Weight loss: Is medicine or surgery the right path for you?

Obesity is a complex chronic disease that affects millions of people worldwide. It is associated with serious health conditions, including type 2 diabetes, hypertension and heart disease. Despite efforts to lose weight through diet and exercise, many individuals struggle to maintain significant and sustainable weight loss. This is where medical interventions, such as weight loss medications and bariatric surgery, come into play.

You may have heard of weight loss medications such as semaglutide (Wegovy, Ozempic), phentermine, liraglutide (Saxenda), naltrexone-bupropion (Contrave), orlistat (Alli, Xenical), phentermine/topiramate (Qsymia) and bupropion (Wellbutrin), but how do you know if they are right for you? Or if weight loss surgery also is an option. Which is the right path for you? The true answer is, it depends.

Understanding obesity as a chronic disease

Obesity is not simply a matter of willpower or personal choice; it is influenced by genetics, hormones, metabolism and environmental factors. The body’s weight regulation system is highly complex, involving signals between the brain, gut and hormones that control hunger, satiety and energy balance. When this system is disrupted, individuals can develop metabolic syndrome – a cluster of conditions that increase the risk of heart disease, stroke and type 2 diabetes.

“Metabolic syndrome is a mix of issues like insulin resistance, high blood sugar, high blood pressure, abnormal cholesterol and too much belly fat,” said Dr. Samer Mattar, Baylor Medicine weight loss surgeon and professor and chief of the Section of Metabolic and Bariatric Surgery. “These imbalances make it tough to lose weight with just diet and exercise. The body fights back by slowing metabolism and making you feel hungrier, which is why long-term weight loss is so difficult without medical help.”

Patients can feel defeated having to turn to weight loss medication or surgery, but the fact remains that this is a disease that they have little control over.

“Patients often feel embarrassed or discouraged when they come to see me about weight loss surgery,” Mattar said. “But I tell them there’s nothing to be ashamed of. Choosing surgery to improve their health and quality of life takes incredible courage.”

Understanding weight loss medications vs. bariatric surgery

Whether it’s weight loss medicines or weight loss surgery, the desired result is the same: to achieve a significant reduction in hunger, appetite and cravings, allowing patients to lose weight sustainably.

“When we talk about weight loss and metabolic syndrome, the underlying issue often stems from a gut-brain axis imbalance,” said Dr. Vani Potluri, physician and assistant professor in the Margaret M. and Albert B. Alkek Department of Medicine. “This means that the body’s natural hunger and satiety signals are disrupted, making it difficult for individuals to control their weight. For many patients, lifestyle modifications alone are insufficient. They have tried various diets, exercise programs and other weight loss strategies without long-term success.”

Medications designed for weight loss target specific pathways in the brain that regulate hunger, satiety and metabolic rate. These drugs help patients manage their weight by reducing cravings and enhancing feelings of fullness. Over the last decade, there have been significant advancements in weight loss medications, leading to safer and more effective treatment options.

“One of the biggest questions we get with the medicine side is, ‘Can I just stop taking it?’” Potluri said. “Often, that is not the case. If you have had trouble with your weight since you were young or in your early adulthood, you most likely will need to continue to be on weight loss medicine to maintain the weight loss.”

Bariatric surgery offers an intervention that provides long-term benefits. It is particularly effective for individuals with severe obesity or those with obesity-related conditions like diabetes and hypertension. Unlike medications, surgery provides a more permanent solution by altering the anatomy of the digestive system to facilitate weight loss and metabolic improvements.

“To be candid, bariatric surgery 20 to 30 years ago had a checkered reputation,” Mattar said. “There were patients who did not do very well at that time, but since then, we’ve improved our standards dramatically. Our successful programs are accredited, and we’ve reached that level of safety that bariatric surgery is now as safe as natural childbirth.”

For some patients, weight loss medication is used as a tool to prepare for surgery by helping them shed excess weight beforehand, which can make the procedure safer and improve outcomes. Others may choose medication as an alternative to surgery, as it offers a non-invasive approach to weight management. Since bariatric surgery is a major decision, some individuals prefer to try medical therapy first to see if it meets their needs before committing to a surgical solution.

Comparing long-term outcomes

Both weight loss medications and bariatric surgery can lead to remission of obesity-related conditions, such as diabetes, high blood pressure and high cholesterol. However, abdominal fat plays a major role in worsening these conditions, and for some patients, a more permanent solution, like surgery, may be necessary.

As medical advancements continue, both options are becoming safer and more effective.

“A lot has changed, and we keep getting better and better,” Potluri said. “We have more options for medicines than we did 10 years ago. And what we have has just been tweaked and finessed and improved to better versions of itself. So, the key takeaway is: now is the time to try to work on weight, especially if it’s been something you’ve been sitting on, before it starts to cause irreparable harm.”

Mattar and Potluri often refer patients to each other depending on the patient’s needs and wants.

To schedule an appointment with Mattar or his colleagues at the Weight Loss and Metabolic Center at Baylor Medicine, call 713–798–6673. To make an appointment with Potluri and her colleagues, call 713-798-2500.

By Tiffany Harston, senior communications specialist in the Michael E. DeBakey Department of Surgery