Weight‑loss drugs vs bariatric surgery: Who should choose what, experts explain | Mint
Weight‑loss drugs vs bariatric surgery: Who should choose what, experts explain
Obesity care is shifting from one‑size‑fits‑all to tailored regimens. Experts explain how weight‑loss medicines like GLP‑1s and bariatric surgery complement each other, with treatment decisions guided by BMI, comorbidities, patient history and long‑term health goals
Obesity treatment is no longer a one-size-fits-all approach. As the popularity of GLP-1 weight-loss medicines spreads, some people with obesity ask the question: Can medicine replace bariatric surgical treatment? Though both have been shown to provide meaningful medical improvements, experts say they’re not competing therapies; they are complementary regimens chosen according to a person’s body mass index (BMI), comorbidities, weight-loss history and long-term expectations
Some patients will be appropriately treated with weight-loss drugs, while the optimal treatment forsevere obesityremains bariatric surgery in most cases and at least set to remain one of the few long-term interventions that produce clinically meaningful changes. And more and more, doctors are double-teaming the approaches for safer procedures, improved weight management and sustainable health
Weight-loss medicines: Who benefits most?
According to Dr Sukhvinder Singh Saggu, Director – Minimal Access, GI & Bariatric Surgery at the CK Birla Hospital, Delhi, Weight-loss medications such as orlistat, phentermine-topiramate extended release (sold under the brand name Qsymia), naltrexone alone and semaglutide are creating a paradigm shift in the treatment ofobesity
“The fact that the increasing utilization of weight reduction medicines will alter how obesity is treated makes it particularly important to recognize that these weight loss medicines are not substitutes for surgery or two treatment strategies for controlling obesity, but rather complementary treatments for both types of patients,” he says
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“These are helpful for patients who manage their weight with diet and exercise and for patients who manage their weight with medicine or surgical procedures,” adds Dr Saggu
He says these medications are typically endorsed for anyone over the age of 18 with obesity or being overweight related to health conditions
In general, weight-loss medicines (such as GLP-1 agonists and dual incretin therapies) can be prescribed to adults with a BMI ≥30kg/m² or those with a BMI ≥27kg/m² and one or more obesity-related comorbidities, such as T2DM, high blood pressure or obstructive sleep apnea
These medications work by reducing appetite, increasing feelings of fullness (satiety) and producing significant weight loss when used in conjunction with lifestyle changes. Individuals who have not successfully lost weight through diet and exercise alone and are at high risk for co-morbidities associated with their body weight, but have not reached their “safety threshold” to consider weight loss surgery
Adding to this, Dr Mriganka S Sharma, Director – General & Minimally Invasive Surgery, CK Birla Hospital, Gurugram, says that a few GLP-1 medications can be quite effective at first, but are only suitable for lifelong commitment, so this seems like an unsuitable starting point for most patients
“For patients with a starting identify — in some instances still not taking weight-loss tablets — GLP-1 medications are often a very good place to begin (especially when managing conditions like type 2 diabetes). However, cautious usage is fundamental, and supplementation may be hard due to facet effects,” he says
They function as a drug-free way to control hunger and blood sugar. These drugs require commitment to compliance for the longer term, but in some patients, even intolerable gastrointestinal side effects of nausea, vomiting and diarrhoea may preclude them from remaining compliant
When bariatric surgery is better choice
Bariatric surgery remains the most effective long-term treatment for severe obesity, with weight loss being only one of the benefits, said Dr Saggu
It is now recommended for individuals with a BMI below 40 kg/m². Nevertheless, most of the healthcare professionals agree that it is relevant to be considered in people who have a BMI of ≥ 35 kg/m2, with or without obesity related comorbid conditions, and ≥30 kg/m2 with one or more obesity related comorbid conditions, and also a special consideration is needed for the Asian population (including Indian)
Apart from this, much of the long-term research proves that bariatric surgery improves control of and often remits type 2 diabetes, fatty liver disease, hypertension and obstructive sleep apnea
According to Dr Sharma, surgery is better suited for high-risk patients with clinically morbid obesity and complex comorbidities
Treatment decisions go beyond BMI
Dr Saggu recommends: “Weight is only one of many factors that must be taken into consideration in determining whether medications or surgery are an appropriate treatment modality.”
The medication-versus-surgical treatment decision should not be determined solely by how much weight the individual wants to lose. Another big aspect is the patient’s BMI, presence of comorbid obesity conditions, history of weight loss programmes, psychological preparedness and motivation to sustain with lifestyle changes and medical fitness to undergo a surgical procedure. Usually, weight-loss drugs are prescribed to minimize the threat of undergoing weight loss surgery or help in sustaining weight after a patient has gone through.
Also Read|Childhood obesity is rising. Is your child at risk?
Integrated approaches are frequently adopted
Obesity treatment is gradually shifting towards blending together surgical and medication options rather than separating the two, Dr Sharma says
Current clinical approaches increasingly integrate nutritional rescue and surgical therapy into a unified treatment strategy rather than treating them as distinct, isolated options
Personalised care gives best results
The two specialists agree that obesity should be treated as a chronic disease, with a treatment plan tailored to the individual
According to Dr Saggu, multidisciplinary evaluation enables the most appropriate treatment recommendation tailored to each patient, thereby improving both weight outcomes and quality of life
According to Dr Sharma, the selection of treatment should finally be based on the degree of obesity, co-existing morbidities and choice by patient, but these need proper evaluation and therefore, a specialist’s consultation prior to deciding on medication or surgery (or both)
(The author, Nivedita, is a freelance writer. She writes on health and travel.)
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