Obesity is only just about weight. It brings with it a plethora of health problems. High blood pressure, type 2 diabetes, constant fatigue, and joint pain make daily movement harder. Over time, the risks can extend to heart disease and several cancers.

Treatment options have expanded in recent years. Alongside surgery, medications like semaglutide and tirzepatide have entered the picture. These drugs mimic gut hormones to reduce appetite and manage blood sugar levels. While early weight loss is often promising, outcomes vary depending on the duration of medication use and individual responses. Discontinuing the drug results in weight gain, and not all people experience steady results.

We spoke to who explained the differences between bariatric surgery and anti-obesity drugs and which one you should opt for.

Semaglutide and tirzepatide work by slowing digestion and helping people feel full with less food. In many cases, weight starts to drop steadily over the first few months.

But there are limits. These drugs do not change how the body stores fat or adapts metabolically over time. If someone stops the medication, the weight may return, especially without support from diet or physical activity.

"Side effects like nausea, constipation, and stomach discomfort are common. Some people tolerate these well, others don’t. There have also been rare reports of pancreatitis and gallbladder issues. People with a history of these problems need to proceed with caution," added Dr Gautam.

Cost is another concern. For individuals without diabetes, insurance coverage for these medications may be limited, leading to high out-of-pocket expenses. Furthermore, rapid weight loss without adequate muscle maintenance can result in feelings of weakness rather than improved health. Without a proper exercise and nutrition plan, significant lean muscle loss can occur.

"Bariatric surgery is not a quick fix. It requires preparation, dedication, and follow-through. But for many with severe obesity, it's the only method that delivers significant, lasting results," said Dr Gautam.

Surgery, such as sleeve gastrectomy or gastric bypass doesn't simply shrink the stomach but also alters hormone levels and how the body reacts to hunger. People often feel less hungry, not because of medication, but because their bodies adapt naturally after surgery.

Bariatric surgery provides several long-term health benefits beyond weight loss. "It leads to sustained remission of type 2 diabetes, improves blood glucose control, reduces or eliminates the need for diabetes medications, and decreases the risk of diabetes-related complications. It can also improve or resolve conditions like Polycystic Ovarian Disease (PCOD), sleep apnoea, and hypertension, while significantly lowering the risk of obesity-related cancers, such as breast and colon cancer," shared Dr Gautam.

In people with type 2 diabetes, results can be seen early. Blood sugar improves, sometimes before major weight loss happens. Insulin use drops. Some go into remission entirely. This is not a temporary effect. Surgery works by tackling the underlying causes, not just the symptoms.

Data from the ARMMS-T2D study, the largest and longest randomised clinical trial of its kind, supports this. Published in JAMA and funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the 12-year study followed 262 participants across four major research centres in the U.S. At seven years, those who underwent bariatric surgery had an average of 20% weight loss compared to only 8% in the medical/lifestyle group. More than half of the surgical group achieved an HbA1c under 7%, and diabetes remission was significantly persistent. Even after 12 years, these advantages persisted. 

Additional findings showed that bariatric surgery improved health outcomes even in people with BMI between 27-34, confirming its effectiveness in lower obesity ranges. Muscle preservation, sustained energy levels, and return to daily life were also more common among surgery patients.

While certain nutritional deficiencies, for example, low iron were observed in the surgery group, these were controlled with adequate supplementation and follow-up. In general, evidence was to confirm that bariatric surgery is a proven and life-altering treatment for those with severe obesity and type 2 diabetes.

"Muscle preservation is another factor. With an appropriate recovery plan, patients tend to maintain or recover lean mass, enhancing strength and energy as fat disappears. In addition, bariatric surgery is usually carried out with a minimally invasive procedure, such as laparoscopic and robotic-assisted methods," added Dr Gautam.

Most patients are sent home by the third postoperative day, which reflects its comparative safety and rapid recovery course. This renders it a tolerable procedure with fewer complications and shorter hospital stays than conventional open operations.

Dr Gautam concluded, "Some individuals may begin with medication to assess their body’s response and later consider surgery for more lasting change. Others do not respond to the expected benefit from medication alone. Research indicates that some patients have no measurable benefit from these medications, despite months of adherence."

No two individuals have the same journey. What remains constant is the requirement for a medically supervised, safe, and sustainable strategy. Bariatric surgery is not a shortcut, it involves lifestyle adjustments and long-term follow-up. But for those with severe obesity and other conditions, it's a more complete, more fundamental reset in how the body processes food and energy.

Ultimately, the choice of medication versus surgery should be made after a thorough consultation between the doctor and the patient. The best is what is best for the individual according to his health status, personal preferences, and ultimate goals.

[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your professional if you are dealing with any health issue to avoid complications.]