“If your weight is taking a toll on your physical and mental health, consider surgery. You only get one life, bariatric surgery can help make sure you make the most of it.”
Matthew McDonald, DOShortly after GLP-1 agonist drugs like Wegovy and Zepbound hit the market in 2022, the number of calls coming into the offices of Drs. Terence Clarke and Matthew McDonald took a noticeable jump.
The doctors, who have a combined 40 years of experience, provide surgical and medical weight loss care through Capital Bariatrics, now an affiliate practice of Southwestern Vermont Medical Center (SVMC). They say interest in the medications remains high. However, they caution patients to think ‘bigger picture’ about their weight-loss journey.
Comparing your options
According to Dr. McDonald, “When you consider a ‘magic’ weight-loss pill versus surgery, it’s understandable why patients come in asking for it. However, when you compare the long-term results, bariatric surgery is consistently a more effective option for long-term weight loss and improved health.”
Citing numbers from the American Society for Metabolic and Surgery, McDonald says most patients who undergo bariatric surgery lose 50% of excess body weight while those using medication tend to lose only 15% to 20% of excess body weight.
But, as both doctors note, the bigger issue is the long-term results.
Studies show the long-term success rate of bariatric surgery runs between 68% and 74% with some patients maintaining weight loss for up to 20 years.
But with drugs, Dr. Clarke says, many patients experience weight regain once they stop taking it. “It’s like any medication you take for a chronic condition,” he says. “Your cholesterol medication may get your numbers where you want but if you stop taking it, your numbers return to problematic levels. It’s the same with weight.”
While there are long-term medication options, Clarke notes they come with challenges including cost (between $1,000 and $2,000 per month, not typically covered by insurance), and potential long-term side effects, including digestive issues, vitamin deficiencies, and even damage to blood vessels in the eyes.
Bringing attention and understanding to bariatric surgery
Even though weight-loss drugs aren’t the answer for everyone, Dr. McDonald is happy for the attention they brought to the subject of managing weight and obesity.
“The good news about the medication hype is that it got more people to come in to discuss their weight struggles,” he says. “Many of them were under the misperception that weight loss surgery is only for those who are hundreds of pounds overweight. Others thought at 60 or 70 they were simply too old. But that’s simply not the case.”
While the average falls in the mid-40s, patients can be as young as 18 or as old as 80—or older —depending on individual circumstances.
“Honestly, the surgery is the easy part of the weight-loss journey,” says McDonald. “It’s minimally invasive, with most procedures taking 1-3 hours. Most patients require an overnight stay, but some go home a few hours after surgery.”
Are you a candidate for bariatric surgery?
The American Society for Metabolic and Surgery recently updated its guidelines to expand patient eligibility for weight-loss surgery. The new guidelines recommend eligibility if you:
- Are at least 18 years old
- Have tried other non-surgical weight loss methods
- Have a BMI of 35 or higher
- Have a BMI of 30 or higher in addition to a weight-related condition such as severe diabetes, hypertension, heart disease, or sleep apnea
- Are psychologically competent and understand the procedure and postoperative plan
Taking a mind and body approach to weight loss
One thing Drs. Clarke and McDonald find themselves stressing to potential patients about bariatric surgery that, like the medication option, it’s not a quick fix. Nor is life post-surgery always easy.
“You can’t lose sight of the fact that it’s taken your entire lifetime thus far to develop the habits and lifestyle that got you to your current weight,” says Clarke. “It’s going to take time to learn new behaviors and un-learn ones that don’t serve you. If you don’t make the effort to course correct and change, you’re not going to get the full benefit of the surgery.”
McDonald adds, “We spend a lot of time consulting with patients, and ideally their families, pre-surgery about what to expect in the days, weeks, and months after the procedure. If they live with others, the post-surgical dietary needs will likely require adjustments by all.”
Changes to diet include:
- An initial liquid diet with the gradual introduction to soft foods and regular foods in 6-8 weeks
- Eat a balanced diet in 5-6 small portions a day. NOTE: Immediately after surgery, you may only be able to tolerate one to two tablespoons of food at a time.
- Eat slowly and in small bites to avoid ingesting air which can be painful
- Switch to a diet high in protein and vegetables and low in carbohydrates
- Avoiding sugary foods and beverages, including fruit juices
- Drinking 64 ounces of water daily
“When we review these dietary needs pre-surgery, a lot of patients ask, ‘When do I get to eat normal again?’” says Clarke. “I tell them you can never go back to the way you were eating previously and expect to lose weight. But, if you’re committed to losing weight and improving your health, you can start eating regular, healthy meals in six to eight weeks.”
Another post-surgical requirement for bariatric patients is exercise.
McDonald says, “Exercise is critical to achieving and maintaining your weight and health. It helps preserve lean muscle, burns calories, and strengthens your bones. The great thing about the surgery is that once you drop some weight, different forms of exercise people may have never considered due to their size suddenly become possible. The more you engage, the more pounds you drop.”
Benefits beyond the scale
While it’s easy to fixate on the numbers on the scale, both Clarke and McDonald encourage patients to keep the other benefits of bariatric surgery in mind:
- Increased energy levels and improved mood are common positive outcomes.
- Improved health including
- Reduced risk of type 2 diabetes, heart disease, stroke, high blood pressure, acid reflux, and sleep apnea
- Reduced need for some medications
- Decreased risk of certain types of cancer
- Improved joint pain and mobility
- Improved mood and quality of life
- Enhanced self-esteem
- Increased life expectancy
Making your health and well-being a priority
“Bariatric surgery can be a life-changing procedure for individuals struggling with obesity,” says McDonald. “If your weight is taking a toll on your physical and mental health, consider surgery. You only get one life; bariatric surgery can help make sure you make the most of it.”