Weight loss medications like Ozempic (semaglutide) and similar GLP-1 receptor agonists have revolutionized how many people approach shedding pounds. Their effectiveness in clinical trials is well-documented. However, a new real-world study suggests that when compared to established surgical methods, these popular drugs may not be the most impactful strategy for achieving significant weight loss over time.
Researchers at New York University (NYU) conducted a study comparing the outcomes of bariatric surgery (specifically sleeve gastrectomy and gastric bypass) against the use of GLP-1 medications such as semaglutide and tirzepatide. Unlike controlled clinical trials, this study analyzed health records to see how patients fared in a real-world setting.
The team meticulously matched patients who received GLP-1 prescriptions with those who underwent bariatric surgery based on crucial factors like age, body mass index (BMI), and blood sugar levels. The goal was to provide a direct comparison using data from everyday healthcare.
Key Finding: Surgery Led to Dramatically More Weight Loss
The core finding from the NYU study was stark:
Surgery Group: Averaged a loss of 25.7 percent of their total body weight over a two-year period.
Medication Group: Averaged a loss of just 5.3 percent of their total body weight over the same two years.
Based on this real-world data, bariatric surgery was, on average, approximately five times more effective for total body weight loss over two years compared to GLP-1 medications in the observed patient groups.
Why the Significant Difference? Adherence Plays a Role
This substantial difference likely stems from multiple factors. One key reason highlighted by the researchers is patient adherence. While bariatric surgery is a permanent change to the digestive system, GLP-1 medications require consistent, long-term use.
According to Avery Brown, a surgical resident at NYU Langone Health, clinical trials show GLP-1s can lead to weight loss between 15 percent and 21 percent. However, this real-world study indicates considerably lower results, even for patients who held active prescriptions for a full year. Brown notes that as many as 70 percent of patients may discontinue GLP-1 treatment within a year, which naturally impacts long-term weight loss averages. Surgery, while requiring significant lifestyle changes, is a physically permanent procedure that bypasses daily medication adherence challenges. The study found surgery yielded better results even over shorter time frames.
Beyond Weight Loss: Other Health Benefits
It’s important to remember that GLP-1 drugs offer benefits beyond weight loss. Medications like Ozempic were originally approved for treating type 2 diabetes due to their ability to lower blood sugar levels. Studies also suggest they may reduce the risk of cardiovascular disease and even certain cancers.
However, the NYU study found that bariatric surgery was associated with even better blood sugar control compared to the GLP-1 medications in the analyzed patient records.
Weighing the Options: Surgery Isn’t Without Caveats
Despite its impressive weight loss results in this study, bariatric surgery is not a simple solution. It is an invasive and permanent procedure that requires patients to commit to lifelong dietary changes, nutritional supplementation, and regular exercise for long-term success.
Furthermore, the study notes its funding source: the American Society for Metabolic and Bariatric Surgery (ASMBS), which could have a vested interest in promoting surgical options. While this doesn’t invalidate the data, it’s a factor to consider when interpreting the findings. Researchers were careful to state they are not dismissing GLP-1 treatments, which still showed beneficial results in the study cohort.
Weight Management is Complex: A Holistic View
Effective weight management is rarely a one-size-fits-all endeavor. While medical and surgical interventions like GLP-1s and bariatric surgery offer powerful tools, they are often most successful when combined with comprehensive lifestyle changes.
Consider the role of practices like yoga, often viewed for flexibility or stress relief, which can significantly support weight management. Yoga cultivates mindfulness, a practice linked by research to more conscious eating habits. It can also help reduce stress and improve sleep quality. Studies show better sleep can positively impact appetite regulation and energy intake, aiding weight loss efforts. Even gentle styles like restorative yoga have shown benefits, helping women with overweight reduce overall weight and abdominal fat. Integrating such mindful movement practices can complement medical or surgical paths by supporting behavioral change and overall well-being.
Looking Ahead
With GLP-1 prescriptions dramatically increasing, studies like this are crucial for understanding how these newer treatments compare to established methods in real-world scenarios. Future research, as planned by the NYU team led by Karan Chhabra, a bariatric surgeon, aims to identify which patients are best suited for surgery versus GLP-1s, explore ways healthcare providers can optimize GLP-1 outcomes, and investigate the impact of factors like out-of-pocket costs on treatment success.
Ultimately, the choice of weight loss strategy depends on individual health status, goals, risk tolerance, and ability to commit to necessary lifestyle changes. While this study highlights the potent effectiveness of bariatric surgery, GLP-1 medications remain a valuable tool for many, and a holistic approach incorporating diet, exercise, and supportive practices is often key to lasting success.
