Metabolic and bariatric surgery or weight loss surgery as it’s commonly referred to has significant benefits for patients who have severe obesity. There are newer weight loss medications that are coming out and I think it’s important to do a comparison of what we can achieve with medicine versus surgery. GLP receptor Agnes are the newest group of weight loss medication‘s that have shown some benefit in weight loss. These medications takeoff up to 20% of total body weight. What that means is if you have 250 pounds lose you may lose up to 50 pounds. and while this is a significant amount of weight loss, not every patient can achieve that. When we talk about weight loss surgery, patients can achieve up to 40% of total body weight loss so for that same patient who weighs 250 they can actually lose up to 100 pounds. The other benefits of metabolic and surgery or weight loss surgery is that these effects are durable in terms of the weight loss and we expect that the patients will keep off a significant amount of weight for up to 10 years after the procedure. When we look at medications, we know that patient will need to continue to take them lifelong and that their weight loss is not ongoing, but that it does level off after the year mark.
In addition, we also know that weight loss medication’s and weight loss can actually help improve cardiovascular outcomes, cancer outcomes, and prove longevity of life. Most of our data comes from the surgical side in patients who have either stage two or stage three obesity which means that they have a BMI of 35 to 40 or 40 and above . These patients who we consider appropriate for surgical weight loss, including patients who have a BMI of 30 to 35, but with a significant health condition, can all expect an increased improvement in all their health conditions as well as in longevity. One of the studies on GLP1 receptor Agonists showed a 20% reduction in major adverse cardiovascular events( MACE), which were non-fatal MI or heart attack, non-fatal stroke, or death. There have been similar studies, looking at the effect of weight loss surgery on Cardio vascular outcomes and that has shown a 40% reduction in MACE.
There are many studies that are also showing improvements in diabetes, hypertension, cholesterol, cancer risk and fatty liver disease after weight loss surgery that has a greater improvement than weight loss from medication. I think it’s important to recognize that medications are helpful and it is also something that I offer a patient , when it is appropriate in their care. however, many studies have shown that greater weight loss results and greater improvement in all of these health conditions that are associated with obesity. As a weight loss surgeon as well as a physician who is boarded in obesity medicine, I discuss all the options with my patient and I know, that in cases of severe obesity, weight loss surgery will give a better weight loss outcome, better improvements in obesity related health conditions, increased longevity an increase durability of the weight loss as our surgical studies evaluate the effects out to 10 and 20 years and with medication’s these effects are only really measured out to one year in most cases and occasionally two years.
M. Kurian, MD, FACS,FASMBS, DABOM, DABS-FPMBS
