In the midst of the “boom” of new weight loss drugs and a few days after the United States approved the first daily pill for weight loss without punctures, a multidisciplinary team from the Clínica Universidad de Navarra published a study in which it compares … the effectiveness of three types of interventions in obese patients: bariatric surgery, pharmacological treatments with GLP-1 receptor agonists (drugs from the Ozempic, Wegovy or Mounjaro family) and lifestyle modifications (diet and physical exercise).
The research results, published in the journal “Obesity”, reveal that weight loss achieved by patients who have undergone bariatric surgery is greater than those who had received one of the new weight-loss drugs or who had changed their lifestyle by improving their diet and doing more physical activity.
The study, published in collaboration with specialists from the Imperial Weight Center in London (Imperial College Healthcare NHS Trust), includes data from randomized clinical trials involving more than 20,000 patients with obesity and evaluates parameters such as percentage of total weight loss, body mass index (BMI) and body composition.
The weight loss achieved by patients undergoing bariatric surgery is greater than with medication or diet.
The meta-analysis includes two surgical techniques – tube gastrectomy and gastric bypass – and three drugs (liraglutide, semaglutide and tizepatide). The results show that although GLP-1 agonists cause clinically significant weight loss, bariatric surgery remains the most effective strategy for weight reduction (each patient’s initial weight) at least two years after the start of surgery, drug treatment or lifestyle change.
But When is bariatric surgery recommended? “It is indicated in patients with a BMI greater than 40 or in those with a BMI of 35 with comorbidities (cholesterol, diabetes, hypertension, joint problems). “In BMIs below 30, only if the patient has type 2 diabetes that is not sufficiently controlled by medication,” Dr. Lucas Sabatella, a trained specialist in the Clinic’s Department of General and Digestive Surgery and first author of the work, explains to ABC.
In obese patients using drugs like liraglutide and semaglutide, weight losses are “very modest”. “It is rare to lose, at maximum doses, more than 10%. » “With tirzepatide, the loss can reach 20%, but with surgery it can reach 40% of body weight“says the expert, who assures that the majority of patients who now present to the operating room have already undergone these medications without success.
rebound effect
Dr. Víctor Valentí, co-director of the obesity sector of the clinic, emphasizes that “bariatric surgery is an intervention with a very low complication rate.” “It is the best option in properly selected patients. The drugs act on gut hormones that regulate appetite, metabolism and glucose, thereby increasing satiety, but they have a high dropout rate which results in regaining lost weight,” he warns.
In fact, studies of patients who do not have such ongoing professional support reveal that more than half of them discontinue treatment within the first few months, limiting its effectiveness. However, with surgery, “it is very rare to regain all the weight if the necessary measures are taken and follow-up is done,” specifies Dr. Sabatella.
In the opinion of experts, medications and surgery can also be successfully combined in some cases. “We can use the drugs as a weapon in super obese patients who need to lose weight before surgery to make it safer, as well as in patients who gain weight after surgery. We must use all our weapons in our favor,” concludes Dr. Sabatella.
The work of the Clinic’s specialists also includes a sub-analysis in people with type 2 diabeteswhere it was observed that weight loss, reduction in BMI and waist circumference were even greater in those who underwent bariatric surgery. However, the authors emphasize that GLP-1 agonists also significantly improve glycemic control and constitute an effective therapeutic tool, particularly in patients who are not candidates for surgical intervention.
“Obesity is a chronic disease in the treatment of which the patient’s expectations are a central point and define the best option in each case. However, for people with greater accumulation of adipose tissue or for whom obesity further limits their daily life, surgery is a significantly superior treatment and it is essential that they evaluate all treatment alternatives. Specialists can and should personalize treatment as much as possible,” explains Dr. Manuel Landecho, specialist in internal medicine in the area of obesity and the clinic’s control unit.
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