Is "5 Times More Effective Than Ozempic" True? The Reality of "Bariatric Surgery" Reconsidered Amidst the Weight Loss Treatment Boom

Ozempic, Wegovy, Mounjaro, Zepbound. In recent years, GLP-1 receptor agonists and related drugs have gained global attention as "weight loss drugs." Originally used as treatments for type 2 diabetes, these drugs have become known for their appetite-suppressing and weight-reducing effects, frequently featured not only in medical settings but also on social media, celebrity news, and lifestyle media.

Amidst this, a study reported by ScienceAlert has stirred the conversation around weight loss treatments. The article's headline is provocative, introducing a weight loss strategy described as "5 times more effective than Ozempic," which is not a new drug or supplement, but bariatric surgery.

The study compared individuals who underwent bariatric surgeries, such as sleeve gastrectomy or gastric bypass, with those prescribed GLP-1 drugs like semaglutide or tirzepatide. After matching for age, BMI, blood glucose levels, and other factors, the study found that two years later, the surgery group had lost an average of 25.7% of their body weight, compared to just 5.3% in the medication group. Simply put, the surgery appeared to be about five times more effective in terms of weight loss.

Looking at these numbers alone, one might think, "So surgery is the better option than medication." However, what this study truly highlights is not a simple win or loss, but the inherent complexity of modern obesity treatment.

"The Ideal of Clinical Trials" vs. "Real-World Treatment"

In clinical trials of GLP-1 drugs, weight loss of around 15-20% has sometimes been reported. Particularly with tirzepatide, trials have shown even greater weight loss effects, and there's no doubt that pharmacotherapy has changed the landscape of obesity treatment.

However, clinical trials are conducted in controlled environments. Participants are selected under certain conditions, and their medication adherence is closely monitored. Medical support is readily available, and the conditions for continuing medication are well established.

In contrast, the situation in actual medical settings is different. The drugs are expensive, and insurance coverage varies by country and system. Some people cannot continue due to side effects. There are times when the drugs are not available due to supply shortages. Weight doesn't decrease, the effects aren't as expected, nausea and constipation are severe, and the monthly costs are burdensome. For these practical reasons, many people discontinue treatment.

The lower weight loss rate in the medication group compared to clinical trials in this comparison can likely be attributed to these "challenges of continuation." In fact, another study in JAMA Network Open reported that among adults who started GLP-1 receptor agonists, 53.6% discontinued within one year, and 72.2% within two years. The discontinuation rate was particularly high among those without diabetes, suggesting that cost and side effects are significant barriers.

This doesn't mean the drugs themselves are ineffective. Even effective drugs won't yield results if they can't be continued. In weight loss treatment, not only "how much weight is lost" but also "how long it can be sustained" greatly influences the outcome.

Why Bariatric Surgery is Strong

There are several types of bariatric surgery. The most common are sleeve gastrectomy, which involves removing a large portion of the stomach to make it narrower, and gastric bypass, which involves dividing the stomach into a small pouch and connecting it to the small intestine. Both not only reduce the amount of food that can be consumed but are also believed to affect hormones related to appetite and blood sugar.

The important point here is that bariatric surgery is not merely a "stomach-reducing surgery." It is positioned as a treatment that affects the body's metabolic system itself, including changes in appetite, satiety, insulin secretion, and gut hormones. For those with severe obesity or obesity-related diseases, it has been shown in many studies to be an option that leads to significant long-term weight loss.

Moreover, unlike medication, surgery does not require ongoing actions like "weekly injections," "monthly purchases," or "prescription renewals." Of course, postoperative dietary management, nutritional supplementation, exercise, and regular check-ups are essential, but because the body's structure and hormonal environment change, the treatment effects are relatively sustainable.

The significant effects seen in the surgery group in this study are likely due in part to this sustainability. If medication is discontinued, its effects may diminish, and weight may return. In contrast, surgery has an irreversible aspect, making it difficult to revert, for better or worse.

However, Surgery is Not a "Magic Solution"

It is important to emphasize that bariatric surgery is not a panacea. Surgery carries risks, including anesthesia, bleeding, infection, gastrointestinal complications, nutritional deficiencies, and the possibility of reoperation. Post-surgery, eating habits change, and vitamin and mineral supplementation may be necessary. Some people struggle with loose skin or changes in body shape after significant weight loss.

Furthermore, some individuals regain weight even after surgery. Even if appetite is suppressed due to changes in stomach capacity or hormones, long-term maintenance is not easy if lifestyle habits, eating environments, mental health, and social stress do not change.

This reality is well reflected in reactions on social media. On Reddit, in response to a post introducing the ScienceAlert article, there are success stories like "I lost 175 pounds with bariatric surgery," alongside cautious voices saying, "If you know the complications after surgery, you understand why people look for alternatives with medication." There are also comments questioning, "Does surgery work 100%?" with responses like, "Not at all. I've seen people regain weight and experience complications."

In other words, while surgery is a powerful treatment, it is by no means an easy shortcut. Instead, it is a medical intervention that requires a commitment to changing one's entire lifestyle.

On Social Media, It's Not "Medication or Surgery" But "Both Have Barriers"

Looking at reactions on social media regarding GLP-1 drugs and bariatric surgery, the discussion is not a simple binary choice.

Those who support medication often cite "non-invasiveness" as a major advantage. For those who are resistant to altering their digestive tract through surgery, suppressing appetite with injectable drugs is preferable. On Reddit's medical threads, comments like "Combining GLP-1 with exercise, strategies to maintain muscle, and interventions for mental and habitual aspects is more desirable for me than surgery" can be found.

On the other hand, medication faces issues of cost and continuity. On U.S. social media, complaints about insurance not covering it, high drug prices, and unstable supply are frequently voiced. Even if one wishes to avoid surgery with GLP-1 drugs, it is not a realistic option if they cannot afford the medication continuously. One post pointed out that some people turn to surgery, which is more likely to be covered by insurance, because their medication is denied coverage.

Those who support surgery appreciate the significant long-term effects. Some people have successfully lost a lot of weight, increased their activity levels, and changed their lives. However, there are also voices expressing concerns about postoperative nutritional management, digestive symptoms, and the fear of weight regain.

Interestingly, on social media, there are both those who believe "surgery will end because drugs are available" and those who believe "surgery remains for those for whom drugs do not work or cannot be continued." Additionally, there is a perspective that "if more powerful and affordable drugs are developed in the future, surgery will become a more limited option." This indicates that obesity treatment is currently in a transitional phase.

"5 Times More Effective Than Ozempic" is a Strong Headline, But Interpretation Requires Caution

The most eye-catching aspect of this report is undoubtedly the expression "5 times." On social media, such numbers are easily spread. However, as a medical article, it needs to be read carefully.

Firstly, the comparison is not based on "ideal continuous use of the drug," but on real-world results based on actual medical records. The medication group may include those who discontinued or could not continue adequately. Therefore, this figure reflects the effect including real-world usage, rather than the drug's maximum effect.

Secondly, the subjects are those with a BMI of 35 or higher, and it does not apply to everyone. The optimal treatment varies depending on mild obesity, the presence or absence of diabetes, age, medical history, surgical risk, and living environment.

Thirdly, attention should be paid to who is presenting the research results. As mentioned in the ScienceAlert article, this study was presented at the annual meeting of the American Society for Metabolic and Bariatric Surgery, a specialist field in bariatric surgery, and the press release also came from the same society. While the value of the research itself is not denied, readers need to confirm "who is presenting it and in what context."

Fourthly, treatment value is not determined by weight loss rate alone. Blood sugar management, cardiovascular risk, cancer risk, quality of life, side effects, costs, access to treatment, and personal values need to be considered. GLP-1 drugs, such as Ozempic, were originally used as treatments for type 2 diabetes, and research on blood sugar management and cardiovascular risk reduction is also progressing. Simply evaluating the meaning of the drug by "the amount of weight loss" is insufficient.

Obesity Should Be Considered a Chronic Disease, Not a "Lack of Willpower"

What should be avoided in this discussion is dismissing obesity as a lack of personal effort. On social media, there are still oversimplified opinions like "just eat less" or "just exercise." However, obesity is increasingly understood as a chronic disease involving appetite, metabolism, genetics, sleep, stress, medication, social environment, income, the food industry, and mental health.

One reason GLP-1 drugs have gained attention is that they help some people reduce strong preoccupations with food, known as "food noise." This has made many people realize that there are physiological mechanisms that cannot be explained by simply "enduring with willpower."

At the same time, bariatric surgery is not merely a physical restriction but affects weight and blood sugar through hormonal and metabolic changes. Rather than being in opposition, drugs and surgery are both medical approaches that work on the body's complex systems.

Therefore, this study should not be read as "surgery wins, drugs lose." Instead, it should be read as "there are multiple effective means of obesity treatment, each with its strengths and weaknesses."

Combination Therapy May Become Important in the Future

In future obesity treatment, rather than a binary choice between drugs or surgery, combinations or staged treatments may become important.

For example, first reduce weight with GLP-1 drugs to lower surgical risk, then undergo bariatric surgery. Alternatively, use GLP-1 drugs for those who regain weight after surgery. Those who achieve sufficient effects with drugs continue them, while those for whom drugs are unsuitable or who need greater effects due to severe obesity consider surgery. Such individualization is likely to advance.

The research team also wants to investigate which patients are suited for GLP-1 drugs, which for surgery, and how out-of-pocket costs affect treatment outcomes in the future. This is a very important perspective because medical choices are not determined by medical effects alone.

Is insurance available? Is there a specialist nearby? Is there family support? Can one endure side effects? Can one take time off work? Can one manage postoperative diet? Can one continue to pay for medication? These conditions influence real treatment outcomes.

What Readers Should Take Away from This News

The headline "5 Times More Effective Than Ozempic" is very strong. However, the message readers should truly take away is more practical.

First, GLP-1 drugs are a groundbreaking treatment option, but they are not a panacea. If they cannot be continued, their effects are limited, and cost and side effects are significant barriers.

Next, bariatric surgery remains a very powerful treatment and continues to be an important option, especially for those with severe obesity or obesity-related diseases. However, it is invasive, requires postoperative lifestyle management, and is not a simple solution.

And most importantly, do not judge weight loss treatments based on "trends" or "headlines" alone. On social media, both success stories and failures are easily visible. Some people's lives have changed with medication, while others have stopped due to side effects. Some have lost significant weight with surgery, while others struggle with complications or regain weight. Both voices are part of reality, but they may not directly apply to you.

Obesity treatment is different from short-term cosmetic dieting. It is a medical decision aimed at long-term health, quality of life, and prevention of complications. How to combine medication, surgery, diet, exercise, sleep, psychological support, and social support is where the core of future obesity treatment lies.

The number "5 times" is shocking. However, behind that number lies the difficulty of continuing medication, the weight of choosing surgery, and the complexity of the disease called obesity. Now, in the era of Ozempic, we need to think not about "ways to lose weight," but about "treatments that can be sustained."

Source URL

ScienceAlert: Introducing the comparative results of GLP-1 drugs and bariatric surgery by a research team including NYU.
https://www.sciencealert.com/one-weight-loss-strategy-is-5x-more-effective-than-ozempic-study-shows

American Society for Metabolic and Bariatric Surgery: Press release of the research presentation. Details on weight loss after two years, study subjects, GLP-1 drug discontinuation rates, and the positioning of bariatric surgery.
https://asmbs.org/news_releases/head-to-head-study-shows-bariatric-surgery-superior-to-glp-1-drugs-for-weight-loss/

ScienceDirect / Surgery for Obesity and Related Diseases: Publication information for the research presentation "Comparative Effectiveness of Semaglutide and Tirzepatide vs Bariatric Surgery."
https://www.sciencedirect.com/science/article/pii/S1550728925001881

JAMA Network Open: Research on the discontinuation and resumption of GLP-1 receptor agonists. Reference to discontinuation rates within one year and two years.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829779

Reddit / r/savedyouaclick: An example of social media reactions to the ScienceAlert article. Referencing success stories of bariatric surgery, concerns about complications, weight regain, and discussions on exercise and diet management.
https://www.reddit.com/r/savedyouaclick/comments/1poydpl/one_weight_loss_strategy_is_5x_more_effective/

Reddit / r/Zepbound: Discussion on the future of bariatric surgery