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Semaglutide Versus Weight Loss Surgery Outcomes

Does max-dose semaglutide work as well as weight-loss surgery?

In a word: no. I can’t criticize semaglutide, which is a wonderfully effective weight loss medication. People who can tolerate the max dose can expect to lose about 12.5% of their body weight on average over a year of treatment. A majority of patients keep most of the weight loss with longer term use. Understand that 12.5% is very good weight loss for a drug. It’s about twice as effective as any of the meds that predated it, and it has a more favorable side-effect profile.

That said, surgery results are better. The sleeve gastrectomy and lap gastric bypass patients of my practice lost on average 32.4% and 36% of their total body weight, respectively, by two years:

Comparison of weight loss data for high-dose semaglutide therapy versus sleeve gastrectomy surgery

Weight loss data: high-dose semaglutide versus lap gastric bypass

The bottom line is that, on average, patients treated with gastric bypass lose three times more weight than would be expected from long-term treatment with high-dose semaglutide. The average bypass patient in my practice starts at 285 pounds and gets down to 183, an average of 102 pounds lost. The same group would lose an average of thirty-five pounds after two years of high-dose semaglutide. Dr. Fitzer’s sleeve patients lost 2.6 times more weight than is expected with long-term semaglutide.

Make no mistake: semaglutide is a great medication, but it’s important to have the right expectations with it. If thirty-five pounds is your weight-loss goal, it’s probably a coin flip as to whether semaglutide will get you there.

  1. MBSAQIP Database, aggregate sleeve and gastric bypass patient data for Dr. Fitzer.
  2. Data reported in Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002.
  3. Data reported in Garvey WT, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, Jódar E, Kandler K, Rigas G, Wadden TA, Wharton S; STEP 5 Study Group. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022 Oct;28(10):2083-2091.