“Bariatric surgery hasn’t gone anywhere,” says Dr. Holly F. Lofton, MD (right), an obesity medicine specialist at NYU Langone Health, and shown here with Dr. Christine J. Ren-Fielding. “What has changed is that patients now have more options. ... Now we have more tools to help people reach a healthy weight.”
Credit: NYU Langone
In the past few years, GLP-1 medications such as Wegovy and Zepbound have skyrocketed in popularity. They’re mentioned everywhere: in the news, on social media, and at the doctor’s office. They’ve helped millions of people lose weight and feel better. But whatever happened to bariatric surgery?
“Bariatric surgery hasn’t gone anywhere,” says Holly Lofton, MD, an obesity medicine specialist at NYU Langone Health. “What has changed is that patients now have more options. Before GLP-1s, it was essentially diet and exercise, or surgery. Now we have more tools to help people reach a healthy weight.”
So how do you know which is better for you, bariatric surgery or a GLP-1 medication? The short answer is that it depends. Here are answers to the questions patients ask most frequently when it comes to weight loss.
Who Are the Best Candidates for Medication or Surgery?
Both approaches are effective, but they work in completely different ways and are better suited for different people
GLP-1 medications mimic a hormone your body naturally makes. They suppress your appetite, increase fullness, and reduce cravings—what some people call “food noise.” They’re nonsurgical and noninvasive.
Bariatric surgery physically changes your stomach and sometimes your intestines, depending on the procedure. You can eat less, you absorb fewer calories, and your hunger hormones decrease, reducing your appetite and making you feel fuller. It’s permanent, though reversible in some cases.
Doctors recommend you consider GLP-1 medication under these conditions:
- have a BMI of 30 or higher
- have a BMI of 27 or higher and have weight-related health problems, such as type 2 diabetes, high cholesterol, or high blood pressure
- want a nonsurgical option
- are willing and able to take medication over the long term
- have insurance coverage or can afford ongoing costs
On the other hand, you should consider bariatric surgery in situations like this:
- have a BMI of 40 or higher
- have a BMI of 35 or higher with serious weight-related health problems, such as diabetes, heart disease, or sleep apnea
- have tried GLP-1 medication and either didn’t respond, lost access to it, or developed side effects
- want a permanent solution with lasting results
- are willing to make permanent dietary changes
For many patients, a weight loss journey might include both options. Some start with a GLP-1 to see how their body responds. Others have surgery and add GLP-1 later if they regain weight. “You’re not a failure if you need both,” says Christine Ren-Fielding, MD, chief of bariatric surgery at NYU Langone. “It’s about finding what works best for your body and lifestyle, at different points in your life.”
How Fast Can You Lose Weight on a GLP-1?
Most people using GLP-1 medications lose approximately 8 to 21 percent of their total body weight in six to 18 months, depending on the medication. For someone who weighs 200 pounds, that’s up to 40 pounds. If you’re not seeing meaningful results after two or three months on the highest dose, your doctor may recommend exploring other options.
Due to the way the medication works, weight tends to come back when you stop using it. The body’s appetite regulation returns to baseline, and many therefore regain the weight they lost. That’s why doctors think of GLP-1s as a long-term treatment, not a short-term fix.
“We consider obesity a chronic condition, like high blood pressure,” explains Dr. Lofton. “You don’t stop your blood pressure medication once you reach your goal, and the same applies here. You continue the medication that got you to your weight loss goal.”
Most side effects of GLP-1s are mild and temporary; they include nausea, constipation, or decreased appetite, and they improve as your body adjusts to the medication. The most serious adverse event—pancreatitis, or pancreas inflammation—occurs in only 0.1 percent of patients, making it highly unlikely. If you develop intolerable side effects at any dose, you can stop using the medication and explore other options.
How Much Weight Can You Lose After Surgery?
Bariatric surgery typically results in 20 to 30 percent loss of body weight. That’s more than the average weight loss of GLP-1 medications alone. For someone who weighs 200 pounds, that’s roughly 50 pounds versus up to 40 pounds with medication.
There are several types of bariatric surgery:
- Sleeve gastrectomy: In the most-popular procedure, the surgeon removes about 80 percent of your stomach, making it smaller and reducing the hunger hormone ghrelin.
- Gastric bypass: In this procedure, the stomach is reduced significantly in size and the intestines are rerouted, limiting both how much you eat and how many calories you absorb. This is an especially effective approach for people with type 2 diabetes.
- SADI and duodenal switch: These procedures combine a sleeve gastrectomy with intestinal bypass for even greater calorie reduction.
- Lap band: In the least invasive of the procedures, an adjustable band device is placed around the stomach, limiting its capacity. This has become a less popular choice recently, but it’s still available.
Recovery from any of these procedures is faster than many expect: most patients stay just one night in the hospital.
What Happens 10 Years After Gastric Sleeve Surgery?
The good news: Most patients maintain most of their weight loss 10 years after surgery. Your stomach doesn’t stretch back to its original size, so weight remains stable.
However, some weight regain does happen naturally as metabolism decreases with age. About 10 to 20 percent of patients experience mild regain, up to 10 percent of the weight they lost. Some may experience more significant regain, potentially more than 50 percent of what they initially lost. When this happens, some patients benefit from adding a GLP-1 medication as an additional treatment.
What triggers weight regain? “Reintroduction of sweet beverages and snacks is the most common reason for weight recurrence,” says Dr. Ren-Fielding. Avoiding those triggers helps protect long-term results.
What Is the 30-Minute Rule for Bariatric Surgery?
Bariatric surgery physically changes your anatomy, which requires some adjustments to how you eat and drink after surgery. For example, doctors recommend avoiding fluids for 30 minutes after eating. This is because liquids empty from your stomach faster than solid food, and that can dilute the satiety signal—the feeling of fullness—that you’re supposed to get from your smaller stomach. You can, however, drink 10 minutes before a meal, since those liquids will have emptied by the time you start eating.
You’ll also need to eat more slowly, chew thoroughly, and eat smaller portions. The goal is to maximize the surgery’s effectiveness by working with your body’s new design, not against it.
Does Having Bariatric Surgery Years Ago Affect the Use of GLP-1 Medication?
If you had bariatric surgery in the past and are now gaining weight, adding a GLP-1 medication is worth discussing with your doctor.
According to Dr. Ren-Fielding, some patients who’ve regained weight after surgery benefit from GLP-1 “as an additive treatment,” meaning it works alongside your surgical anatomy rather than replacing it. The combination can provide additional weight loss support when surgery alone isn’t maintaining results over time. Your doctor will help you determine if low-dose GLP-1 is the right next step, or if another approach would be better suited to your body’s new anatomy.
What About Cost and Insurance Coverage?
GLP-1 medications can cost up to $650 a month without insurance, using a manufacturer’s coupon. With insurance, costs vary. Some plans cover them fully, others partially, and some don’t cover them at all. And insurance coverage can change: In January 2026, several major insurance companies suddenly stopped covering certain GLP-1s, leaving patients scrambling. This unpredictability is one reason some people choose surgery instead.
Bariatric surgery typically costs $15,000 to $35,000, and many insurance plans cover a significant portion of the cost, reducing your out-of-pocket expense, or even the entire cost of surgery. Over two years, even at full up-front cost, bariatric surgery may save money compared to continuous GLP-1 use. Studies show surgery could save $12,000 to $22,850 over two years when you factor in medication costs, doctor visits, and fewer weight-related health problems.
Obesity Is a Medical Condition—with More Tools Than Ever
For too long, people struggling with excess weight were told to eat less and exercise more, and if you can’t lose weight, it’s your fault. But science has revealed the truth: obesity is a medical condition rooted in biology, not willpower.
“Weight loss medications have been so important in validating this medical condition,” Dr. Ren-Fielding says. “Once you address what’s happening in your body—whether through medication or surgery—suddenly, diet, and exercise work again.”
Beyond GLP-1 and traditional surgery, two newer options are also worth discussing with your doctor:
- Endoscopic sleeve gastroplasty (ESG): In this procedure doctors use sutures placed through your mouth (no incisions) to reduce stomach size. It’s less invasive than surgery, reversible, and increasingly covered by insurance—a middle ground for people who want something between medication and full surgery.
- Swallowable balloon capsule: The FDA recently approved an oral capsule that expands in the stomach like a water balloon for four months, creating a feeling of fullness. Then it naturally dissolves and passes. It’s particularly effective when combined with low-dose GLP-1, offering good results at a lower cost.
The best choice for medical weight loss is the one that fits your body, your health, your lifestyle, and your goals—and that choice may evolve over time.
NYU Langone’s Weight Management Program has locations across New York City and Long Island:
