In the new year, many people focus on self-improvement, such as losing weight and exercising.

This year, there is a lot of buzz about promising weight loss results using injectable diabetes drugs. Glucagon-like peptide 1 (GLP-1) agonists, the diabetes drugs with semaglutide as the primary ingredient like Ozempic and Wegovy, have gained popularity and are associated with losing about 15% to 20% of total body weight.

The drugs work by mimicking the action of a hormone called glucagon-like peptide 1, causing the body to produce more insulin to lower blood sugar levels. This helps control diabetes. For weight loss, they appear to curb hunger and slow the movement of food from the stomach into the small intestine, causing people to feel full faster and longer, and thus, eat less.

The Federal Drug Administration (FDA) has approved Wegovy for the treatment of obesity and will likely approve more of the GLP-1 agonists for this use. It is important to note that these medications and surgery are not for people who need to lose a few pounds. These interventions are only for people who need to lose significant weight. 

As specialists in treating obesity, we are often asked about how these popular weight-loss drug solutions compare with weight loss surgery. 

For patients who are overweight or obese, losing weight is important to improving health, quality of life and reducing mortality. Everyone’s weight loss journey is a personal decision, with many available tools.

Here are a few things we know about these drugs vs. weight loss surgery:

• The drugs are expensive, between $800 and $1,200 or more a month, are in short supply and currently are not covered by insurance. Bariatric, or weight loss surgery, generally costs between $15,000 and $20,000. The surgery for people with a Body Mass Index (BMI) of 40 or greater or a BMI of 35 or more with diabetes, high blood pressure, sleep apnea or other comorbidities is covered by Medicare and most insurance.

• Use of the drugs can cause side effects in up to 75% of patients, including mild rapid heart rate, infections, headaches, heartburn, dizziness, vomiting, constipation, diarrhea and nausea. Bariatric surgery risks can include acid reflux, nausea and vomiting, infection and stomach obstruction. However, doctors consider the risks low compared with the health benefits. 

• While weight loss can be significant with the drugs, weight loss from bariatric surgery is two to three times more than with drugs. While only 5% to 10% of dieting patients are successful in the long term, most bariatric surgery patients can keep their weight off long into the future.

• The success and safety of bariatric surgery has been proven through time and research, with studies on the long-term safety of these procedures beyond 10 years. Since their use for weight loss is so new, long-term use studies of semaglutide-based drugs for weight loss have not been done. Doctors do not know if the drug will stop working, or even if it is safe to take long-term at a high dose.

• Beneficial hormone changes are caused by the drugs and bariatric surgery. However, the beneficial metabolic changes occur only while taking the drugs. Bariatric patients benefit from permanent metabolic changes from the surgery, offering a permanent weight loss solution when coupled with lifestyle changes. Also, bariatric procedures like gastric sleeve and gastric bypass are significantly more effective at triggering and maintaining weight loss. In part, this is because the surgical effect of increasing GLP-1 is higher than with injections.

• Regaining lost weight has been experienced by patients using semaglutide after they stop using it. Regaining weight is also a reality for some after bariatric surgery, with about one-fifth of patients regaining more than 15% of their weight five years after surgery. 

How patients embark on their weight loss journey is a personal decision. Bariatric surgery and GLP-1 agonists are just some of the tools available to support overall improvement in health and quality of life.

Semaglutide may be a viable choice for someone who needs to lose significant weight but does not qualify for surgery. These drugs can also be used to help support weight loss before surgery or after surgery for an extra boost if someone is struggling.

One thing is certain for all weight loss methods: permanent lifestyle changes are required to keep the weight off. Resuming old eating habits and becoming sedentary after losing weight, both of which contributed to the original problem, will result in weight gain.

The key to finding what works for you is partnering with an experienced physician who can create a plan that will work with your body, lifestyle and medical needs. 

Dr. Moses Shieh specializes in advanced laparoscopic, bariatric and general surgery and is founder of Surgical Healing Arts, a center serving Southwest Florida for surgical weight loss treatment, with an emphasis on follow up care for success. For information, visit SurgicalHealingArts.com.