In 2002, Paul Lesser weighed 385 pounds and was experiencing severe back problems from a herniated disc that impacted his quality of life. As a condition of treating him, his doctor insisted he lose weight.
After several unsuccessful attempts to lose weight, Lesser was referred to Dr. Christine J. Ren-Fielding, a bariatric surgeon at NYU Langone Health in New York City. Together, he and Ren-Fielding discussed treatment options and elected to go with the adjustable and minimally invasive gastric band surgery, also known as a Lap-Band surgery.
Following surgery, Lesser began to lose weight quickly, which not only alleviated his back pain, but led to the discontinuation of pain medication. Over the years, he’s maintained a weight of about 197 pounds, down from nearly 400 pounds at his heaviest. He credits this to a combination of the Lap-Band procedure, rigorous exercise and a disciplined approach to nutrition. He’s managed to stay active, working full time and engaging in physically demanding tasks into his early 70s.
“Obesity is not a lifestyle choice and should not be a stigma. Rather, it’s a chronic disease that can cause serious medical problems,” says Dr. Robert F. Kushner, an obesity medical specialist at Northwestern Feinberg School of Medicine. “If you suffer from obesity, instead of blaming yourself, consult with an obesity medical specialist, because medication and surgical options are available.”
These days, there are various treatment options for obesity, including weight loss surgery and weight loss drugs, such as the popular glucagon-like peptide-1 (GLP-1) drugs that have swept the market in recent years.
What Is Semaglutide?
One of the GLP-1 drugs approved by the Food and Drug Administration is semaglutide, the active compound in Ozempic, which was approved by the Food and Drug Administration to treat Type 2 diabetes, and Wegovy, which was approved in 2021 to treat obesity.
Semaglutide is a GLP-1 agonist that mimics the GLP-1 hormone, which is produced in the gut and targets receptors in the brain and throughout the body, and prompts the body to produce more insulin, which reduces blood sugar. Semaglutide, sold as Ozempic, has traditionally been used to treat diabetes.
In higher amounts, GLP-1 interacts with parts of the brain that suppress appetite. It slows down how quickly the stomach empties, which makes you feel fuller longer. When it’s combined with a healthy diet and exercise, it can result in significant weight loss in people who are obese or overweight.
[READ How to Spot Fake Ozempic]
Safety and Efficacy of Semaglutide
Medications for weight management are meant to be considered for people who have already tried making lifestyle changes with unsatisfactory results.
While existing research shows that semaglutide is safe, it’s still unclear how safe these drugs are for long-term use, says Dr. William Yancy, an obesity specialist at Duke Health.
Multiple studies have shown that semaglutide is effective in promoting weight loss in nondiabetic individuals without obesity. A 2021 clinical trial evaluating the efficacy of semaglutide showed that more than one-third of participants, many of whom weighed more than 200 pounds, lost 20% of their weight. This is in addition to the 12.5% mean weight reduction above the placebo group, who received lifestyle interventions only.
If you lose weight with semaglutide and want to maintain that weight loss, you may have to commit to taking the drug lifelong. These drugs should only be prescribed when a patient combines the treatment with regular exercise and healthy eating.
[READ: Zepbound: FDA-Approved Medication for Weight Management]
Side Effects of Semaglutide
Common side effects of semaglutide include:
— Diarrhea
— Constipation
— Gas
— Nausea
— Vomiting
— Pain
— Bloating
— Acid reflux
— Dizziness
— Fatigue
— Headaches
— Allergic reactions, such as skin rashes, itching, hives, face swelling, and lip, tongue or throat swelling
More serious side effects include:
— Pancreatitis
— Vision changes
— Low blood sugar
— Kidney problems or failure
— Gallbladder complications
The most common reason people stop taking a semaglutide is constant nausea.
“All medications have side effects,” says Dr. Amanda Velasquez, director of obesity medicine at Cedars Sinai in Los Angeles. “But if they’re managed appropriately, they may be treatable, which is why it’s so important to work closely with your team of health care providers.”
[READ: Weight Loss Plateau: How to Break Through.]
What Is Bariatric Surgery?
Weight loss surgery, also known as bariatric surgery, usually becomes an option when diet and exercise haven’t worked to alleviate obesity or when obesity poses a greater risk to health from life-threatening problems than the risk of surgery.
Weight loss surgery modifies your digestive system (your stomach and small intestine) to regulate how much food and how many calories you can eat and absorb. It can also reduce hunger signals that travel from your digestive system to your brain.
Many patients may need to follow a restrictive diet, such as the Dr. Now diet, prior to surgery to prepare for the procedure. Afterward, patients must be able to continue a long-term plan that includes exercise and healthy eating habits and be in good mental health.
“Bariatric surgery requires a huge commitment because you’ll be required to do a lot of self-management, be mindful about what you eat, be active, takevitamins and minerals and, generally, adopt a focused, new lifestyle,” Kushner says.
Some weight loss surgeries may require a revisional surgery to repair or change a previous procedure, particularly if the initial surgery was unsuccessful in promoting weight loss or if there are complications. However, if done correctly and appropriate lifestyle changes are made, most people will typically only require a single operation.
Various surgical procedures are available, so it’s important to talk with your doctor about which one is best for you.
Common weight loss surgeries include:
— Sleeve gastrectomy
— Gastric bypass
— Duodenal switch
— Gastric banding
Sleeve gastrectomy
When this procedure is performed, about 80% to 85% of the stomach is removed. The remaining stomach is stapled together to limit the amount of food you can eat. While it helps stabilize metabolism, decrease appetite and regulate blood sugar levels, it doesn’t affect the absorption of calories and nutrients in the intestine.
This procedure is not reversible and requires spending several days in the hospital.
Patients usually lose weight quickly in the first few months and then the weight loss tapers off.
The surgery is considered successful if you lose 50% of your excess weight and keep it off.
Gastric bypass
Also known as Roux-en-Y gastric bypass surgery, an incision is made across the top of the stomach and is sealed off from the rest of the stomach to create a walnut-sized pouch that can hold about 1 ounce of food. (A stomach normally holds about 33 ounces of food.)
The surgeon cuts the small intestine and sews part of it onto the pouch so that food first goes into the small pouch, then directly to the intestine sewn into it, bypassing most of the stomach and the first section of the middle part of the small intestine.
Usually not reversible, this procedure is generally safe and results in rapid initial weight loss. It requires spending two to five days in the hospital, followed by several weeks of recovery from surgery. It may affect the absorption of some minerals.
Estimated weight loss in the first couple of years is about 50% to 65% of excess weight.
Duodenal switch
While a duodenal switch is a more complicated procedure than the others, it is considered the most effective bariatric surgery that can lead to more weight loss. It is a combination of sleeve gastrectomy and intestinal bypass.
The first part of the small intestine is divided with a stapler. The sleeve is then attached to a part of the small intestine so that most of the small intestine doesn’t have food traveling through it. The sleeve holds much less food, and the body absorbs fewer calories and nutrients from that food.
The procedure involves spending one or two days in the hospital. After patients leave the hospital, they are usually back to normal activity within two weeks.
The average weight loss for a patient who undergoes duodenal switch surgery is 80% of excess weight over two years.
Gastric banding
A surgeon places an adjustable silicone band around the upper part of the stomach to create a small pouch to hold food. Food travels from the upper stomach and band into the larger, lower stomach, but more slowly because of the small opening through the band.
The band around the stomach will determine the amount of food the stomach can hold. After surgery, it can be adjusted to make food pass more slowly or more quickly through the stomach.
Gastric banding is typically a minimally invasive procedure that is performed at an outpatient center, such as an ambulatory surgery center or hospital outpatient department. Many patients go home the same day and are limited to a liquid-only diet for the first two weeks after surgery.
Most patients are back to their normal activities within a few weeks and steadily lose about one or two pounds a week. The average weight loss is about 40% of excess weight over two years.
[See: The Best Diets for Fast Weight Loss.]
Risks of Bariatric Surgery
Bariatric surgery is generally considered safe compared to most other elective or mandatory surgeries, but there are risks.
Common risks and complications of bariatric surgery include:
— Excessive bleeding
— Infection
— Blood clots
— Bowel obstruction
— Hernias
— Ulcers
— Malnutrition
— Dumping syndrome, a condition in which food moves from your stomach into your small bowel too quickly
Health Benefits of Semaglutide vs. Bariatric Surgery
Obesity is associated with many chronic diseases, including:
— High cholesterol
— High blood pressure
— High blood sugar
— Obstructive sleep apnea
— Nonalcoholic fatty liver disease
— Certain types of cancer
With significant, sustained weight loss
, many of these chronic conditions will improve or disappear, allowing people to no longer need medications.
Health benefits of semaglutide
A November 2023 clinical trial published in the New England Journal of Medicine trial showed that semaglutide lowers some people’s risk for heart attack, stroke and cardiovascular death by as much as 20%.
Health benefits of bariatric surgery
Large scientific studies have shown that bariatric surgery reduces the risk of death from any cause by over 40%.
“It’s been well documented that bariatric surgery reduces death rates resulting from obesity, increases longevity and decreases obesity-caused health risks, like heart disease, stroke, diabetes, depression and cancer,” Kushner says.
A 2018 JAMA study showed that people who had bariatric surgery lived longer than those of a similar age, sex and BMI who did not have surgery.
Bariatric Surgery or Semaglutide: Which Is Better?
While weight loss drugs, like Wegovy, have skyrocketed in popularity, research suggests bariatric surgery is still a tried-and-true cost-saving option.
An April 2024 study published in JAMA Network Open found that bariatric surgery, specifically endoscopic sleeve gastrectomy, was more cost-effective and led to greater weight loss over a five-year period compared to semaglutide. The analysis showed that patients who underwent bariatric surgery had an average BMI of 31.7, whereas those on semaglutide had an average BMI of 33.
Cost and Insurance Coverage
Most health insurers cover weight loss interventions — including weight loss surgery and weight loss drugs — if deemed medically necessary. However, if it’s not covered in your health insurance plan, it may be cost-prohibative, says Dr. Holly Lofton, director of the medical weight management program at NYU Langone.
Whether your weight loss treatment is covered by insurance depends largely on:
— Health insurance plan and coverage
— Health history
— Underlying conditions
It’s important to note that individual policies and requirements vary, so check with your insurance company directly to make sure.
Cost of semaglutide
Semaglutide costs about $1,200 every month, depending on the dose. The protocol calls for eligible individuals to take the medication once a week indefinitely.
According to a 2024 analysis published in JAMA Network Open, the annual cost of semaglutide is currently $13,618 and, while the drug is effective for weight loss, it is not an economically viable, long-term option compared to weight loss surgery, specifically sleeve gastroplasty, which is typically a one-time procedure. In order for semaglutide to be cost-effective, the overall annual cost of the drug would need to be reduced by more than 73%, from $13,618 to $3,591.
Cost of bariatric surgery
The average cost of bariatric surgery is between $17,000 and $26,000. While some weight loss surgeries may require a second surgery to revise or repair a previous procedure, they typically only require a single operation. As a result, weight loss surgery is often less expensive than weight loss drugs, which requires long-term, indefinite use.
It’s estimated that insurance companies will recover the costs of bariatric surgery within two to four years, as health care costs for other problems will decrease and are estimated to be reduced by 29% within five years of surgery.
Eligibility for Semaglutide
If you’ve tried lifestyle changes that haven’t worked, you may be eligible for a semaglutide if you meet one or more of the following criteria:
— BMI of 30 or greater
— BMI equal to or greater than 27 with one or more obesity-related conditions, like high blood pressure, Type 2 diabetes and sleep apnea
— Have not lost 5% of total body weight in 3 to 6 months with lifestyle changes alone
To be prescribed the medication, you should also be willing to make changes in diet and exercise.
If you have or have a family history of certain endocrine or thyroid issues, especially medullary thyroid cancer, you should not be prescribed a GLP-1 agonist.
Eligibility for Bariatric Surgery
To be eligible for bariatric surgery a diagnosis of Class III obesity must be established. That means you must meet the following criteria:
— BMI of 40 or higher is extreme obesity and is associated with a high risk for disease. Usually, this means you’re about 100 pounds overweight.
— BMI of at least 35 and at least one health related medical condition — like Type 2 diabetes, high blood pressure or sleep apnea — and at least six months of supervised weight loss attempts.
Your surgeon will evaluate your general health and age and if it’s determined that there is no medical reason you shouldn’t have surgery, you’ll proceed to nutritional counseling. You may also be required to undergo counseling with a mental health professional and physical therapy prior to surgery to ensure the best outcome.
Bottom Line
Obesity is a common, complex, serious and costly chronic disease. In the U.S., 4 out of every 10 adults are now considered obese, according to the American Medical Association.
“You don’t have as much control over your weight as you might think,” Lofton says.
Weight gain is not always a result of a lack of willpower. There are environmental, metabolic, genetic and hormonal reasons people have weight fluctuations throughout their lives.
If you’re suffering from being overweight or obese, you have options that range from making lifestyle changes to weight loss medication and surgery. You should make an appointment with your primary care professional or an obesity medicine specialist.
“Based on your current health and medical problems, you and your physician can make a joint decision on how to proceed if you want to make a change, improve your health and change your lifestyle,” Kushner says.
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Semaglutide vs. Weight Loss Surgery: Which Is Better? originally appeared on usnews.com
