Weight loss can be an overwhelming journey, especially when diet and exercise alone aren’t enough. Fortunately, there are now various options for those who are starting their weight loss journey. Surgery has been a long-proven method for significant and sustained weight loss, but I am regularly asked about the role that these newer weight loss medications can and should play in the care of patients with obesity.
There is a current popularity wave of injectable medications all in the category of GLP-1 receptor agonist. These include medications like Ozempic, Wegovy, Mounjaro, and Zepbound amongst others. In this post I am going to focus on Wegovy the most simply because it is the medication most people mention by name, but all these medications have similar function and efficacy. Let’s dive into some of the pros and cons of both surgery and GLP-1 medications to help better guide you in navigating these complex topics and help you understand which might be the best choice for you.
Wegovy: A newer medical approach to weight loss
Wegovy is a relatively new weight loss medication approved by the FDA. It belongs to a class of drugs called GLP-1 receptor agonists, which were originally used to manage diabetes but have proven to be effective for weight loss as well. Wegovy works by mimicking a hormone that targets areas in the brain responsible for appetite regulation, helping users feel full sooner and eat less.
Pros of Wegovy
- Non-Surgical Option
Wegovy is a non-invasive, injectable treatment that doesn’t require surgery. This makes it an appealing option for those who aren’t ready for surgery or don’t meet the qualifications. - Effective Weight Loss
In clinical studies, Wegovy showed promising results, with patients losing around 15% of their body weight on average. Many patients see improvements in related health conditions like hypertension, high cholesterol, and type 2 diabetes. - Flexibility and Convenience
Wegovy is administered once a week via injection, and patients can self-administer it at home. - Minimal Lifestyle Disruption
Since it doesn’t involve a hospital stay or significant downtime, most people can continue with their usual routines, including work and social commitments, without interruption.
Cons of Wegovy
- Side Effects
Common side effects include nausea, diarrhea, and constipation, particularly in the first few weeks. These side effects can be severe in some users which could necessitate stopping the medication. - Long-Term Commitment
Wegovy’s effectiveness relies on continued use, and there are concerns about weight regain if patients discontinue the medication. Studies point towards weight regain if the medication is stopped. - Cost and Insurance Coverage
Wegovy is expensive, and while some insurance plans cover it, most do not. Out-of-pocket costs can be significant, making it less accessible to those without comprehensive coverage. - Limited Long-Term Data
Since Wegovy is relatively new, there’s limited data on its long-term effects. This can be a concern for those who prioritize proven, long-term safety and efficacy.
Weight Loss Surgery: A Permanent Solution?
Weight loss surgeries, including gastric sleeve, gastric bypass, and lap band surgery, have been widely used for decades, providing an effective and often permanent solution to obesity. These procedures change the digestive system to help provide not only physical restriction, but to also lead to systemic hormonal changes to not only start weight loss but help to sustain this weight loss for the long term.
Pros of Weight Loss Surgery
- Significant and Sustained Weight Loss
Weight loss surgeries offer a more permanent solution, with most patients losing 60–70% of their excess weight within the first 12–18 months and with proper lifestyle adjustments can be maintained over the long term. - Resolution of Comorbidities
Most patients experience resolution or significant improvement in obesity-related conditions like type 2 diabetes, hypertension, and sleep apnea. - Proven Long-Term Safety and Efficacy
Weight loss surgeries have been studied extensively over several decades showing consistent excellent results. This has provided substantial data on long-term outcomes and potential complications, giving patients and healthcare providers a better understanding of what to expect. - Reduced Hunger Hormones
The same hormones changed by the injectable medications are also affected in the post-surgical patient leading to drastic changes in hunger and cravings as well as sustained changes in baseline metabolism. All of this combines to help make long-term weight management easier.
Cons of Weight Loss Surgery
- Surgical Risks and Complications
As with any surgery, there are inherent risks. These are overall very rare, but include infection, blood clots, and anesthesia-related complications. The modern surgery has minimal long-term issues like malabsorption, nutrient deficiencies, or need for revision surgeries. - Lifestyle Changes and Restrictions
After surgery, patients need to follow strict dietary and lifestyle changes. This includes eating smaller portions and avoiding certain foods. Adapting to these changes can be challenging for some individuals. - Extended Recovery Time
While recovery from the surgery itself is typically very quick, there is additional time required before patients are back to a more normal diet. Patients are restricted to an easy to digest liquid diet initially after surgery. - Cost and Insurance Nuances
While most insurance plans cover weight loss surgery, most insurance plans nowadays carry high deductibles so there may still be significant out of pocket costs.
Wegovy vs. Weight Loss Surgery: Which is Right for You?
Both Wegovy and weight loss surgery offer compelling solutions, but which one is best for you depends on several factors and these are the types of discussions I often have in person with patients in my office. These are generalizations but are a good place to start.
- Body Mass Index (BMI): Total weight loss from the medications is lower on average than from surgery and so treatments can sometimes be best selected based on the weight range we are starting with. For those with a BMI between 27–40, Wegovy may be effective, while individuals with a BMI over 40 might benefit more from weight loss surgery.
- Health Conditions: If you have severe obesity-related health conditions, the rapid, more predictable weight loss from surgery might provide greater health benefits.
- Readiness for Lifestyle Change: Weight loss surgery requires a greater commitment to lifestyle changes, while Wegovy allows more flexibility, but both require long-term dedication.
- Risk Tolerance: Wegovy comes with manageable but notable side effects, while surgery involves higher upfront risks with a more proven track record.
- Financial Considerations: Cost and insurance coverage can be decisive factors for many. Checking with your provider about coverage for either option is essential.
Conclusion
Wegovy and weight loss surgery both offer life-changing weight loss potential, but the best choice depends on individual preferences, health needs, and readiness for the journey. For those looking for a non-surgical approach and are willing to take a new lifelong medication, Wegovy might be ideal. For those ready for a more proven and long-term solution to significant and sustained weight loss, surgery may be the better route. Come in to see me and discuss your personal needs so we can help guide your weight loss journey.