Bariatric surgery vs. weight loss drugs: What's right for you?

What’s the deal with all of these weight loss options?

“If you’re scrolling through social media, you’re going to see something about a weight loss drug,” says Dr. John Tann, board-certified general surgeon and fellowship trained bariatric surgeon, within our larger HCA Healthcare network.

Online pharmacies, medical spas and diet clinics take advantage of the fact that our country has alarming statistics on obesity and that the situation is truly an epidemic.

Dr. Tann says more than one-third of adults — or 78.6 million people — are obese, often leading to an increased risk of chronic and life-threatening diseases like heart disease, kidney failure, stroke and Type 2 diabetes.

“A lot of this data was pre-pandemic, and we all know how the pandemic negatively impacted our health and weight,” Dr. Tann says.

He says the key to finding what works for you is partnering with an experienced physician who can create a plan that will work with your body.

“Our goal is to help patients find short-term and long-term weight loss solutions specific to their needs and health history – making them feel more comfortable and confident,” Dr. Tann says.

Short-term weight loss solutions

Diet pills and fad diets:

He says quick fixes like pills or fad diets aren’t the key to long-term, successful weight loss. “I encourage patients to approach weight loss as a lifestyle change, starting with a plan for goal weight, overhauling diet and eliminating sweets, refined sugars and processed foods and developing an exercise routine,” he says.

Weight loss injections:

Dr. Tann says weight loss injections do not work for everyone and they are not risk free, which is why it’s important to work with a physician. “The use of medically-supervised injectables has been a game changer in making a difference, but the key is partnering with a physician who has the experience to customize the program that is right for you,” he says.

“I prescribe weight loss injectables regularly both preoperatively and post operatively to patients,” Dr. Tann says. “They do really well and they are helping change the way your metabolism works, which is why they work so much better than fad diets and pills.”

Dr. Tann says the medication in injectables immobilizes the muscles of the stomach wall for about three months and prevents them from contracting. This keeps food in the stomach longer, slowing digestion and helping you feel fuller faster and for a longer time.

Dr. Tann says weight loss injections may be a good option for adults who:

• Have moderate weight loss goals, such as to lose weight before an elective surgery or to assist with fertility
• Have a body mass index (BMI) of 30 to 40
• Have not had success with lifestyle modifications, such as diet and exercise
• Want to jump-start a healthier lifestyle
• Want to reduce the risk of weight-related illness, such as high blood pressure, diabetes, stroke, sleep apnea or heart disease
  
  

He also recommends strategic lifestyle changes like keeping a food journal, tracking daily steps, setting daily goals and eating breakfast.

“As a bariatric surgeon, I’m passionately dedicated to providing long-term solutions for patients through metabolic and bariatric surgery; however, we have found great success in starting our program with short term, customized solutions to help the patient with big wins, early on so they find that success as they prepare for longer term solutions,” Dr. Tann says.

Dr. Tann says creating a long-term plan is key.

“What we see in clinical trials is when you stop taking the medication, the weight will come back,” Dr. Tann says. “That is why we want to focus on surgery for patients who meet the criteria for weight loss surgery. Right now, that is someone with a BMI of 35.”

Long-term weight loss solutions

“With success of the short-term process, we move the patient to that next step, as appropriate, to surgical weight loss surgery,” Dr. Tann says.

Based upon the patient’s specific needs and goals, there are several weight loss surgery options, including, minimally invasive and robotic-assisted weight surgeries:

Gastric bypass:

This procedure does not remove anything; however, the stomach is separated into a smaller section for the food intake, and then a new end of the intestines is attached in order to empty the food and reconnect with the rest of the digestive juices a bit further downstream.

Gastric sleeve:

This procedure removes a significant portion of a patient’s stomach, reducing food intake capability. “The normal stomach can hold about 1.5 liters of fluid, and we downsize it to a four- to six-ounce capacity,” Dr. Tann says. He says a person undergoing gastric sleeve surgery has the potential to lose 50 to 80 percent of their excess body weight.

Duodenal switch (and SADI-S):

Think if it more like a more advanced technique that combines the gastric bypass and gastric sleeve. This is used for more severe obesity and resistant comorbid conditions. This is a good option for a revision from a sleeve if they had weight regain after surgery.

Gastric balloon:

This is a non-surgical way to help people lose weight who haven’t had success losing weight with other diet programs. “This procedure is a temporary tool to help an individual lose weight. The surgery is a two-part weight loss system that includes placing a soft, deflated gastric balloon through the mouth and into the stomach and then fills it with a safe saline solution until it’s the size of a grapefruit,” Dr. Tann says.

He says it stays in place for six months and patients work closely with their doctor, dietitian and other specialists to develop healthier eating and lifestyle habits. After six months, the balloon is removed in a similar, non-surgical procedure.

Endoscopic sleeve gastroplasty (ESG):

Endoscopic sutures are placed on the inside of the stomach to induce reduction of digestive enzymes and motion. It also downsizes the stomach because of the permanent stitches.

Whether you choose weight loss injectables or weight loss surgery, Dr. Tann says the right combination of tools and lifestyle change are essential to a successful obesity treatment plan.

“I encourage all of my patients to achieve their individual goals by approaching weight loss as a lifestyle change for a healthier life, starting with partnering with the specialist you feel most comfortable with – and check their credentials. Don’t be shy about asking for references,” Dr Tann says. “Then, together, you’ll determine your ideal goal weight, develop that plan and approach the program like a partnership.”

Determining your next steps

We offer the resources and support you need for a successful weight loss journey. Our team of experts will partner with you to develop an individualized weight loss care plan that is best for both your physical and emotional health. Learn more about the types of weight loss surgery we offer.