Obesity is a complex condition with many causes and is not simply a lack of willpower — that’s a misconception,” says Ryan Horsley, DO, a bariatric and general surgeon at Geisinger. “Obesity is caused by biological, hormonal and metabolic factors outside our control, and it’s a chronic condition just like diabetes or high blood pressure.”

Thankfully, proven weight-loss treatments can help. Bariatric surgery is a safe, effective procedure that offers significant weight loss and remission of obesity-related diseases. But with the rising popularity of prescription weight-loss medication , you may be weighing your options carefully and wondering which is right for you.

Weight-loss drugs and bariatric surgery are the most effective treatments for obesity, but the decision on which path to take depends on your age, health conditions and weight-loss goals.

“Doing your homework and consulting with your healthcare team are essential to determine which weight-loss treatment is appropriate for you,” says Dr. Horsley. “Together, you can assess your specific circumstances and weight-loss goals, BMI (body mass index), medical history and overall health to identify the best course of action to optimize outcomes and minimize risks.”

What is bariatric surgery?

Bariatric surgery, or weight-loss surgery, is an effective treatment to help you achieve long-term weight loss and improve related chronic conditions when traditional weight-loss methods aren’t enough.

There are several bariatric surgical options. Most commonly performed are gastric bypass and sleeve gastrectomy, which permanently modify the digestive system to support weight loss. Some procedures limit how much you can eat, while others work by reducing the body’s ability to absorb fat and calories from the food you eat, or do both.

“With bariatric surgery advancements to use minimally invasive techniques with smaller incisions, patients have less pain, fewer complications, shorter hospital stays and faster recoveries,” says Dr. Horsley. “In fact, complication rates for these surgeries are lower than common procedures like gallbladder removal, hysterectomy and hip replacement.”

Am I eligible for bariatric surgery?

To be eligible for bariatric surgery, you must meet 1 or more of these medical guidelines:

A BMI of 40 or higher, which indicates extreme obesity
A BMI of 35 or greater and have a serious weight-related health condition, such as Type 2 diabetes, high blood pressure or sleep apnea
Unsuccessful attempts to lose weight through diet and exercise alone

How do weight-loss drugs work?

Today, many FDA-approved prescription medications for weight loss are available. Some work by reducing fat absorption, while others target appetite suppression or increase satiety — feeling full longer.

“Newer anti-obesity prescription weight-loss drugs like semaglutide (Wegovy® and Ozempic®) and tirzepatide (Zepbound®) have made headlines and swept social media feeds due to their effectiveness,” says Dr. Horsley. “They can be a beneficial option to treat obesity and Type 2 diabetes if you haven’t reached your weight-loss goals through diet and exercise alone.”

Am I eligible for weight-loss medication?

Weight-loss medication is meant to be used for medical — not cosmetic — reasons and there are certain criteria you must meet before getting a prescription:

A body mass index (BMI) of 30+
Or a BMI of 27+ and at least 1 weight-related condition like sleep apnea, Type 2 diabetes or high cholesterol

Bariatric surgery or weight-loss drugs: Which weight-loss treatment is best?

When weighing your options, assess the benefits and risks of each weight-loss treatment:

Benefits of bariatric surgery

Bariatric surgery affects more of the gut hormones than the medications can and may lead to more substantial and sustained weight loss — up to 40% of body weight — within the first year. In fact, research shows it’s a much more effective and permanent weight-loss solution.

In addition, bariatric surgery has been shown to improve or even resolve health conditions related to being overweight, such as heart disease, high blood pressure, high cholesterol, sleep apnea, Type 2 diabetes and fatty liver disease.

And fortunately, most insurance plans, including Medicare, cover bariatric surgery to treat obesity.

Potential downsides of bariatric surgery

While bariatric surgery is considered very safe, like any surgical procedure, it carries certain risks, including bleeding, infection and blood clots. And each type can lead to its own specific risks, such as nutritional deficiencies or dumping syndrome.

In addition, preparing for surgery can take several months of personal commitment, and patients must be healthy enough for surgery.

“If you’re considering bariatric surgery, you’ll first have a comprehensive evaluation by a team of healthcare providers, including a doctor, nutritionist or dietitian, psychologist and surgeon,” says Dr. Horsley. “You’ll need to meet specific medical, lifestyle and psychological guidelines to be eligible for weight-loss surgery.” `

Benefits of weight-loss medication

Conversely, weight-loss medication may be a good option for you if you’re moderately obese, not eligible for surgery or haven’t achieved sufficient results through diet and exercise alone. They’re less invasive than surgical options and can help you lose weight more effectively than lifestyle changes alone.

“Newer weight-loss medications like semaglutide average about 16% weight loss in clinical trials and the newest FDA-approved drug, Zepbound, shows up to 21% reduction in weight,” Dr. Horsley says. “For comparison, diet and exercise commonly max out at about 7%.”

Potential downsides of weight-loss medication

The downside of weight-loss medications is they require long-term use — possibly lifetime use — for sustained weight loss. Most people regain the weight in about a year after they stop taking the medication.

They also require a prescription and aren’t for everyone.

“A thorough medical evaluation is crucial to determine eligibility, as these medications may not suit everyone, especially if you’re pregnant or breastfeeding, have certain medical histories or are on specific medications that could cause interactions,” says Dr. Horsley.

Weight-loss medications also come with side effects like nausea, diarrhea or constipation and in rare cases, increased heart rate. And sometimes, their effectiveness decreases over time.

But the dealbreaker for many is the fact that insurance coverage varies and some plans don’t cover weight-loss drugs.

What about combining both weight-loss treatments?

For some people, the answer to which weight-loss treatment is right for them is combining both options.

If you have severe obesity and serious related health conditions, combining bariatric surgery and weight-loss drugs as part of a comprehensive weight-loss treatment plan can enhance outcomes.

“In some cases, patients not yet eligible for surgery due to medical reasons might find weight-loss drugs helpful to achieve weight reduction and make them eligible for surgery,” says Dr. Horsley. “In other cases, some patients hit a plateau or start to gain weight after bariatric surgery and can benefit from weight-loss medications.”

Weighing your options: Which weight-loss treatment is best?

If you’re having trouble losing weight on your own, talk to your doctor about your goals to help you determine the plan that best suits your needs. Everyone’s journey is different, and not all options are right for everyone.

To find a weight-loss treatment that’s best for you:

Determine your weight-loss goals
Understand your current health status and medical conditions
Consider the risk, recovery and cost commitments of each treatment

But whether you choose surgery, medication or both, they’re most effective when used as part of a comprehensive treatment program tailored to you.

“At Geisinger, our weight management team includes obesity medicine specialists, dietitians, bariatric surgeons, behavioral specialists and exercise physiologists to guide patients through each step of their personal weight-loss journey,” says Dr. Horsley.

Surgery and medications are not a quick fix. Instead, they’re meant to kick start your weight-loss journey, while building long-term lifestyle changes for sustained success.

“Obesity is a chronic, debilitating disease that can lead to serious health problems like diabetes, heart disease and sleep apnea,” Dr. Horsley says. “The good news is losing weight can lower your risk of chronic conditions. Even losing as little as 5% to 10% of body weight can provide significant health benefits and improve your quality of life.”