Medication or surgery for weight loss?

Overweight (over 60%) and obesity (over 30%) continue to increase in prevalence in Australia. Overall, this significantly reduces a person’s quality of life, contributes to several serious health issues and reduces life expectancy. Dietary and lifestyle measures have and continue to be offered as the ideal management strategy however are usually ineffective alone once the condition becomes chronic.

GLP-1 Agonists

Medications are often used as a next step. In recent decades these have been in oral forms and a commonly prescribed medication has been Phentermine. Developments in “metabolic active” medications has seen an increasing use of GLP-1 agonists which were originally offered to diabetics only. These are injectable form and were originally daily injections (Liraglutide or “Saxenda”), although evolution led to a more manageable once weekly medication called Semaglutide (branded as Wegovy or Ozempic). Naturally these are attractive for people suffering and a ready option for prescribers such as GP’s. [further developments have and are still being developed which act in similar ways – eg. Tirzapetide]

Bariatric Surgery

Surgical management has been around for nearly a century, although the more commonly performed safer and well tolerated options (Laparoscopic sleeve gastrectomy, gastric bypass, gastric banding) have mostly evolved since the 1990’s. Acceptance of surgery to treat obesity has significantly increased over the last two or more decades, due to the acceptable minimally invasive approach, the reduction in complication rates, the long term effectiveness and an appreciation of the inescapable “obesogenic” environment of a Western lifestyle.

Medication or Surgery for my patient?

Often a treatment algorithm entails a scale up approach, with diet/lifestyle, followed by medication then surgery. Certainly, Semaglutide is a ready option for a GP to offer initial management (assuming supply is adequate, especially for diabetics). Ideally, a patient is educated not only on the cause and contribution to their obesity but also to the pros and cons of either approach.

	Pros	Cons
Semaglutide	Primary care option Effective at mild/modest weight loss (on average)	Evidence suggests necessity for long term or life-long Ongoing injections necessary Ongoing high medication cost Side effects (mostly gastrointestinal)
Bariatric Surgery	Single procedure attains long term effect (on average) Significantly higher weight loss/co-morbidity resolution (on average)	Requires referral, hospital admission and upfront cost Closer monitoring of adequate nutrition required Surgery risk

Either option is reasonable, and the patient should be involved with the decision with adequate counselling. A specialist clinic allows a full discussion of options, both medical or surgical.

Written by Dr Philip Le Page.

Dr Phil Le Page is one of Sydney’s leading Laparoscopic, Upper GIT, Obesity, and General Surgeons, with an established practice treating both private and public patients. He is highly qualified in patient assessment and surgical expertise. Notably, Dr Le Page provides a coaching program that facilitates the eventual weaning off Semaglutide, addressing the root causes and contributing factors of obesity. This program is also offered to surgical patients to ensure a holistic approach to their treatment.

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