Bariatric surgery will not be replaced by medications anytime soon and remains the best long-term option for weight loss, surgeons assure.
“Surgery remains superior to medication for a large proportion of obese patients,” says Dr.r Simon Marceau, who has been doing bariatric surgeries for 25 years at the University Institute of Cardiology and Pneumology of Quebec (IUCPQ).
In general, surgery allows you to lose 25% to 35% of weight, more than medication (15%), underlines the Dre Marie-Philippe Morin, surgeon specializing in bariatrics at the IUCPQ.
In the United States, the number of bariatric surgeries decreased in 2023 compared to 2022, a recent study published in JAMA Network. During the same period, prescriptions for semaglutide (the active ingredient in Ozempic and Wegovy) increased.
Not always ideal
Important fact: Some patients do not lose weight on semaglutide. Others do not want to take medication that can cause a host of side effects (nausea, headaches, intestinal problems). In addition, only a small portion of Quebecers with diabetes and obesity have access to the drug at the moment.
“There are different patients and different responses to treatments. You have to find the right treatment for the right patient, it’s an additional tool,” explains Marie-Philippe Morin.
Marie-Philippe Morin. Specialist in general internal and bariatric medicine, Head of general internal medicine department IUCPQ credit: Sarah Tailleur
Photo provided by SARAH TAILLEUR
She adds that the drug can help patients before or after bariatric surgery, to lose or maintain weight. Conversely, the procedure is sometimes too risky and medication becomes the only avenue to lose weight.
And since the medication has been available since 2019 in Quebec, it is difficult to know what the long-term result will be.
“The tip of the iceberg”
In Quebec, the number of people undergoing bariatric surgery has been increasing for two years. However, patients must be patient (often more than three years).
Bariatric surgeries in Quebec
- 2024: 4217*
- 2023: 4281
- 2022: 3383
- 2021: 3125
- 2020: 2595
- 2019: 4238
- 2018: 3899
- 2017: 3737
- 2016: 3132
- 2015: 3029
- 2014: 2910
Source: RAMQ
*2024: as of November 25
“We are operating on the tip of the iceberg,” deplores the Dr Marceau. People wait three years to see me.”
Even if reimbursement for semaglutide were expanded, we would have to wait several years before seeing a real effect on the number of surgeries.
“I don’t think we’re going to see a drop,” adds his colleague.
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