Bariatric Surgery vs. Weight Loss Drugs Like Ozempic: What’s Better?

Bariatric Surgery vs. Weight Loss Drugs Like Ozempic: What’s Better?
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If you have obesity and are considering treatments that can lead to significant weight loss, you may be wondering how the two leading options compare: bariatric surgery, which permanently alters the digestive tract, versus powerful new appetite-suppressing medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound).

There isn’t one “best” obesity treatment for everyone, and weight loss surgery and medications each have pros and cons that are worth evaluating against your own personal needs and goals.

Whichever option you pick, experts emphasize that by achieving a healthy weight, you can lower your risk of illnesses such as cancer, type 2 diabetes, cardiovascular disease, respiratory conditions, and digestive disorders.

“It cannot be stressed enough that obesity is a disease, and the disease is associated with a higher risk of certain other conditions, compared with people who are considered a healthier weight,” says Samantha Cassetty, a registered dietitian based in New York City and the coauthor of Sugar Shock.

Illustrative graphic titled How Medical Weight Loss Methods Compare shows Bariatric Surgery verses GLP-1s. Everyday Health logo
Both bariatric surgery and medications like semaglutide can help you lose a significant amount of weight. Your doctor can help you decide if either is a good option for you.

How Weight Loss Surgery and GLP-1 Drugs Work

How Weight Loss Surgery Works

Weight loss (bariatric) surgery involves a variety of procedures that change your digestive system so that you eat less and feel full sooner.

There are three main types of weight loss surgery:

  • Gastric sleeve surgery (also known as sleeve gastrectomy or vertical sleeve gastrectomy): A surgeon removes about 80 percent of the stomach, leaving behind a “sleeve” or tube made up of the remaining 20 percent. This limits the amount of food the stomach can hold.
  • Gastric bypass: Also called Roux-en-Y, this surgery involves reducing the functional part of the stomach to a small, egg-sized pouch. A surgeon also removes the top half of the small intestine and connects the stomach pouch to the middle part of the small intestine. The majority of the stomach and the first part of the small intestine are now “bypassed” in the digestive process.

How Weight Loss Drugs Work

GLP-1s are a new class of potent weight loss drugs that mimic the action of hormones called incretins. The body releases these hormones naturally after eating to help regulate blood glucose and insulin levels.

Receptors for incretin exist throughout the body — on nerves and pancreatic cells and in the heart, lungs, skin, brain, and other organs. By acting on these receptors, GLP-1 medications trigger weight loss.

GLP-1s cause weight loss by:

  • Slowing how quickly the stomach empties its contents (gastric emptying)
  • Slowing digestion and food absorption
  • Decreasing appetite and increasing feelings of fullness
  • Improving insulin sensitivity
  • Decreasing energy consumption
  • Improving fullness by targeting brain receptors

Examples of GLP-1 drugs include:

  • semaglutide (Ozempic, Rybelsus, Wegovy)
  • liraglutide (Victoza, Saxenda)
  • tirzepatide (Mounjaro, Zepbound)

Weight Loss Results: Surgery vs. GLP-1 Drugs

Weight Loss Results From Bariatric Surgery

“Bariatric surgery represents the most powerful and invasive tool for significant and sustained weight loss,” says Christopher Thompson, MD, a professor of medicine at Harvard Medical School and the codirector of the Weight Management Center at Brigham and Women’s Hospital in Boston.

Dr. Thompson, who is also the founder of Bariendo, a weight loss clinic, says that patients often lose 25 percent of their body weight after bariatric surgery, although one study found an average weight loss of up to 33 percent.

Most people tend to regain some of the weight over time, but it’s a relatively small amount compared to how much they’d lost initially.

In a study of people who had undergone gastric bypass surgery, the average weight regain after five years was 15 percent (counting from the maximum amount of weight lost).

Weight Loss Results From GLP-1 Drugs

Thompson says that GLP-1 drugs, when tolerated, contribute to approximately 11 percent of weight loss in real-world studies.

Clinical trials report that semaglutide leads to an average weight loss of 15 percent of body weight, and tirzepatide leads to an average weight loss of 20 percent of body weight.

“However, the long-term implications of prolonged GLP-1 medication use remain a topic of ongoing research and debate,” Thompson says. “Most patients regain weight after stopping their injections, which suggests the need to stay on the medication potentially for a lifetime.”

Risks and Side Effects of Bariatric Surgery vs. Weight Loss Drugs

Risks and Side Effects of Bariatric Surgery

“While bariatric surgery can produce profound results, it is not without risks,” says Thompson. “And the procedure is not reversible.”

He says the following complications can occur in about 20 percent of cases:

  • Infection
  • Bleeding
  • Gastrointestinal leaks
  • Gastric reflux
  • Narrowing of the gastric sleeve
Other side effects of weight loss surgery can include:

  • Leakage in the stomach or small intestine
  • Diarrhea
  • Blood clots

Still, Marina Kurian, MD, a clinical associate professor in the department of surgery at NYU Grossman School of Medicine in Manhattan, highlights the overall safety of weight loss procedures.

“The risks of metabolic and bariatric surgery are so low now that the death rate and complication rates are lower than laparoscopic gallbladder removal, which a lot of people have had done,” says Dr. Kurian, who is also the immediate past president of the American Society for Metabolic and Bariatric Surgery.

According to a review of the medical literature, the risk of dying after weight loss surgery is less than 1 in 1,000 (0.08 percent).

It’s also important to note that the fitter and healthier you are before the surgery, the better your chances of recovery and the lower the risk of complications.

Risks and Side Effects of GLP-1 Weight Loss Drugs

“Like any medication, GLP-1 drugs come with potential risks and side effects,” says Thompson.

The side effects you might get will vary with the drug you take. But, overall, common digestive side effects include:

  • Nausea
  • Vomiting
  • Constipation
  • Indigestion
  • Pain in the abdominal area
  • Diarrhea

Explore our recommendations for the best online GLP-1 providers, including Henry Meds, Found, and Noom Med.

Eligibility

What are the eligibility criteria for surgery and medication, respectively, and how does a person determine if they are better suited to one or the other?

“Typically, if a patient has a drastic amount of weight to lose, such as 100-plus pounds,” says Thompson, “they would likely be a better candidate for weight loss surgery.”

“Surgery candidates usually fall in the category of having a BMI, or body mass index, of 40 or higher. However, patients may also qualify if they have a BMI of 35 or higher and serious health conditions related to obesity, such as diabetes or high blood pressure,” he says.

By contrast, he says, “If a patient aims to lose 15 or 20 pounds, they may be a better candidate for weight loss medications. Typically, this is seen in patients with a BMI of 27 or higher.”

Cost and Access

Cost and Access: Weight Loss Surgery

Weight loss surgery, on average, costs about $10,900 to $13,600, according to recent research. Insurance may cover all or part of that cost, if you’re eligible.

Insurance companies may also require you to use a certain surgeon or facility, or to prove that you couldn’t lose the weight with other methods. You’ll want to contact your health insurance provider to see what’s included in your plan.

Cost and Access: Weight Loss Drugs

“Medications are typically not be covered by insurance plans,” says Thompson. “Patients could expect to pay up to $24,000 a year for the medications, which they should expect to stay on in perpetuity, potentially posing a barrier to access for some people.”

The average cost of weight loss drugs is about $12,000 per year.

Most insurance companies, Medicare, and Medicaid do not cover the cost of GLP-1s for weight loss.

Lifestyle Implications and Changes

How Life Changes After Bariatric Surgery

“Patients should expect to spend up to three days in the hospital post-surgery and will need to factor in up to four weeks of leave from work for recovery,” says Thompson.

Patients who undergo bariatric surgery will also need to make some changes to their diet. They will have to follow a liquid diet immediately after surgery, adding in soft foods after a few weeks and working up to solids.

Because bariatric surgery limits nutrient absorption, patients will also need to take special vitamin and mineral supplements over the long term. Nutritional deficiencies and weight regain are both risks after surgery if patients do not pay attention to proper diet.

Thompson stresses the importance of a healthy and active lifestyle after surgery for the benefits to be sustainable. “Lifelong adherence to dietary and lifestyle modifications is essential for long-term success,” he says.

How Life Changes After Starting Weight Loss Drugs

GLP-1 medications are intended to be used long term, and weight regain may occur if a patient stops taking them. Also, taking these medications doesn’t mean you won’t have to make other healthy changes to your day-to-day life.

“With both surgery and medication, lifestyle changes must happen in conjunction with treatment,” says Cassetty. “Pairing treatment with lifestyle modifications will result in the healthiest outcomes.”

It’s also important to note that while GLP-1 medications have been used to treat type 2 diabetes since 2004, they’re a relatively new obesity medication. They are still being studied for this purpose, so the long-term effects aren’t fully known.

Getting Medical Advice

If you’re considering weight loss surgery or medication, have a conversation with your healthcare provider about both options. An obesity management specialist can help walk you through the options in a way that is tailored to your unique needs. You can find an obesity specialist through the American Board of Obesity Medicine.

“When you’re working with providers who specialize in obesity management, they are going to be able to help meet you where you are,” says Cassetty. “They’re taking into consideration things like your access to food, your culture, and foods you might want to include. They’re really working with you personally to help you get healthier.”

Furthermore, they may be able to tell you about options that you’re not even aware of. “Most people are not aware of the fact that there are actually three major classes of weight loss therapies: weight loss surgery, weight loss medications, and a third option, endoscopic nonsurgical procedures,” says Thompson.

Endoscopic sleeve gastroplasty, for instance, is a relatively new procedure that does not require a surgeon to make incisions in the skin. Instead, doctors thread a tube down the throat into the stomach and then use sutures to create accordion-like folds in the stomach tissue, reducing the amount of room for food.

“Endoscopic nonsurgical procedures are what I would consider the middle option for weight loss. These procedures are less invasive and less risky than surgery and deliver greater and more durable weight loss than medications,” Thompson says.

To find an obesity specialist who can walk you through your options and your benefits and risks:

Questions to Ask Your Doctor

When you see a doctor, you may want to ask:

  • What kind of weight loss can I expect to achieve?
  • What treatment options do you recommend, what are the side effects, and how long should I expect to have them?
  • What other health benefits might I see with weight loss? Can I expect to see improvements in my diabetes control or blood pressure levels?
  • What are the risks and benefits of taking weight loss medication versus not taking it? What are the risks and benefits of having or not having surgery?
  • Will I have access to other healthcare providers such as a registered dietitian or a behavioral specialist?
  • What does my insurance cover?

The Takeaway

  • If you have obesity, and lifestyle changes aren’t helping, you may want to consider either weight loss surgery or weight loss medication.
  • Surgery offers significant and sustainable weight loss, but it is an invasive procedure and comes with a risk of complications. It’s usually covered by insurance, if you qualify.
  • Weight loss drugs are not invasive, but they have side effects. You’ll need to take them for life to avoid regaining the weight. Most insurance plans do not cover weight loss drugs.
  • Talk to your healthcare provider about the pros and cons of these options, so that you can find the treatment that’s best for you.

Adam Gilden, MD, MSCE

Medical Reviewer

Adam Gilden, MD, MSCE, is an associate director of the Obesity Medicine Fellowship at University of Colorado School of Medicine and associate director of the Colorado University Medicine Weight Management and Wellness Clinic in Aurora. Dr. Gilden works in a multidisciplinary academic center with other physicians, nurse practitioners, registered dietitians, and a psychologist, and collaborates closely with bariatric surgeons.

Gilden is very involved in education in obesity medicine, lecturing in one of the obesity medicine board review courses and serving as the lead author on the Annals of Internal Medicine article "In the Clinic" on obesity.

He lives in Denver, where he enjoys spending time with family, and playing tennis.

Ana Sandoiu

Author

Ana is a freelance medical copywriter, editor, and health journalist with a decade of experience in content creation. She loves to dive deep into the research and emerge with engaging and informative content everyone can understand. Her strength is combining scientific rigor with empathy and sensitivity, using conscious, people-first language without compromising accuracy.

Previously, she worked as a news editor for Medical News Today and Healthline Media. Her work as a health journalist has reached millions of readers, and her in-depth reporting has been cited in multiple peer-reviewed journals. As a medical copywriter, Ana has worked with award-winning digital agencies to implement marketing strategies for high-profile stakeholders. She’s passionate about health equity journalism, having conceived, written, and edited features that expose health disparities related to race, gender, and other social determinants of health.

Outside of work, she loves dancing, taking analog photos, and binge-watching all the RuPaul’s Drag Race franchises.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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