Nutrition, Drugs, or Bariatric Surgery: What’s the Best Approach for Sustained Weight Loss?


Did you know over 100 million adults in the U.S. are living with obesity, including 22 million with severe obesity? For many, it’s not just about weight—it’s about managing related health issues like type 2 diabetes and heart disease.


With so many options available—lifestyle changes, medications, and bariatric surgery—how do you know which approach is right for you? Let’s explore these strategies, their challenges, and what it takes to achieve lasting results.


Lifestyle Changes: The Foundation of Weight Loss


Making changes to your diet and activity levels is often the first step recommended for weight loss.

  • The Upside: Lifestyle changes promote overall health, are accessible, and have no serious side effects.
  • The Challenges: Up to 50% of lost weight is regained within one year, and nearly all is regained over time.
  • Evidence in Action: Intensive programs that include plant-based diets, exercise, stress management, and group support have shown significant benefits. For instance, one 5-year study revealed that participants sustained a 5.8 kg weight loss compared to no change in the control group.


Anti-Obesity Medications (AOMs): Game-Changers With Caveats


New medications like GLP-1 receptor agonists (semaglutide) and GLP-1/GIP combinations (tirzepatide) are revolutionizing weight loss treatments.

  • The Results:
  • Semaglutide: 17.3% average weight loss, though 11.6% was regained when the medication was stopped.
  • Tirzepatide: 20.9% weight loss, but discontinuation led to 14% regain.
  • The Drawbacks: These medications can be expensive, often lack insurance coverage, and may cause side effects like nausea or constipation.


Bariatric Surgery: Effective for Severe Obesity


Surgical options like Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding are often recommended for individuals with severe obesity and related complications.

  • Long-Term Outcomes:
  • Roux-en-Y gastric bypass: 31.2% weight loss at 1 year, reduced to 25.5% at 5 years.
  • Sleeve gastrectomy: 25.2% weight loss at 1 year, reduced to 18.8% at 5 years.
  • Considerations: Surgery comes with risks, including micronutrient deficiencies and weight regain (49% of patients experience some regain).


Key Takeaways for Lasting Weight Loss


Here’s what we know about sustaining weight loss:

  • It’s Not Either-Or: Combining approaches, like pairing lifestyle changes with medications or surgery, often leads to better results. For example, bariatric surgery patients who adopt a plant-based diet post-surgery often sustain their weight loss more effectively.
  • Address Root Causes: Obesity is influenced by emotional factors like stress or comfort eating, poor food quality, and cultural habits. Tackling these behaviours is essential for lasting success.
  • Whole-Food, Plant-Based Diets Work: Studies show these diets lead to greater compliance and outcomes, with BMI reductions of 4.4 points in just six months compared to 0.4 in standard care.


Imagine losing 20% of your body weight, only to regain most of it within a year. This is a common reality for many people who stop using weight-loss medications or fail to integrate sustainable habits post-surgery.


Why Do So Many People Regain Weight?


Sustained weight loss requires more than willpower. Here’s why people often struggle:

  • Biology Fights Back: After weight loss, the body works to regain lost weight through hormonal and metabolic changes.
  • Access & Cost: Medications and surgeries are expensive and often inaccessible.
  • Side Effects & Compliance: Medication side effects and the demands of surgical aftercare can make it hard to stick with these treatments.


So, What’s the Best Approach for You?


The truth is, there’s no universal answer. Your path depends on your individual needs, preferences, and health goals. Whether it’s nutrition, medications, surgery, or a combination, the key to success is addressing the underlying drivers of weight gain and committing to sustainable lifestyle changes.


Reference



Nutrition, Drugs, or Bariatric Surgery: What’s the Best Approach for Sustained Weight Loss? - Medscape - January 10, 2025.