Comparing GLP-1s and Weight Loss Surgery Options

You know you’re ready to lose the weight, keep it off, and get your life back. That’s fantastic!

But you’re not sure how to lose the weight just yet. You’ve heard about bariatric surgery, and also about weight loss medications such as Ozempic and Mounjaro. Which of these two solutions is right for you?

Let’s walk through that question together.

What Are GLP-1 Receptor Agonists, and How Do They Work For Weight Loss?

Weight loss medications like Ozempic and Wegovy (whose active ingredient is Semaglutide) and Mounjaro and Zepbound (whose active ingredient is Tirzepatide) are a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 is a hormone which is secreted by our intestines when we eat. This hormone tells our body to produce insulin. It also tells our brain that we are full, which slows digestion. 

These medications mimic the GLP-1 hormone. When you take a GLP-1 receptor agonist, the medication tells your body to produce more insulin, which is why these medications are used to treat type 2 diabetes. It also tells your body that you’re full, which is one reason that Semaglutide and Tirzepatide help patients to lose weight.

How Effective Are These Medications When It Comes to Weight Loss?

These new medications are substantially more effective than prior generations of weight loss drugs when it comes to helping patients to lose weight. One clinical trial found that patients who took Semaglutide lost an average of 12.4% more of their body weight compared to the placebo group. Another trial found that patients who took Tirzepatide lost an average of 17.8% more of their body weight compared to the placebo group. It’s important to note that this weight loss only occurred in the context of pairing these medications with dietary and exercise changes.

It’s also important to note that these numbers are averages, and not all patients lose even this much weight. In the Semaglutide clinical trial, only 60% of patients saw weight loss of 12.4% or more of their body weight. In the Tirzepatide clinical trial, only half of patients saw weight loss of 17.8% of their body weight or more. Some patients take these medications and experience substantially less weight loss.

These medications also don’t change the patient’s body. They mimic the secretion of a hormone, but nothing else. What this means is that, if you want to lose weight and keep it off via these medications, then you will need to keep taking these medications for as long as you want the weight to stay off. When patients stop taking these drugs, they often find that they regain weight back to their starting point.

What Is Bariatric Surgery, and How Does It Work For Weight Loss?

Bariatric surgery works by restricting the size of the patient’s stomach so that they get full faster and feel full for longer. This is called a restrictive surgery. For example, duodenal switch surgery involved removing about 85% of the patient’s stomach, leaving a thin tube-like stomach about the diameter of your index finger 

Some surgeries, such as duodenal switch surgery and gastric bypass surgery, also reroute the intestines so that food bypasses part of the stomach and small intestines. Your stomach and intestines will still break down food, but the rerouting means that you will absorb fewer nutrients from a meal than you did before. This called a malabsorptive surgery. 

How Effective Is Bariatric Surgery When It Comes to Weight Loss?

Bariatric surgery has helped many patients just like you to lose weight, keep it off, and build the wonderful life that they deserve. In conjunction with diet and exercise, surgical weight loss can help patients to lose 65-100% of their excess body weight and keep it off. At the BMCC, our duodenal switch patients lose an average of 90% of their excess body weight within 9 months and keep it off. Imagine how that would feel.

Bariatric surgery can also relieve many problems that are associated with obesity. Part of this is because these problems are caused or influenced by obesity, and so losing weight can resolve them. But bariatric surgery also has profound effects on your gut, brain, liver, pancreas, and kidneys; as well as on your muscle and even your bone. In fact, bariatric surgery is so successful at rewiring patients’ metabolic systems that it is sometimes referred to as ‘metabolic surgery.’ 

Bariatric surgery can prove very successful at resolving comorbidities such as sleep apnea, high blood pressure, high cholesterol, liver disease, and type 2 diabetes. In fact, duodenal switch surgery is effective at curing type 2 diabetes in up to 98% of our patients. The health benefits of weight loss surgery actually go far beyond weight loss.

How do weight loss surgeries compare to GLP-1 medications in terms of effectiveness? Most of these second-generation medications are simply trying to mimic a small portion of the benefit of bariatric surgery. In addition to reducing the size of your stomach and helping you to feel full faster and for longer, and the metabolic benefits to many of your organs and bodily systems, bariatric surgery also increases your GLP-1 levels just like Semaglutide or Tirzepatide. This powerful 1-2-3 punch can level the playing field in your battle against obesity. In the recent head-to-head trial, bariatric surgery was found to be 5 times more effective that GLP-1 drugs at the end of 2 years.

What Are the Potential Side Effects of GLP-1 Receptor Agonists?

Unfortunately, second-generation weight loss drugs do come with substantial risks. Side effects are common, and can include nausea, diarrhea, vomiting, and constipation. Side effects can also be more severe. One study found that Semaglutide patients suffered from an increased risk of gastroparesis (stomach paralysis), though it’s not clear if gastroparesis in this case was temporary or permanent. Patients of all four weight control medications also suffer from a higher risk of developing endocrine tumors, pancreatitis, and possibly cancer.

One study found that 81% of Tirzepatide patients suffered at least one side effect. The most common side effects were nausea (35.5% of patients), diarrhea (21.1%), constipation (20.7%), and vomiting (16.3%). While more severe side effects were less common, a full 7% of patients reported such severe symptoms that they had to stop taking the medication.

What Are the Potential Side Effects of Bariatric Surgery?

Compared to drugs like Ozempic and Wegovy, the risks of bariatric surgery are minimal. International studies have found that only 6-7% of patients experience complications, most of which are very easily treated and effectively resolved. At a certified ASMBS comprehensive MBSAQIP center like the BMCC, your risk is no greater than it would be for any minor outpatient procedure such as gallbladder surgery. In fact, for many of our patients, bariatric surgery is an outpatient procedure with many patients going home the same day as their surgery.

At the BMCC, our complication rate is very low, and most potential complications are preventable by simply following our thorough safety protocols. In the unlikely event that a minor complication does occur, our double-board-certified bariatric surgeon personally commits to working with you every step of the way to resolve the complication.

Are Weight Loss Medications Right For You?

Weight loss medications can be the right approach for some people to lose weight. The weight loss benefits of medications like Ozempic and Mounjaro are real, even if they are modest.

One of the biggest issues with these medications is the cost. These medications typically cost from $500 to $1,300 per month, or $6,000 to $15,000 per year. Many insurers also don’t cover these medications. Depending on the region, around 70-97% of Americans in 2024 didn’t have insurance coverage for these drugs, and Medicare and Medicaid also don’t cover them. What this means is that most patients have to pay the entire cost of these medications out of pocket.

Because these medications only work for as long as they’re taken, this means that patients who want to lose weight with drugs like Ozempic have to keep taking the drugs—and keep paying thousands of dollars every year—for as long as they want to keep the weight off. That cost can reach tens or even hundreds of thousands of dollars over several years.

These medications also aren’t necessarily effective at treating obesity. If a person weighs 300 pounds and loses the average 17.8% of their body weight from taking Tirzepatide, then that only translates to weight loss of around 50 pounds. If you suffer from obesity, that’s unlikely to get you down to your ideal weight.

These medications can be good for people who don’t suffer from obesity and who just want to slim down and lose a few pounds. They are also effective at treating type 2 diabetes, and some of our patients continue to take these medications for this reason. However, if you suffer from obesity and want your best chance of losing weight and keeping it off, then second-generation weight loss medications may not be the right approach.

To recap: if you’re wondering “What should I consider before choosing between GLP-1s and weight loss surgery?” the answer is that you should consider several factors. Look at your long-term weight loss goals, the cost of each approach, and the risks and side effects of medications versus obesity. If you would like more guidance, feel free to give our friendly office staff a call.

Is Bariatric Surgery Right For You?

Bariatric surgery isn’t the right solution for everyone. For one thing, at the BMCC we only offer surgery to patients who suffer from class 2 or Class 3 obesity (meaning that they have a BMI >40, or a BMI >35 with obesity-related comorbidities). If you just want to lose a few pounds, then bariatric surgery is not the right fit.

But if you’re suffering from obesity and you want a lifelong tool that delivers the best possible weight loss, we highly recommend that you consider bariatric surgery. The benefits of bariatric surgery are remarkable. It is safer and more effective than second-generation weight loss drugs. It’s also more affordable than these medications in almost all cases.

Most of our patients say that the decision to undergo bariatric surgery was the best decision they ever made.

“We were no longer prisoners in our own bodies, we were no longer handicapped by our weight, we were living and moving and feeling better than we had felt in so many years.”—Lisa and Chris Chesrown, duodenal switch patients. If you’re suffering, don’t wait. Contact our Denver office today.