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Weight Loss Surgery vs. Weight Loss Drugs: Which Is Right for You?

By Dr. Ajay Goyal | July 31, 2012

With two new weight loss drugs just approved by the Food and Drug Administration for the first time in 13 years, hopeful patients have been coming to me asking whether these revolutionary drugs could be an alternative to weight loss surgery. Let’s take a look at these two new weight loss drugs – Qsymia and Belviq – and see how their results compare with the procedures we do at the New Jersey Bariatric Center®: Gastric Bypass, Gastric Sleeve and LAP-BAND.

Who is a candidate?

Qsymia & Belviq: The FDA approved both of these medications for people who are “obese” (a BMI or body mass index of 30 or above) or “overweight” (with a BMI of at least 27) with a weight-related illness such as diabetes, high blood pressure or high cholesterol, according to FDA press releases.

Weight Loss Surgery: Bariatric surgery, including Gastric Bypass, Gastric Sleeve and Gastric Band (LAP-BAND or REALIZE), is approved for people with a BMI of 40 or above, or for patients whose BMI is between 35 and 39.9 with a weight-related illness. The LAP-BAND is also approved for patients with a BMI of 30 to 35 with a co-morbid condition.

The Take-Home: As you can see there is some overlap in the qualifications. Patients with a lower BMI of 30 to 35 who have weight-related illnesses now have the option between LAP-BAND or the approved drugs. For patients in the lower BMI range who don’t have an obesity-related illness, the medication is the only option.

How much weight can people expect to lose?

Qsymia & Belviq: According to the FDA, clinical trials performed by the drug manufacturers found that Qsymia leads to an average drop in total body weight of 6-9 percent depending on the dose. For a patient who weighs 250 pounds, that’s a weight loss of about 22 pounds. Belviq leads to an average drop in body weight of about 3-4 percent or about 10 pounds for a 250-pound person.

Weight Loss Surgery: With bariatric surgery, we look at excess weight loss, which is the difference between your actual weight and a healthy weight. Patients who’ve had Gastric Bypass typically lose 75 percent of excess body weight; LAP-BAND or REALIZE Band patients lose about 50 percent of excess body weight; Gastric Sleeve patients fall somewhere in between at about 68-70 percent.

So let’s say that same 250-pound person is about 100 pounds overweight. With the Gastric Bypass, they can expect to lose about 75 pounds; with Gastric Sleeve about 70 pounds and with LAP-BAND or REALIZE Band, about 50 pounds.

The Take-Home: You can see that for someone who is 15 to 25 pounds overweight, the drug can be an effective means to lose weight. But for those whose weight loss challenges are greater and have 75-100 pounds or more to lose, neither Qsymia nor Belviq will be sufficient.

How long does the weight stay off?

Qsymia & Belviq: Weight loss drugs must be used in combination with diet and exercise to maximize weight loss. Patients are usually only able to maintain weight loss while on the drug. Unless you are able to maintain the good eating habits and exercise programs you started  while on the drug, you will likely gain the weight back when you come off the drug.

Weight Loss Surgery: At the New Jersey Bariatric Center®, we find that more than 75 percent of patients who have had weight loss surgery maintained their weight loss five years after surgery. In patients who stick to a healthy diet and routinely exercise, we find these numbers are even higher. Patients who don’t follow the prescribed dietary and exercise recommendations are the ones who fall into the 25 percent who regain weight.

The Take-Home: Everyone who struggles with weight knows the frustration of losing and gaining with each new diet. For many of New Jersey Bariatric Center®’s patients, weight loss surgery ends that cycle. That’s not to say weight loss surgery is an easy way out. Neither is medication. Both weight loss surgery and weight loss drugs should be looked at as resources that are available to assist you in your weight loss journey. Both take work and dedication. You will have to make changes to your lifestyle to see results. Making healthy food choices and exercising must be added to ensure long-term success.

What are the side effects or risks?

Qsymia & Belviq: According to the FDA, neither Qsymia nor Belviq can be used during pregnancy because it can cause harm to a fetus. In addition, Qsymia must not be used in patients with glaucoma or hyperthyroidism. Qsymia is not recommended in patients with recent (within the last six months) or unstable heart disease or stroke. Belviq may cause serious side effects, including serotonin syndrome, particularly when taken with certain medicines that increase serotonin levels or activate serotonin receptors. These include, but are not limited to, drugs commonly used to treat depression and migraine. Belviq may also cause disturbances in attention or memory.

Weight Loss Surgery: Not everyone is a candidate for surgery either. You have to be healthy enough to tolerate a surgical procedure involving anesthesia. In addition, weight loss surgery has all the risks that are associated with undergoing surgery, including but not limited to pain, infection, bleeding and deep vein thrombosis, as well as complications due to anesthesia. Additional surgery-specific risks include leaks, nausea, vomiting and band erosion and slippage (band only).

The Take-Home: As a new treatment, the safety of these drugs beyond two years is really unknown. Bariatric surgery is an established procedure that has been proven safe and effective in multiple studies. New Jersey Bariatric Center® surgeons have performed more than 2,000 bariatric procedures with no mortalities and a lower-than-average complication rate. However, bariatric surgery as with all surgeries comes with risks.* (Read about Risks of Bariatric Surgery)

In the end, determining whether you’re a candidate for weight loss surgery or one of these new weight loss drugs should be a decision that you come to with your doctor. Think about what fits best into your individual goals and have realistic expectations of what each method offers. A successful program will give you the tools to lose weight, the education to maximize your weight loss through healthy eating and exercise and the support from a team of specialists to help you keep it off for the long term.

Ajay Goyal, MD, FACS, is founder and director of the New Jersey Bariatric Center, a medical & surgical weight loss center with offices in Springfield, Somerville, Hoboken, East Brunswick, Sparta, and Totowa New Jersey. New Jersey Bariatric Center helps patients achieve long-term weight loss success through the most advanced bariatric surgery procedures, including gastric sleeve and gastric bypass procedures. New Jersey Bariatric Center’s approach to patient care has resulted in zero mortalities and a complication rate that is lower than the national average.
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