GLP-1 or bariatric surgery? Learn how to choose the right weight-loss approach for your goals and health.
In this article:
- Weight-loss treatment isn’t one-size-fits-all—the best option depends on BMI, health conditions, and goals.
- Bariatric surgery often leads to greater, longer-lasting weight loss, but it’s invasive and can have side effects.
- GLP-1 medications are less invasive and can help with weight and blood sugar, but they usually require ongoing use and may cause side effects.
Teresa has a BMI of 29. She exercises regularly but just can’t shed the extra pounds.
Jake needs to lose weight to control his Type 2 diabetes. His current BMI is 37.
Kelly dropped 106 pounds after her bariatric surgery, but the extra weight is slowly returning.
Teresa, Jake and Kelly are all struggling with their weight, but that doesn’t mean they should use the same approach to weight loss. Teresa may be a good candidate for anti-obesity medications, or AOMs, such as a GLP-1. Jake could benefit from bariatric surgery, which will both help him slim down and lower his A1C. Kelly needs to maintain her post-surgery weight loss, and a GLP-1 drug could help her do just that.
Obesity in the United States has reached epidemic proportions. According to the U.S. Centers for Disease Control and Prevention, 40.3% of Americans are obese. Hollywood and social media often sets unrealistic standards for thinness while body positivity proponents preach self-acceptance over weight loss. But the truth is, obesity can weaken the immune system, cause chronic inflammation and increase the risk of serious health conditions like Type 2 diabetes, asthma, heart disease, stroke, sleep apnea and even certain cancers.
For many years, the only way to tackle obesity was through diet and exercise. Medical science has since developed two additional weight-loss methods: bariatric surgery and GLP-1 medications. Both have their advantages, drawbacks and side effects.
Bariatric Surgery
Bariatric surgery refers to different procedures that can alter the digestive system or remove part of the stomach. The results mean people feel full after eating a smaller amount of food. In addition, the surgery reduces levels of the appetite-stimulating hormone ghrelin. Bariatric surgery lowers blood sugar and may even induce remission in people with diabetes. There are two common approaches to bariatric surgery:
- Laparoscopic sleeve gastrectomy removes 75-80% of the stomach, leaving a pouch the size and shape of a banana. The surgery promotes weight loss and decreases hunger signals.
- Roux-en-Y gastric bypass, or RYGB, also known as gastric bypass, involves the creation of a small pouch at the top of the stomach, bypassing the rest of the stomach. The surgeon then connects this pouch directly to a lower part of the small intestine. Because food now skips most of the stomach and the first section of the small intestine, the body absorbs fewer calories and nutrients. The bypassed section of stomach and intestine is still connected farther down so digestive juices can mix with food normally later in digestion.
Anti-Obesity Medications
Anti-obesity drugs go by several names, including incretin drugs and GLP-1 receptor agonists, but regardless of what they’re called, we’ve all heard of them. Injectable forms of these drugs have been used to treat diabetes since 2005. In 2014, the FDA began approving GLP-1 medications as weight-loss tools.
GLP-1 drugs mimic glucagon-like peptide-1, a hormone your intestines release after you eat. These medications help control weight in several ways:
- They act on the brain to reduce appetite
- They delay digestion so you feel full longer
- They improve blood sugar control, stimulating the pancreas to release insulin when blood sugar rises
Until recently, these drugs had to be taken via weekly injections in the belly, upper arm or thigh. Newer GLP-1 medications such as Oral Wegovy and Foundayo are available as once-a-day pills.
Which Approach Is Best?
There is no absolute “best approach.” Bariatric surgery and GLP-1 medications both have their advantages and disadvantages, as described below.
Lasting Results
A recent study by the American Society for Metabolic and Bariatric Surgery found that after two years, former bariatric surgery patients had lost five times more weight than people getting weekly shots of GLP-1 drugs. Bariatric surgery is a one-time surgical procedure that ushers in a permanent lifestyle change. It modifies your digestive tract to accommodate and digest less food, and it reduces hormonal hunger cues. Patients typically lose 25% to 35% of their total body weight. The weight loss is swift and long-lasting, although some people do manage to gain back some of their weight. Between 50 and 60% of bariatric surgery patients with diabetes go into remission. The surgery can also have a positive impact on hypertension, liver disease, sleep apnea, asthma, incontinence and arthritis.
Unlike bariatric surgery, GLP-1 drugs do not permanently reset your metabolism. Moreover, although researchers still don’t know why, injectables are not effective for everybody. In many cases, people can lose about 30 pounds, or about 20% of their body weight. However, the medications work only as long as patients continue to take them. Weight gain is common when patients stop their medications. Treatment requires ongoing weekly injections or daily pills.
Invasiveness
Most modern bariatric surgery is minimally invasive because it is performed laparoscopically. This means less postoperative pain, shorter hospital stays, a faster recovery, lower infection risk and smaller scars. At El Camino Health, most procedures are performed with robotic-assisted techniques to minimize complications and ensure faster recover. In certain cases, safety concerns may lead the surgeon to recommend traditional open surgery. Learn more about bariatric surgery.
GLP-1 drugs are a noninvasive treatment.
Insurance
Bariatric surgery is often covered by insurance based on specific BMI and obesity-related criteria. Out-of-pocket costs vary depending on the facility and your insurance plan. Coverage for weight-loss drugs varies heavily by insurance plan, and many require patients to pay out of pocket.
Side Effects
In the two weeks following bariatric surgery, you may experience nausea, vomiting, diarrhea, constipation and soreness around the incisions. Long-term side effects may include nutritional deficiencies and require the use of vitamin and mineral supplements. Side effects may include gallstones, stomach ulcers and temporary hair thinning. Some people who have had the RYGB procedure may experience dumping syndrome, which occurs when food moves through the small intestine too fast. Symptoms occur shortly after eating and include sweating, dizziness, rapid heart rate, severe abdominal cramping and diarrhea. This response can be minimized with diet and lifestyle changes.
While bariatric surgery has been around since the 1950s, the use of GLP-1 drugs for weight loss is relatively recent, so there is less data regarding long-term safety and efficacy. Almost 50% of patients taking Wegovy, Ozempic, Zepbound or Mounjaro develop some degree of gastrointestinal side effects, including nausea, vomiting, bloating, reflux, stomach pain, diarrhea and constipation. Some report fatigue, dizziness or muscle loss. More serious but rare complications include gallbladder disease, pancreatitis, gastroparesis, or stomach paralysis, and bowel obstruction. According to the Cleveland Clinic, 14-17% of people taking GLP-1 drugs quit because of the side effects.
A Personalized Approach
As the examples at the beginning of this article illustrate, everyone is different, with their own unique lifestyle, health history, metabolism and weight-loss goals.
Doctors view obesity as a spectrum. If the goal is to drop 10 to 20 pounds, old-fashioned diet and exercise are still the best option. If someone needs to lose 30-50 pounds, GLP-1s are a good option, especially if the person has been diagnosed with diabetes or prediabetes, sleep apnea or hypertension. People with a BMI that puts them in the morbidly obese category may need a combination of surgery and medication to help them reach their goal weight.
If you are looking to lose weight, talk to your doctor to see what path you should pursue. He or she can make a recommendation or refer you to a bariatric specialist based on your weight-loss goals, BMI, current health status and any chronic conditions you may be managing. For help finding a doctor, click here.
This article first appeared in the June 2026 edition of the HealthPerks newsletter.
