GLP-1 Medications vs. Bariatric Surgery

GLP-1 medications have become a hot topic lately, with celebrities and other public figures praising them as an effective way to lose weight quickly. That publicity hasn’t gone unnoticed, with an impressive eight in 10 adults saying they’ve heard at least “a little” about these types of drugs.

GLP-1 medications are effective, but they certainly aren’t the only—or inherently the best—option for people who need to address obesity and manage their weight. Bariatric surgery is another popular and proven choice.

Let’s look at the difference between these two routes and why bariatric surgery might be the better option.

What are GLP-1 medications?

GLP-1 is an abbreviation for glucagon-like peptide, a hormone that stimulates the body to release insulin when blood sugar levels rise.

These types of drugs are agonists, meaning they activate a receptor in the body. In the case of GLP-1 medications, they activate receptors in the pancreas to release more insulin and reduce the release of glucagon (the hormone that raises blood sugar levels) to help blood sugar levels stay in a healthy range.

These medications are typically administered by self-injection, with the primary goal of improving blood sugar for people with diabetes. However, because they reduce appetite and lead to slower gastric emptying (when your stomach contents move from your stomach to your small bowel), they also commonly lead to weight loss and are becoming increasingly popular for that purpose. Some of the more common brand names of GLP-1 medications include:

• Mounjaro
• Ozempic
• Rybelsus
• Trulicity
• Wegovy

While most have been FDA-approved for diabetes, only some are FDA-approved specifically for weight loss—and a good number of people do take them with weight loss in mind. According to recent research, one in eight adults has taken a GLP-1 agonist, and the majority (62%) do so for diabetes. However, four in 10 people did take GLP-1 medications to lose weight.

GLP-1 medications are effective, but they aren’t accessible to everybody. They are prescribed to people who have type 2 diabetes, heart disease, or obesity (defined as a BMI of 30 or higher).

What is bariatric surgery?

Bariatric surgery (often called “weight loss surgery”) is a group of surgical procedures that address obesity and related conditions.

From a sleeve gastrectomy to an adjustable gastric band, there are several different types of bariatric surgery. While the mechanics vary, all of them make the stomach physically smaller so that people feel full faster, eat smaller portions, and lose weight.

It’s surgery—meaning it’s more invasive than GLP-1 medications. However, it’s also one of the most effective ways to treat obesity and its related conditions.

Much like the medication route, the guidelines for qualifying for bariatric surgery hinge on BMI. According to the Mayo Clinic, adults with a BMI of 40 or higher are eligible for this type of procedure. But bariatric surgery is also an option for adults who meet all three of these conditions:

• BMI of 35 or higher
• At least one obesity-related medical condition (e.g., type 2 diabetes, heart disease)
• At least six months of physician-supervised weight loss attempts

People who meet the eligibility requirements will undergo a pre-operative screening to confirm that they’re healthy enough to undergo the procedure and to identify other medical issues that could contribute to obesity and/or interfere with surgery.

Why bariatric surgery might be a better weight loss solution than GLP-1 medications

Understandably, many people want to avoid the operating room. If they can manage their conditions or meet their health goals with medications, that’s often preferable to having surgery. And ultimately, it’s up to patients and their healthcare providers to decide the best route forward.

But with that said, even though bariatric surgery might initially seem like the riskier and more extreme option, there are a few compelling reasons it can be the better choice for patients and their employers.

Bariatric surgery is more effective long-term

There’s a good reason GLP-1 medications have skyrocketed in popularity and notoriety: they promise impressive results. Research shows that most patients who take these drugs lose weight, with one third of patients losing more than 5% of their body weight at the 72-week mark in the study.

Another study that looked specifically at extremely obese patients (those with a BMI of 70 or above) noted that participants who took multiple GLP-1 medications lost about 13% of their total body weight within 73 days. Those who took a single GLP-1 drug lost a little more than 8% of their body weight in the same amount of time.

These drugs are effective—there’s no denying that. However, the issues crop up when people stop taking them. One study looked at 670 participants who lost an average of 20% of their initial body weight within 36 weeks. At that point, they were either switched to a placebo or continued to receive a high dose of the drug for a year.

Those who continued to receive active treatment lost another 5.5% of their body weight, while those who were on the placebo gained an average of 14% of the lost weight back. Experts hypothesize that people need to take the medications long-term to maintain the results and, unfortunately, the long-term side effects of these drugs haven’t been studied closely yet.

In comparison, weight loss surgery doesn’t rely on a chemical reaction in the body. It’s a physical adjustment that makes the stomach smaller—making patients less likely to deal with rebound weight gain.

According to recent research, more than 90% of bariatric surgery patients manage to maintain long-term weight loss of 50% or more of their excess body weight, proving that bariatric surgery can offer better and more lasting results.

Bariatric surgery is more cost-effective

Surgery might seem like the pricier option at first glance, but the reality is that GLP-1 medications aren’t cheap.

Estimates vary, but these injectable weight-loss drugs can cost well over $1,000 per month. And while one third of employer health plans are currently offering coverage of GLP-1 medications, doing so is rapidly accelerating their medical costs. Additionally, the increasing popularity of these drugs repeatedly causes shortages—inspiring insurance providers to show some resistance to continuing to cover these medications.

Bariatric surgery involves a heftier one-time payment, but it doesn’t come with the enduring cost of weight loss drugs. Here’s the price comparison, according to research from Northwestern:

• Weight loss injections: $11,628 annually
• Bariatric surgery: $18,581 once

Considering 32% of people are still taking GLP-1 medications more than a year after starting them, bariatric surgery quickly comes out as the more cost-effective option that ultimately yields better results. That’s likely why more employers (an estimated 45% of them) cover bariatric surgery for employees, and some insurers are even finding ways to expand access to these procedures.

Where a bariatric center of excellence program fits in

The advancement of modern medicine means that, fortunately, people who need or want to lose weight have choices. However, the best option will balance health outcomes with real-world logistics like cost and accessibility.

That’s where a centers of excellence (COE) program comes in. Carrum Health connects self-insured employers to high-quality healthcare providers for surgical and cancer care (including bariatric surgery) to improve the patient experience, provide better results, and reduce the cost burden for employers and their workers.

After all, unpredictable and unmanageable costs associated with weight loss treatment ultimately detract from the most important point of focus: helping people improve their long-term health and well-being.

To learn more about how we can help members with high-quality weight loss solutions, reach out here.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.