Weight-loss drugs replacing some surgeries, but doctors say they’re ‘not a miracle drug’

Fewer patients are seeking weight-loss surgeries as anti-obesity drugs have surged in popularity, a new study learned.

Surgeries that alter a person’s stomach have long been the go-to option to manage obesity. However, researchers determined more people are opting for the much less invasive choice to take medications like Ozempic and Wegovy to lose weight.

“It’s not surprising that a lot of us have seen a dip in surgeries,” said Dr. Matthew Pittman, regional director of bariatric surgery for Northwestern Medicine. “Most of us expected this, or should have expected this, given the success of these drugs.”

But the study’s findings don’t mean those surgeries are going away anytime soon, nor does it mean these drugs are a miracle cure, Chicago bariatric surgeons told the Sun-Times.

The drugs are another option for patients to manage their weight, and surgery remains the gold standard treatment for severe obesity.

“This is not a miracle drug but another tool we can use to help patients,” Pittman said. “We are still relatively in the early phases of these drugs. We don’t have long-term data yet, while surgery has decades of data. But we have more options now to determine what’s best for patients, whether it’s a medical approach or going a surgical route.”

Researchers from Harvard and Brown University looked at the health records of 17 million Americans with obesity and determined that between 2022 and 2023, rates of bariatric surgeries dropped by 25%, while prescriptions for weight-loss drugs more than doubled.

The U.S. Food and Drug Administration approved the drugs for weight loss in 2021. The drugs, called glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, have helped some patients lose an average of 5% to 10% of their body weight, according to the FDA.

About 70% of American adults are obese or overweight. Obesity is linked to several other serious health issues — including diabetes, high blood pressure and high cholesterol — and leading causes of death like heart disease, stroke and certain cancers.

Obesity, a treatable biological disease, has also long been a stigmatized condition, stopping people from seeking treatment, said Dr. Vivek Prachand, a bariatric surgeon and co-director of the University of Chicago’s Digestive Diseases Center.

“Obesity in our society has a stigma of individual laziness and failure, and there’s a lot of guilt and shame associated with it,” he said. “This makes people hesitate to even talk to physicians about it. And that awkwardness works both ways. Some doctors don’t feel comfortable broaching the subject with patients.”

Patients who might otherwise feel uncomfortable talking about their weight have been asking about the drugs, Prachand said. And for patients not ready to consider surgery, they might be willing to try medication.

“That gets them part of the way there because the medications are still not as strong of a tool as surgery,” Prachand said.

Surgery remains the gold standard for treating severe obesity. But for people with more moderate obesity or who are overweight, medications could replace the need for surgery, Prachand said.

That could also explain the drop in bariatric procedures identified by the study. Bariatric surgery programs that don’t treat severe obesity will likely continue to see a drop, Prachand said.

“As a surgeon, I’m very much in favor of these medications,” Prachand said. “The implication that we want to avoid is that you tried medication and failed, now you need surgery. It’s about trying the right tool in the right situation at the right time.”

While the medications are still new and have yet to be studied long term, bariatric surgeries have been performed for decades and have gotten safer and more effective, several studies have found.

One study found that seven years postoperation, most patients had maintained weight loss, and high cholesterol, high blood pressure and diabetes were less common. Another study spanning 40 years found the procedure reduces the risk of premature death, especially from obesity-related conditions like cancer, diabetes and heart disease.

“Bariatric surgery is the most effective method for achieving significant and sustained weight loss in individuals with extreme obesity,” researchers wrote in another long-term study.

The medications aren’t without limitations. Patients have to inject the drug weekly. They also have to stay on it indefinitely to keep the weight off. Most gain back some, if not all, of the weight when they stop taking the drug. It’s also pricey, and insurance might not cover the expense. And because the drugs are in high demand, not every pharmacy can keep them in stock.

Some patients also might not tolerate the slew of potential side effects: nausea, diarrhea, vomiting, constipation, stomach pain, headaches, fatigue and indigestion.

But both Pittman and Prachand emphasized that most people struggling with obesity don’t receive treatment of any kind, whether it’s the inability to afford it or fears of judgment.

“For those who qualify for surgery, we’re treating only 1% of them,” Pittman said. “A large percentage of the population who we aren’t even talking to would benefit from any treatment.”

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