Weighing in on weight loss

With obesity affecting more than 40% of U.S. adults, millions are turning to injectable weight loss medications like Ozempic®, Wegovy® and Mounjaro®, also known as GLP-1 agonists. But are these a real, long-term solution?

A recent Gallup poll shows 15.5 million Americans have tried these types of weight loss drugs. On average, people taking these medications along with diet and exercise lose 15% of their total body weight in one year, according to the Journal of the American Medical Association (JAMA).

The medications work by mimicking a digestive hormone that helps control insulin and blood glucose levels, slows digestion and controls appetite. GLP-1 medications were first approved by the FDA for weight loss in 2021, and are sometimes referred to generically as semaglutides.

But there’s a catch: “The key to keeping the weight off is staying on the medication,” said Steven Hodgett, MD, FACS, a surgeon with North Florida Surgeons who performs bariatric surgery at Baptist Health.

“Once people go off the meds, the weight regain can be aggressive, coming back on as quickly as it took to lose or faster.”

The downside of weight loss medications: cost, availability and side effects

Drawbacks have some consumers questioning the long-term viability of weight loss medications. The most common side effects include nausea, vomiting, diarrhea, fatigue, dizziness and constipation. In a U.S. clinical trial, nearly half of the people taking GLP-1 weight loss medications reported adverse effects.

Most insurances won’t cover GLP-1 prescriptions, making them too expensive for many people. Even with insurance coverage, the medications can be several hundred dollars per month.

For some patients, the idea of having to inject the medication is a deal breaker.

“For all of these reasons, long-term compliance of remaining on a weight loss medication is fairly low,” explained Craig Morgenthal, MD, FACS, with North Florida Surgeons who also performs bariatric surgery at Baptist Health.

A 2023 study found 68% of people taking GLP-1 medication stopped within a year, according to the Obesity Medicine Association.

“We’re starting to see patients who’ve tried one of these medications, but don’t want to take them for the rest of their lives,” Dr. Morgenthal said. “They’re looking for a better solution that will work long term.”

Bariatric surgery still the gold standard

While GLP-1 medications have been approved by the FDA to treat obesity for three years, bariatric surgery has been around for 60 years.

“Bariatric surgery has a proven track record as a safe and effective solution, with the first procedures taking place in the 1960s,” said Dr. Hodgett. “Comparatively, there is no long-term data to verify the safety or efficacy of the new weight loss medications.”

Through the years, there have been several advances in bariatric surgery, making it less invasive with fewer complications.

At Baptist Health, bariatric surgery is performed using minimally invasive approaches resulting in smaller incisions, reduced pain and a quicker return to normal activities. Some patients can return home the same day as their surgery.

Some programs, including Baptist Center for Bariatric Surgery, have become accredited Centers of Excellence through the American Society for Metabolic and Bariatric Surgery, demonstrating a commitment and ability to consistently deliver safe, high-quality and successful bariatric surgery care.

How bariatric surgery works

Bariatric surgery reduces the size of the stomach, limiting food intake while altering the hormones that regulate appetite and metabolism. It’s recognized by the National Institutes of Health as the most effective long-term weight loss treatment for obesity.

To qualify for bariatric surgery, a patient must have a body mass index (BMI) of 40 or a BMI of 35 with weight-related medical issues, such as diabetes or high blood pressure. Patients must have attempted weight loss with behavioral modification or medical treatment and be committed to long-term lifestyle change.

For those who meet these requirements, bariatric surgery is usually covered by Medicare and private insurances.

Baptist Health offers the most popular weight loss procedures: sleeve gastrectomy and gastric bypass, as well as revisional operations for patients who had a prior bariatric procedure.

Bariatric surgery: a long-term, effective solution

With sleeves and bypass surgeries, patients lose 25 - 35% of their total body weight 5 years out from surgery, according to JAMA. Typically, these procedures result in 50 - 70% loss of excess weight.

Along with weight loss, bariatric surgery is proven to resolve or decrease the severity of weight-related conditions, such as heart failure, stroke, high blood pressure, type 2 diabetes, and certain types of cancer.

Weight loss drugs vs. weight loss surgery: finding the best solution for you

“This is an exciting time for breakthroughs in treating obesity,” said Dr. Hodgett. “Having more options, including weight loss medications, is a positive step for people struggling with obesity.

“Patients should talk to their physician to select the option that is best for them, taking their goals and BMI into consideration. For some patients, a combination of weight loss medications for a short period of time coupled with bariatric surgery may be the best approach.”

No matter the choice, success requires multiple factors, including regular exercise and a healthy eating plan.

Baptist Bariatrics provides weight loss surgery at its campus at Baptist Medical Center Jacksonville and will begin providing weight loss surgery at Baptist Medical Center Clay on Fleming Island in the fall of 2024. For more information, visit baptistjax.com/weight loss or call 904.202.SLIM.