Due to the rise in obesity, many people have started taking various medications, including popular injectable drugs (GLP-1s). The use of such drugs has increased significantly in recent years, contributing to weight loss. Simultaneously, a large number of people are seeking surgical treatment. Bariatric surgery is the most common method, but the question arises whether the operation is suitable for all patients. For people suffering from obesity, it is crucial to understand when medication therapy is sufficient and when surgery is necessary.
Before delving into the details, let's look at the statistics on obesity in the country. According to a report from PubMed Central, obesity is a rapidly growing public health problem in India, affecting over 135 million people. This risk is observed more frequently among urban residents, women, and the elderly. Notably, Indians have a risk of developing abdominal problems and related diseases even at a lower Body Mass Index (BMI) compared to residents of Western countries. Consequently, obese individuals require adequate treatment.
Professor Dr. Manjunath Maruti Paul, a specialist in metabolic, bariatric, and transplant surgery from the Department of Surgery at AIIMS Delhi, spoke to Aajtak.in about this issue. Dr. Maruti emphasized that the decision between choosing weight-loss medications and surgery should be based not on comparing these methods, but on assessing the disease risk and the benefit of the proposed treatment. The main goal is to find an obesity treatment method that ensures long-term improvement in the patient's health.
Dr. Maruti noted that although weight-loss drugs are effective and used to treat obesity and diabetes, they do not eliminate the need for metabolic surgery for some patients. The choice is made individually for each person, considering a number of factors. There are specific conditions under which surgery becomes necessary.
Metabolic surgery may be required in the following cases:
- If the BMI exceeds 27.5, the patient takes more than three anti-diabetic drugs, and suffers from uncontrolled type 2 diabetes despite maintaining a healthy lifestyle (diet, exercise, sleep).
- At a BMI above 32.5, especially if there are comorbidities.
- If the patient experiences sleep apnea that negatively affects work and daily activity.
- If the patient has metabolic diseases such as high blood pressure, dyslipidemia, osteoarthritis, and fatty liver disease.
Dr. Manjunath explained that when making a decision, doctors consider the patient's BMI, waist circumference (visceral fat), stage and severity of diabetes, as well as the degree of metabolic disorders. They also take into account pancreatic beta-cell reserves, nutritional status, patient preferences, and their ability for long-term follow-up.
Dr. Maruti added that weight-loss drugs (GLP-1s) are attractive because they do not require surgery and can lead to a weight loss of 18%–22% over eighteen months of use. However, these medications usually need to be taken continuously, and some patients may have difficulties with taking or long-term treatment, or the effect may be insufficient. Stopping the medication can lead to weight regain.
Although surgery is an invasive procedure, for suitable patients, it can provide more significant and sustained weight loss (60%–80% weight loss within a year) and increase the chances of recovery from diabetes. Furthermore, there is an improvement in conditions such as hypertension, sleep apnea, and fatty liver disease. Nevertheless, the key point remains determining which treatment method offers the best chance for this specific patient to maintain metabolic health in the long term.
For some patients, lifestyle changes and medication may be the optimal choice, while for others, surgery may be the better option. Therefore, the decision is always made based on the patient's physical condition. However, if the listed problems are present, surgical intervention may be recommended.
