Is bariatric surgery still best? What new research says about the procedure as weight loss drugs surge in popularity.
Weight loss drugs have grown in popularity over the last few years. But is taking medication the most effective way to slim down? According to new research, bariatric surgery — also known as metabolic and bariatric surgery, or weight loss surgery — remains the gold standard for weight loss and managing weight-related markers of health.
Studies presented on June 11 at the American Society for Metabolic & Bariatric Surgery (ASMBS) 2024 Annual Meeting highlighted the following three major findings:
Bariatric surgery is more effective in both the short and long term than medications or lifestyle intervention
Bariatric surgery has a notable impact in slowing or stopping the progression of prediabetes into type 2 diabetes
Bariatric surgery is overall more cost-effective than weight loss medications
Even so, bariatric surgery is underutilized, according to Dr. Marina Kurian, a bariatric surgeon who co-authored the first study. Here, experts break down what you need to know about the procedure and why these findings are important.
What to know about bariatric surgery for weight loss
Three primary types of bariatric surgery are performed in the U.S, according to the National Institutes of Health (NIH):
Vertical sleeve gastrectomy (VSG), also known as gastric sleeve, which removes about 80% of the stomach in order to restrict the amount of food a patient is able to consume.
Gastric bypass surgery, also called Roux-en-Y gastric bypass, which involves creating a small pouch from the stomach to connect directly to the small intestine. This allows food to go directly into the small intestine, bypassing most of the stomach and resulting in fewer calories being absorbed.
Adjustable gastric band, referred to as Lap-Band, where an inflatable band is placed at the top part of the stomach to create a small pouch, which makes a patient feel full after consuming a small amount of food.
The surgeries are mostly performed laparoscopically, states the NIH, meaning that they’re minimally invasive. This is largely a result of how long they’ve been around and how much the technology has advanced during that time. That’s also why so much research is available about bariatric surgery’s long-term outcomes.
“Bariatric surgery has been around longer than the newer injectable medications, so we have more long-term data about benefits and risks,” Dr. Melanie Jay, director of NYU Langone’s Comprehensive Program on Obesity, tells Yahoo Life.
And as the most recent data shows, gastric bypass and sleeve gastrectomy have demonstrated a total weight loss of 31.9% and 29.5%, respectively, one year after surgery, with weight loss of approximately 25% maintained for up to 10 years after surgery. The percentage of weight loss achieved by weekly injections of a medication such as semaglutide or tirzepatide is lower, with additional risk of weight regain once treatment stops.
As with weight loss medications, however, surgery isn’t a one-size-fits-all treatment and must be paired with lifestyle changes to achieve best results.
Who is eligible for bariatric surgery?
Cleveland Clinic notes that requirements begin with a diagnosis of class III obesity, which would mean:
A body mass index (BMI) of 40 or higher
A BMI of 35 or higher with at least one weight-related health problem
Adolescent candidates must have an obesity-related medical condition in addition to the baseline BMI requirements
However, other evaluations of both mental and physical health may be required and should be discussed with a doctor.
Why experts say these findings are significant
While 2 in 5 adults in the U.S. have taken a GLP-1 drug like Ozempic or Mounjaro for the purpose of weight loss, bariatric surgery continues to be “underutilized,” experts say. The ASMBS reports that in 2022, there were nearly 280,000 bariatric procedures performed in the U.S., which means that only 1% of people eligible for the surgery actually had it.
Dr. Tim Church, an obesity researcher and chief medical officer of Wondr Health, tells Yahoo Life that these findings may alleviate the apprehension that many people have toward bariatric surgery.
“Surgery is underutilized by patients due to fears about cost, safety, permanency and stigma. These are important considerations to discuss with your doctor, but it's a proven, safe procedure and generally affordable,” says Church.
The latest studies assure safety and permanence, address the overall value cost and even present bariatric surgery as a means of treating and preventing type 2 diabetes. Dr. Katherine Saunders, clinical assistant professor of medicine at Weill Cornell Medicine and co-founder of Intellihealth for metabolic health, says that the data points outside of weight loss may also help to decrease the stigma of surgery.
“Many people still view obesity as a lifestyle problem that can be cured by eating less and exercising more. As a result, medical treatments are viewed as cheating or an easy way out,” she tells Yahoo Life. “Medical treatment for obesity should be viewed like medical treatment for other chronic diseases like type 2 diabetes and hypertension.”
Most importantly, medical professionals are hopeful that research and conversations on the topic of obesity will lead to better awareness of all treatment options.
“The conversations about new medications have sparked a broader interest in treating obesity as a disease rather than as a behavioral issue,” says Jay. “I have patients come in asking for the GLP-1 receptor agonists and then deciding to go on some of the older and cheaper oral medications instead. It also gives me the opportunity to talk to them about bariatric surgery.”
“There are so many misconceptions related to obesity,” says Saunders. “We need more education and more conversations that are rooted in science so more individuals receive the care they need.”
