Bariatric Surgery or Weight-loss Drugs? How About Both

Weight-loss surgeries are proven to help overweight people lose weight and keep it off permanently, with limited risk. Now a slew of drugs are being prescribed with the same promise.

In certain cases, a combination of the two might help you the most.

Why Start with Weight-Loss Surgery?

For decades, doctors have used weight-loss, or bariatric, surgeries, to help overweight and obese patients lose significant amounts of weight. Today up to 2 percent of people worldwide have these procedures performed annually, usually laparoscopically, meaning the surgeons use small incisions to reach and alter the patient’s stomach area. Together with dietary changes, regular exercise and, often, behavioral therapies, heavy and obese individuals can drop large amounts of weight — and keep it off.

The sleeve gastrectomy and the Roux-en-Y gastric bypass are used most often today, and they have these benefits:

• It’s a one-time fix. Once you recover from surgery, you won’t need to do more than eat small portions in one sitting and take vitamin supplements daily. It’s easy to keep your weight issue in remission following these surgeries since they involve anatomical changes. A sleeve transforms your stomach from extra large to extra small. A Roux-en-Y results in a very small pouch that can only hold so much food at one time.
• You won’t overeat. You’ll feel uncomfortable if you do, so you’re likely to stick with reduced portions of healthier foods.
• Insurance is likely to cover most costs. If you’re deemed eligible for bariatric surgery, chances are your insurance policy will assist with the financial aspect.

Is It Safe To Use the New Drugs, Too?

Over the past couple of years, some overweight people have started using drugs instead of, or in addition to, weight-loss surgery. Semaglutide, liraglutide and tirzepatide are the primary options available, each available under brand names. Some are marketed specifically as a way to shed pounds, while others are designed to treat conditions such as Type 2 diabetes or nonalcoholic liver disease, but are prescribed “off-market” for weight-loss purposes.

In general, these pharmaceuticals decrease gastric emptying, which means your stomach will empty more slowly, and increase satiety, which means you’ll feel full and satisfied more quickly. The body mass index requirement is lower from the drugs than for bariatric surgery, so these might be the only choice if your BMI is only a little too high.

Like any medical solution, the meds, too, have downsides.

• You’ll have to take some forever. If you stop, your hunger and weight will return. Being overweight is a chronic disease like hypertension; if you stop taking the medication, the condition can return.
• Side effects might not be known. These products haven’t been around long enough for doctors to have identified all of the long-term side effects. Headaches, diarrhea, nausea, constipation, dizziness, fatigue, hypoglycemia, abdominal pain, palpitations and indigestion have been reported.
• They may not work with other drugs you’re on. “Contraindications” might dictate that you’d have to stop something else that benefits your health in order to use the weight-loss medication.
• They can be expensive. Some have high price tags, and your insurance plan might not cover the cost.
• Family history matters. If relatives have had medullar thyroid cancer or multiple endocrine neoplasia, this might not be a solution for you.

When It’s Best To Combine Weight-loss Surgery and Meds

If you’ve ever been on a diet, you know that at some point your weight will plateau. Day after day, the scale just won’t budge. Following bariatric surgery, this often occurs after losing 10 percent to 30 percent of excess bodyweight. That takes from three to 12 months. Plateaus are natural. They are your body’s way of protecting you from starvation. After all, there’s no way to inform your metabolism that you chose to have a surgery that is meant to make you thinner.

That’s the sweet spot where weight-loss drugs might help you most. You can wait out the plateau; eventually your weight will stop dropping again if you continue to eat less, choose healthier foods and exercise. But the drugs will end the plateau sooner. Weight-loss drugs can be a great complement to bariatric surgery.

In limited cases, you might even be able to take one of these drugs temporarily, then resume your weight-loss journey without them.

Interested in following up weight-loss surgery with weight-loss drugs? Talk to your bariatric surgeon during or after your three-month post-surgical check-up. Your doctor will evaluate your situation, including your protein intake and exercise routine. Then the doctor will help you make the best choice for your body.