Weighing the options between medication and weight loss surgery

Assisted weight loss was once a quiet topic but is now openly discussed and widely accepted. It is increasingly recognized and embraced across many platforms. Weight-loss options are expanding, but it’s important to work with a trusted physician. They can help guide you to the best plan for success.

It’s been well established that diet and exercise alone will not result in any significant weight loss for 95% of individuals who are overweight or have the metabolic disease of obesity, according to Kenneth Copperwheat, DO, a Bariatric Surgeon with Piedmont Physicians Surgical Specialists and Bariatrics of Columbus. The average person with obesity attempts to lose weight through dieting more than eight times in their life.

“With the odds of success stacked so highly against them, many patients are seeking out more effective solutions,” Dr. Copperwheat says. “Thankfully, there are many different treatment options available.”

When choosing between medication and surgery, understand the differences. Compare expected outcomes before deciding.

There are many different medications available to help with weight loss. Medications like phentermine can lead to about 8% weight loss. Newer GLP-1 drugs (e.g., semaglutide, tirzepitide) can achieve 15–20%.

“It’s important for patients to realize that they will likely need to take these medications indefinitely in order to maintain their weight loss,” Dr. Copperwheat explains.  “Typically, medication therapy is appropriate and effective for patients with mild obesity.”

Alternatively, many patients will choose surgery for their treatment. Patients can typically expect to lose 20–40% of their total body weight, depending on the procedure.

“Choosing which surgery is most appropriate is a decision that you should make with your bariatric surgeon,” Dr. Copperwheat advises. “Surgical treatment is typically favored for patients with moderate to severe obesity.  In addition to treating obesity, these operations also treat the diseases that go along with obesity, such as diabetes, sleep apnea and high blood pressure.”

Presently, there is also a wide variety of surgical options available. Recommendations are tailored to individuals based on their specific goals.

Surgical options for weight loss

• Sleeve Gastrectomy (VSG): Approximately 80% of the stomach is removed, converting it into a narrow tube.
• Roux-en-Y Gastric Bypass: A small stomach pouch is created. The rest of the stomach and first part of the small intestine are bypassed and no longer digest food.
• Single-Anastomosis Duodenoileostomy (SADI): After creating a sleeve gastrectomy, the stomach is separated from the small intestine. A loop of intestine is then measured and reconnected to the stomach.
• Biliopancreatic Diversion with Duodenal Switch: Following the creation of a sleeve gastrectomy, the stomach is separated from the small intestine.  The stomach is then reconnected into the latter part of the small intestine.

Who is a candidate for treatment?

Medications: These are recommended for individuals with a body mass index (BMI) of 30 kg/m² or higher. This applies regardless of other health conditions. They are also considered for individuals with metabolic disease and a BMI greater than 27 kg/m².

Surgery: Metabolic and bariatric surgery (MBS) is recommended for individuals with a BMI of 35 kg/m² or higher. This applies regardless of other health conditions.

MBS should be considered for individuals with metabolic disease and a BMI of 30-34.9 kg/m².

BMI thresholds should be adjusted in the Asian population such that a BMI greater than 25 kg/m² suggests clinical obesity. Individuals with a BMI greater than 27.5 kg/m² should be offered MBS.

“Overall, the goal of these treatments is to allow patients with the metabolic disease of obesity to enjoy a better quality of life and a longer lifespan,” Dr. Copperwheat says.

Learn more about Dr. Copperwheat and the entire Piedmont Bariatrics team.