Weight Loss Surgery vs Weight Loss Medications. Which one's better?

Weight loss surgery can help you lose significant weight, often bringing additional health benefits. Many obesity-related conditions, like type 2 diabetes, sleep apnea and high blood pressure, may improve or go into remission. After surgery, about 95% of people report a better quality of life.

Understanding Weight Loss Treatments: Alternative/Adjunct  to Weight Loss Surgery

Let’s understand some of the weight loss treatments:

1. Diet and Exercise: Diet and exercise have been the standard methods for weight loss, but they often result in only modest weight loss—about 7.4% on average. Many regain weight within four years, showing the challenge of losing weight through these methods alone

2. Obesity Drugs-Ozempic, Wegovy and Mounjaro: Ozempic, Wegovy and Mounjaro contain semaglutide, which helps reduce cravings and increase fullness. Mounjaro (Tirzepatide) works by targeting the area of the brain that regulates appetite, slowing down the emptying of the stomach, meaning people feel fuller quicker and for longer. While they can lead to around 10.6% weight loss in five months, patients often regain about half the weight within a year after stopping the treatment.

It is important to understand that these medications are not “quick fix” because as soon as people stopped taking them, they would regain weight and the benefits would be lost. The medication gives an individual the opportunity to start addressing weight loss. This must be coupled with a dietitian supporting them through good food choices. Positive habits that see a sustainable lifestyle change through Dr. Monica.

It is much cheaper to buy highly processed food than it is to get access to foods that will be nutritious, not just filling. This involves a mindset change. Continue or commence an exercise regime to keep the weight off.

The TGA has approved Mounjaro and Wegovy for use in adults with an initial body mass index (BMI) of ≥30 kg/m² or a BMI of ≥27 kg/m² if they have at least one weight-related condition, such as hypertension, dyslipidemia, obstructive sleep apnea, cardiovascular disease, prediabetes, or type 2 diabetes.

Types of Bariatric Surgery

The most common types of bariatric surgery in Australia are:

• Gastric Bypass

• Roux En Y Gastric BYpass

• Mini/Omega Loop Gastric BYpass

• Gastric Sleeve Surgery (Sleeve Gastrectomy)

These surgeries are usually done as minimally invasive keyhole (laparoscopic) procedures with small incisions in the abdomen. In some cases, open surgery with a larger incision is needed.

• Gastric Bypass: A small stomach pouch is created and connected directly to the small intestine, bypassing most of the stomach and reducing calorie absorption.
• Gastric Sleeve Surgery: Most of the stomach is removed.
• Lap Band Surgery: An adjustable ring is placed around the top of the stomach, creating a small pouch that slows down food passage. It is not commonly done anymore as there are better surgeries that support patients, like Gastric Bypass / gastric sleeve.
  
  

Weight Loss Surgery vs. Medications: The Superiority of Bariatric Surgery

Obesity rates in Australia are high, leading to serious health issues like heart disease, diabetes, and cancer. Effective treatments like bariatric surgery are important. 

Both tools, “Surgery / Medications” aid with weight loss. Both tools need a multidisciplinary support team to aid an individual in achieving sustainable weight loss. 

So why do we think that Bariatric Surgery remains superior :

1. Effectiveness and Durability: 

a. Weight loss surgery has the ability to lead to around 30% weight loss within a year and patients maintain 25% weight loss even after 10 years. 
b. Mounjaro, Ozxempic, Wegovy: There is no long term data to support the safety and efficacy of the use of pharmacotherapy for obesity. 

2. Surgery as a First-Line Treatment: Bariatric surgery, when considered earlier in the treatment of obesity, significantly reduces health risks. This early intervention not only offers lasting weight loss but also brings about substantial health improvements, making it a superior choice for obesity treatment.

3. Regulations and Accessibility: Bariatric surgery in Australia is regulated for safety, with eligibility based on health assessments and BMI. 

4. Addressing Concerns and Misconceptions: Many fear bariatric surgery due to concerns about recovery and complications, but modern techniques have improved recovery times. It is well known that bariatric surgery in expert hands (Bariatric Surgeons) has been shown to have a lower mortality rate than gallbladder surgery. The general inpatient stay in most instances would be around 2 days and in the majority of cases, surgery is performed with the keyhole technique.

Who is eligible for Bariatric Surgery?

To determine if Bariatric surgery is suitable, a pre-operative assessment includes a detailed history and physical exam. Surgery is typically considered for:

• Individuals with a BMI over 35 kg/m².
• Individuals with a BMI over 30 kg/m² and one or more obesity-related complications.
• Individuals are at least 16  years old.
• Individuals are ready to make lifestyle changes, including following a healthy diet and exercising regularly.

For managing type 2 diabetes (T2DM), bariatric-metabolic surgery is recommended for:

• All individuals with T2DM and a BMI of 30 kg/m² or higher.

What to expect after Bariatric Surgery?

After surgery, you'll start with liquid foods and gradually move to pureed and solid foods. Your meals will be much smaller, and you will need to avoid drinking with meals due to your smaller stomach size.

To lose weight and keep it off, you must make significant lifestyle changes. These include following dietary guidelines, taking vitamins or supplements as your doctor advises, and increasing physical activity. A dietitian may provide a personalised, tailored approach to help you adjust.

Some people may initially lose weight but regain some over time as their body adjusts. To maintain long-term weight loss, it's crucial to follow your healthcare team's advice and raise any concerns you have.

You'll need regular check-ups and blood tests for the rest of your life, and your medications may require adjustments after surgery.

How do you choose a Surgeon or Weightloss Clinic?

It is important to choose an experienced and qualified bariatric surgeon for Bariatric surgery in Melbourne. You can ask your doctor for a referral or search online for surgeons in your area.

Once you find a few options, schedule consultations to learn more about their approach and experience with the specific surgery you're considering. This will help you make an informed decision. Find out about their team (dietitian/ Habits Coach/ The experience of the  surgeon)

Ready to take the first step towards a healthier you? Book a consultation today to discuss your weight loss goals and get personalised solutions.