GLP-1 medications have become game changers for people trying to lose weight, but bariatric surgery is still superior when it comes to total and lasting weight loss, a new study has found.
Patients who underwent a sleeve gastrectomy or gastric bypass lost about five times more weight after two years than people who had weekly injections of semaglutide or tirzepatide (the active ingredients in the anti-obesity drugs Wegovy and Zepbound, respectively), researchers reported Tuesday, June 17, at a meeting of the American Society for Metabolic and Bariatric Surgery.
That translated into bariatric surgery patients losing 24% of their body weight — 58 pounds on average — compared to about 5%, or 12 pounds on average, for patients who had a GLP-1 prescription for at least six months.
Even people who continuously took GLP-1 drugs for a full year lost significantly less weight than those who got surgery.
“Clinical trials show weight loss between 15-21% for GLP-1s, but this study suggests that weight loss in the real world is considerably lower,” Dr. Avery Brown, the lead study author and a surgical resident at NYU Langone Health, said in a statement.
The study highlights that “what happens in a clinical trial might not actually be happening in the real world because people aren’t always compliant with medications,” said NBC medical contributor Dr. Natalie Azar on TODAY on June 18.
That may be because clinical trials often take place in idealized settings with experienced doctors and very close follow-up, says Dr. Karan Chhabra, senior study author, bariatric surgeon and assistant professor at the NYU Grossman School of Medicine.
“As more and more doctors are getting into the business of GLP-1 prescribing — and now there are these direct-to-consumer options for getting GLP-1 drugs — I think a lot of them are being given without careful oversight,” Chhabra tells TODAY.com.
“We have to take the prescribing of them much more seriously. I don’t think we can be giving them out like candy.”
The new study included 38,545 people taking a GLP-1 drug and 12,540 people who had undergone one of the bariatric surgery procedures.
The findings show bariatric surgery is associated with “superior sustained, long term weight loss” compared to GLP-1s among patients eligible for both options, the authors wrote.
But the GLP-1 medications are still an important tool for treating obesity, Chhabra says.
Dr. Shauna Levy, an obesity medicine physician and medical director of Tulane’s Bariatric and Weight Loss Center, agreed.
“We’ve never had such a good obesity medicine,” Levy tells TODAY.com. She was not involved in the new study and has done consulting work for Novo Nordisk, the pharmaceutical company that makes Ozempic and Wegovy.
“There are plenty of people that would benefit from GLP-1s, and they’re still the best category of medication we have on the market to treat this disease.”
Here’s what you need to know about semaglutide, the drug commonly marketed as Wegovy and Ozempic.
Weight Loss Injections Vs. Surgery
GLP-1 drugs mimic at least one hormone produced by the gut to signal fullness, leading to a reduced appetite.
Since obesity is a chronic condition, patients must plan to take the medications for life to maintain their weight loss, Levy says.
But up to 70% of people taking a GLP-1 drug stop treatment within one year, Brown noted. Early discontinuation is a “big part” of why the medications are less effective in the real world, Chhabra says.
Possible reasons people stop taking them include the high cost of the weekly injections and the perception that the drugs aren’t needed once weight goals are met, experts say. Patients may lose insurance coverage, Azar noted.
The medications also come with side effects, so some people wonder whether GLP-1 drugs like Ozempic are safe for weight loss in the long term.
Doctors have long known bariatric surgery has a much higher weight loss potential since it permanently changes the digestive system by making the stomach smaller and limiting how much food a person can eat.
Surgery is “very, very effective” and “one and done,” Azar noted.
Patients lose 20-50% of their weight, Levy says.
“You have the tool with you always rather than going off or on, or having access or no access,” Levy says.
Surgery could also be more cost effective over a patient’s lifetime than taking a medication for life, Azar added.
The downside of surgery is that it’s invasive and comes with potential complications and side effects like bleeding, infection and nutritional deficiencies.
Which Is Better: GLP-1 or Bariatric Surgery?
It’s a conversation you should have with your doctor, experts say.
Levy poses these questions to her patients:
Do You Want to Take a Medicine for the Rest of Your Life?
“A lot of people, when they get bariatric surgery, are doing it because they want to come off medicines. They want to stop taking their blood pressure medicine or their cholesterol medicine,” Levy says.
“So then taking a GLP-1 for the rest of their life may not be something that they want to do.”
If a patient wants a one-time treatment, surgery is the best approach because you get it once and the results last for at least a decade, Chhabra adds.
But there’s a chance of weight recurrence with surgery as well, Levy notes.
How Much Weight Do You Want to Lose?
People lose 40-50 pounds with a GLP-1 drug, on average, but there’s more weight loss potential with surgery, Levy says.
“If you’re interested in losing more weight, then bariatric surgery might be the right answer for you,” she says.
But if patients don’t qualify for surgery or don’t want the invasiveness of it, the medications are a good option, Chhabra says.
What Are Your Preexisting Conditions?
If somebody has acid reflux, it may get worse with a GLP-1, while bariatric surgery could put it into remission, Levy says.
This story first appeared on TODAY.com. More from TODAY: