How to choose: Weight loss medications or bariatric surgery

Weight loss medications are gaining in popularity. But they may not be the best option for everyone. Some people, depending on their weight and medical conditions, may find more long-term success with bariatric surgery.

Weight loss medications and bariatric surgery serve different purposes. People looking to kick-start their weight loss journey may be candidates for weight loss medications, which are not meant to be taken long term. In most cases, patients who take weight loss medications without any other interventions lose only around 5% to 10% of their body weight.

Surgery is typically recommended for people with a body mass index (BMI) of 35 or higher, or if they have weight-related illnesses, such as diabetes, hypertension, sleep apnea or joint issues.

“Patients should have already tried multiple diets and worked with their primary care doctors to explore all other options before proceeding with bariatric surgery,” says Dr. George Mueller, medical director of bariatric surgery at Sharp Memorial Hospital.

Bariatric surgery is most effective for long-term weight loss

Both weight loss medications and bariatric surgery can help improve symptoms of weight-related illnesses, such as diabetes. However, when it comes to long-term health improvement, weight loss medications only work for as long as they are taken.

“To remain effective, these medications need to be taken routinely,” says Dr. Michael Morell, a board-certified general surgeon affiliated with Sharp Coronado Hospital, who performs bariatric surgery. “If these medications are stopped for an extended period, the benefits will stop, and patients may experience weight regain or a recurrence of diabetes.”

Bariatric surgery can also help address metabolic issues that cause obesity. For this reason, bariatric surgery is the most effective method for long-term significant weight loss, according to the National Institutes of Health.

“Surgical patients often experience increased energy and remission of certain conditions, including hypertension, Type 2 diabetes, sleep apnea and infertility,” says Dr. Morell. “Surgery can also decrease the risk for heart disease and many types of cancer.”

Both medication and surgery require lifestyle changes

While weight loss medications and bariatric surgery can make an impact, neither treatment is a magic cure. For long-term health benefits, people also need to make lifestyle changes.

“Weight loss medications are a good option to help patients start making lifestyle changes that support weight loss,” says Dr. Mueller. “This includes eating appropriate, quality foods along with portion control and exercise.”

The same is true for bariatric surgery, he says. Surgery is a weight loss tool but needs to be combined with long-term habits, including healthy eating and staying active.

Patients should consider possible side effects for each weight loss solution

As with any medication, weight loss drugs have several potential side effects.

“Weight loss medications cause food to stay in the stomach longer; that’s one way medications help curb a patient's appetite,” says Dr. Morell. “However, this may also cause nausea, vomiting, heartburn, reflux, gastritis, abdominal pain and bloating.”

Side effects for bariatric surgery can include leaks, bowel obstruction, reflux and “dumping,” when sugary foods are digested too quickly and cause discomfort. The risk for these side effects is low. This is particularly true when the surgery is performed by an experienced surgeon at a hospital with a nationally accredited bariatric surgery program, such as Sharp Coronado Hospital and Sharp Memorial Hospital.

It’s important to talk to a doctor about the best option for you

Meeting with a doctor is the best way to determine the right course of action for you, depending on your specific health needs.

“We're still learning a great deal about these weight loss medications, including their benefits and side effects,” says Dr. Morell. “They can be used safely and effectively under the guidance of a health care professional, such as a bariatric surgeon or primary care provider.”

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