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“Bariatric surgery and GLP-1-based medications (weight loss drugs) have become two of the most significant options for treating obesity in recent years, each with its own benefits, drawbacks, and long-term effects,” Dr Gautam tells Health Shots.

How GLP-1 medications work and what you can expect

GLP-1 receptor agonists like Ozempic are injectable and oral drugs that work like glucagon-like peptide-1, a hormone that helps control appetite and blood sugar levels. They make the stomach empty more slowly, make people less hungry, and help them feel full with smaller amounts of food. Many people start to lose weight within weeks, and their blood sugar levels often get better at the same time.

But these drugs do not work all the time. The doctor explains: “They do not change the way the body stores fat or how it changes over time in terms of metabolism. If the medication is stopped, appetite and weight often come back, especially if there are no changes to diet or activity level. In practice, you need to keep using them to keep getting the benefits, which makes them more of a long-term treatment than a one-time fix.”

Side effects of GLP-1 medications

Many people who take this medicine reportedly complaint of nausea, bloating, constipation, and stomach pain as side effects. “While most people can handle them, some stop taking them because they keep having stomach problems. Pancreatitis and gallbladder problems are also rare but serious complications that need to be watched closely. People who have had these kinds of problems in the past may be told not to use these medications,” adds Dr Gautam.

The cost – approximately ₹10,000-20,000 for injectables – every month, may be another factor to consider in case long-term use of weight loss drugs is planned. “People who do not have type 2 diabetes may not always have insurance. The cost can make it hard to stick with it in the long term. Also, losing weight quickly from medication without a structured resistance-training program could cause patients to lose lean muscle, making them feel weaker instead of stronger,” says the expert.

Is bariatric surgery for severe obesity better?

In some severe obesity cases, doctors suggest a bariatric surgery for long-term benefits. Bariatric surgery has two types: sleeve gastrectomy and gastric bypass. These don’t just make your stomach smaller, but also change the hormones in your gut, the signals that tell you you’re hungry, and how your body breaks down food.

“Many patients say they feel less hungry without taking medication. The surgery changes the anatomy and hormonal environment of the gastrointestinal tract, which is why this happens. There are many more benefits than just losing weight. Surgery can help people with type 2 diabetes stay in remission, lower their blood pressure, and fix or improve sleep apnea, polycystic ovarian disease, and metabolic syndrome. The chances of getting cancers linked to being overweight, especially breast and colon cancer, are also lower,” explains Dr Ashish Gautam about the benefits of bariatric surgery.

For obese patients who deal with type 2 diabetes, blood sugar levels go down within days of surgery. The need for insulin drops a lot, and some patients go into remission for years. This is because the surgery changes how sensitive insulin is and how hormones are released in the gut, he adds.

Citing a ARMMS-T2D study, which took place over 12 years at four major US research centers, he points out how bariatric surgery patients kept off an average of 20% of their weight, while those who received medical and lifestyle interventions only lost 8% of their weight. More than half of surgical patients achieved HbA1c levels under 7%, and diabetes remission was significantly more common and persistent. Even people with a BMI of 27 to 34 saw benefits.

What are the side effects of bariatric surgery?

One of the side effects of bariatric surgery is that it may lead to nutritional deficiencies like low iron post-surgery. This can usually be avoided by taking supplements and monitoring health parameters.

“Most bariatric surgeries today are done with small incisions or robotic help, so patients often leave the hospital in two to three days. Recovery is quicker, and there are fewer complications than with older open surgeries. Following the procedure with proper nutrition and strength-focused exercise helps protect muscle, keeping strength and energy levels up while losing weight,” he says.

Bariatric surgery vs GLP-1 drugs

According to the surgeon, bariatric surgery always leads to more weight loss that lasts longer than GLP-1 drugs. Drugs can have big effects in the short term, but stopping them often means gaining weight back.

• Metabolic effect: Surgery changes hormones right away and for a long time, which helps regulate appetite and glucose metabolism. GLP-1 drugs have similar effects, but they need to be taken all the time and stop working when you stop taking them.
• Risks and side effects: There are risks involved with surgery, but modern methods have made complications less likely. Medicines don’t have the same risks as surgery, but they can upset the stomach and, in rare cases, cause more serious problems.
• Cost: The cost of surgery up front can be high, but insurance will often pay for it if certain medical conditions are met. You have to keep paying for GLP-1 drugs, which can add up to more than the cost of surgery over a number of years.
• Lifestyle commitment: Both methods require changes to your lifestyle. Surgery patients need to change how they eat and keep taking their vitamins, while medication users get the most out of their medications when they are also following a diet and exercise program.

“For those who prefer to avoid surgery, want to lose weight beforehand, or can’t undergo surgery for medical reasons, GLP-1 medications can be an option. They may also suit people who are moderately overweight or want to try appetite suppression before considering surgery,” says Dr Gautam.

He adds that surgery remains the most effective option for people with severe obesity, especially when other health conditions are also present.

“Some patients may do better with a combination of treatments. For example, they could start with GLP-1 medication to lose weight and lower the risk of surgery, and then have surgery to keep the weight off for good. When pharmacologic therapy stops working as well, some people may switch from medication to surgery,” says Dr Gautam.

A word of caution

Before you choose between bariatric surgery and GLP-1 therapy, you need to have a full medical evaluation, talk about your goals, and be honest about how long you plan to stick with it. Both can be useful, but how well they work depends on each person’s health, ability to stick to lifestyle changes, and ability to follow up with care.