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Bariatric Surgery vs. Weight Loss Pills – What’s Right for Me?

January 15, 2024

If you’re ready to take the next step in your weight loss journey, then you might be wondering what’s right for you – bariatric surgery or weight loss pills like Ozempic.

But the answer really depends on you.

“When you are looking to lose weight and improve your quality of health, I think you have to be open to both options and see what is best for you,” explains Devika Umashanker, MD, the system medical director of Medical Weight Loss at Hartford HealthCare Medical Group. “It’s important to be flexible and adaptable to what can get you the best results.”

Here’s what you need to consider, according to Dr. Umashanker.

Am I eligible for weight loss surgery?

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2 reasons to consider bariatric surgery or weight loss pills.

Dr. Umashanker generally sees people primarily fall into two buckets.

  1. You have a new diagnosis (i.e., high blood pressure, type 2 diabetes, sleep apnea) that correlates with a higher BMI or obesity classification.
  2. Your weight negatively impacts your ambulation, activity, sleep or quality of life.

“If someone feels like they can’t lose or maintain weight loss with lifestyle modifications alone, it’s reasonable to seek out medical help to assist you,” says Dr. Umashanker.

The guidelines for weight loss surgery recently changed.

The guidelines for weight-loss surgery just changed after 30 years.

The current ASMBS/IFSO Guidelines now recommend metabolic and bariatric surgery for “individuals with a BMI of 35 or more regardless of presence, absence, or severity of obesity-related conditions.”

The guidelines also consider bariatric surgery for the following people:

  • Individuals with a BMI of 30-34.9 and metabolic disease and “appropriately selected children and adolescents.”
  • People without metabolic disease who have a BMI starting at 30 and “do not achieve substantial or durable weight loss or obesity disease-related improvement using nonsurgical methods.”

Additionally, the guidelines recommended adjusting obesity definitions using standard BMI thresholds by population. As a result, Asian individuals can consider weight-loss surgery beginning at a BMI of 27.5.

> Related: You May Be Eligible for Weight Loss Surgery Based on New Guidelines

The criteria for weight loss medication is similar.

You may be eligible for FDA-approved anti-obesity oral medications or injectables (i.e., Ozempic®, Wegovy®) if you have a BMI greater than 30 or a BMI greater than 27 with weight-related comorbidities.

However, not all anti-obesity medications will work for all people. Some conditions (i.e., type 2 diabetes, heart disease, history of kidney stones) will determine the prescription.

“We first need to review your medical history thoroughly,” says Dr. Umashanker. “Then we can assess the appropriate medications as first-line or second-line therapies.”

Weight management is more than a number.

Beyond the weight loss method or the scale, Dr. Umashanker often asks patients bigger questions to gauge success.

  1. Does this weight loss improve your overall health?
  2. Can we reduce the number of medications you’re on for high blood pressure?
  3. Are we able to get you off insulin for type 2 diabetes?
  4. Are we able to improve your activity levels or your mental health?

“It’s also essential to think of surgery or medications as a tool for weight loss,” adds Dr. Umashanker. “As time goes on and you want to maintain the weight loss you’ve achieved, it’s not just nutrition. It’s also physical activity, which can be the hardest part for patients.”

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The importance of a personalized treatment plan starts with you.

Dr. Umashanker lends some advice if you’re starting this weight loss journey.

“Obesity and weight management is a chronic disease,” she says. “Sometimes surgery is the answer, medication is the answer, or sometimes it can involve both. Be open to the different surgical or nonsurgical modalities of treatment. You haven’t failed at anything. Instead, this is an opportunity to see the options that can help improve your health.”

Most importantly, where are you in this weight loss journey?

“That’s where we first meet you with a collaborative conversation,” says Dr. Umashanker. “We support you where you are today and when you’re ready to make a change.”