Bariatric Surgery, Dietary Change, and Sustainable Weight Management

By Dr Siva Gounder, Bariatric Surgeon (Perth, WA)

Obesity is a chronic condition that demands effective long-term solutions. In recent years, medications like semaglutide (Ozempic®) have gained popularity for weight loss, but many patients eventually face diminishing returns with these drugs. Bariatric surgery – coupled with significant dietary and lifestyle changes – has emerged as one of the most effective and enduring interventions for severe obesity (Weight loss maintenance after bariatric surgery – PMC) (Weight loss maintenance after bariatric surgery – PMC). This article examines how post-surgery dietary changes contribute to sustainable health, why bariatric surgery often outperforms pharmacological treatments in the long run, and the importance of using each tool appropriately for lasting weight management.

The Power of Dietary Transformation Post-Surgery

(Should I Have Bariatric Surgery or Go On Ozempic? | Rochester Regional Health) Patients receive ongoing guidance on nutrition and lifestyle after bariatric surgery, underscoring the importance of dietary change in achieving long-term success.

One of the fundamental ways bariatric surgery leads to lasting weight loss is by catalysing profound dietary and behavioural changes. The surgery physically reduces stomach capacity (and, in some procedures, alters gut hormone signaling), which immediately forces a drastic reduction in calorie intake. Post-operatively, patients are typically limited to liquids and purees initially, gradually progressing to small, protein-focused meals. This enforced change breaks long-standing habits of overeating and resets how patients approach food. Indeed, due to anatomical and hormonal changes, caloric intake drops sharply right after surgery, aiding initial weight loss (Weight loss maintenance after bariatric surgery – PMC). Patients often find their appetite and portion sizes are dramatically reduced, and sensations of fullness occur much sooner than before.

Critically, success after surgery depends on adhering to healthy dietary guidelines. Bariatric patients work closely with dietitians to prioritise high-quality protein, vegetables, and adequate hydration, while avoiding concentrated sugars and high-fat junk foods. These nutritional guidelines are not temporary; they form a new lifelong eating pattern. Research shows that patients who stick to their recommended post-surgery diet (regular small meals rich in protein and fibre, limited in sugary or fatty snacks) tend to lose more weight and keep it off, whereas those who revert to poor-quality, high-calorie eating are more prone to weight regain (Weight loss maintenance after bariatric surgery – PMC). In fact, poor diet quality – for example, frequent snacking on sweets or high-fat foods – is strongly associated with post-surgery weight regain (Weight loss maintenance after bariatric surgery – PMC). This underlines that bariatric surgery is not a standalone fix; it is a powerful tool combined with dietary and lifestyle change. Patients often describe the surgery as “a reset” that gave them the ability to adopt healthier eating behaviours that were hard to maintain before. Many problematic eating habits (such as binge eating or mindless grazing) improve after surgery, because the physical and hormonal effects support better appetite control and satiety signals.

Over time, these dietary transformations contribute not only to weight loss but also to broader health improvements. By consuming a more nutrient-dense diet in controlled portions, patients can correct nutritional deficiencies and improve metabolic health. High-protein, low-sugar meal plans help stabilise blood sugar levels, which is especially beneficial for those with type 2 diabetes or insulin resistance. Patients also report that the smaller portion sizes and mindful eating practices learned after surgery tend to persist, fostering a healthier relationship with food for years to come. In short, bariatric surgery sets the stage for a dietary overhaul – and it is this sustained change in eating habits, as much as the surgery itself, that leads to long-term health benefits and weight stability.

Bariatric Surgery as a Long-Term Weight Loss Solution

Bariatric surgery (such as gastric sleeve or gastric bypass) has decades of evidence supporting its effectiveness for significant and durable weight loss. It is widely considered the most effective treatment for severe obesity and its related medical conditions, far exceeding the results of diet, exercise, or medications alone (Weight loss maintenance after bariatric surgery – PMC) (Weight loss maintenance after bariatric surgery – PMC). Unlike short-term diet programs where weight is often regained, bariatric surgery has a proven record of helping patients lose a large percentage of their weight and keep it off over the long term.

Multiple long-term studies have demonstrated the durability of surgical weight loss. On average, patients lose roughly 25–35% of their starting body weight in the first year after surgery (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery). For example, gastric bypass patients typically see around 30% total body weight loss at one year, and sleeve gastrectomy patients around 25–30% (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery). Remarkably, a substantial portion of this weight loss is maintained even a decade after surgery – studies report patients keeping off roughly 25% of their original weight up to 10 years post-op (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery). In one cohort, over 70% of gastric bypass patients maintained at least a 20% total weight reduction at the 10-year mark, and 40% had kept off more than 30% of their original weight (Weight loss maintenance after bariatric surgery – PMC). These outcomes are in stark contrast to non-surgical approaches, where weight regain is the norm. Even the best lifestyle interventions usually result in far smaller losses (often under 10% of body weight) and the weight often returns within a few years (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery).
Not only does bariatric surgery produce greater weight loss, but it also brings significant improvements in health conditions. After surgery, many patients see rapid reductions in obesity-related illnesses. Type 2 diabetes, for instance, can go into remission within weeks of surgery (even before significant weight loss occurs) due to hormonal changes. Clinical trials have shown metabolic surgery to be more effective than medication alone in achieving diabetes remission and better blood sugar control (Type 2 Diabetes and Metabolic Surgery – American Society for Metabolic and Bariatric Surgery). In one landmark trial, about 29–42% of surgical patients had their diabetes go into remission one year after surgery, versus virtually 0% of those on medical therapy alone (Type 2 Diabetes and Metabolic Surgery – American Society for Metabolic and Bariatric Surgery). Improvements in blood pressure, cholesterol, sleep apnoea, joint pain, and fertility are also well documented after substantial post-surgery weight loss. Over the long term, bariatric surgery is associated with lower risks of heart attacks, strokes, and even certain cancers, likely due to sustained weight reduction and metabolic changes. The Swedish Obese Subjects study – a decades-long study of thousands of patients – found that those who underwent bariatric surgery not only kept weight off but also had significantly lower overall mortality rates compared to matched obese individuals who did not have surgery (Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study – PubMed). In other words, surgical patients tended to live longer and healthier lives. Researchers observed a reduction of about 30% in overall mortality among surgery patients over ~10 years (Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study – PubMed). This underscores that bariatric surgery isn’t merely about losing kilos – it can be a lifesaving intervention that reduces the risk of serious diseases and extends life expectancy.

It’s important to acknowledge that bariatric surgery, like any major intervention, carries some risks and requires lifelong follow-up. Patients must take vitamin supplements and have regular medical check-ups to ensure they maintain proper nutrition. There can be complications in a minority of cases, and some amount of weight re-gain can occur years down the line if healthy habits slip. However, even with some regain, most patients maintain a much lower weight than their pre-surgery baseline (Weight loss maintenance after bariatric surgery – PMC). The vast majority consider the trade-offs well worth the dramatic improvement in quality of life. For individuals with severe obesity (for example, a BMI ≥40, or ≥35 with serious health issues), bariatric surgery offers a level of long-term success that no other approach can match at present. As Dr Siva Gounder often emphasises, bariatric surgery is not “cheating” or an easy way out – it is a proactive health decision that provides a powerful tool for people who have struggled for years to achieve sustainable weight loss through other means.

The Rise of Weight Loss Injectables/ Medications and Their Limitations

In recent years, glucagon-like peptide-1 (GLP-1) receptor agonist medications have revolutionised the conversation around medical weight management. Drugs like semaglutide (brand names Ozempic® for diabetes and Wegovy® for obesity) and liraglutide (Saxenda®) were initially developed to treat type 2 diabetes, but doctors observed significant weight loss as a side effect. Now, these weekly (or daily) injections are being used to help patients with obesity lose weight by mimicking gut hormones that increase satiety and reduce appetite, essentially helping people feel full with less food (Ozempic and similar medications are revolutionising weight loss, with far-reaching economic effects – ABC News). For patients and clinicians wary of surgery, these medications have been hailed as a game-changer – and indeed, they can be very effective up to a point. Clinical trials show semaglutide can help patients lose around 10–15% of their body weight, and higher-dose agents like tirzepatide (Mounjaro®) can achieve up to 20% or more in some cases (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery). People often report that the constant “food noise” in their mind quiets down, making it easier to eat less and make healthier choices.

However, it’s crucial to understand the limitations of GLP-1 medications for long-term weight management. First, the weight loss from drugs tends to plateau. Patients commonly hit a “Ozempic plateau” after about 9–12 months of therapy (Ozempic weight loss plateau: What is it and how to get past it). For example, one study noted semaglutide users stopped losing additional weight after roughly 60 weeks (a bit over one year) on the medication (Ozempic weight loss plateau: What is it and how to get past it). At that point, the body often stabilises at a new set-point, and no further weight is lost unless something else changes (such as increasing the dose, switching medications, or intensifying diet and exercise) (Ozempic weight loss plateau: What is it and how to get past it). This plateau effect is actually common to most weight loss methods – the body adapts – but for someone with a very high starting BMI, a 10–15% reduction might not be sufficient to reach a healthy weight. For instance, a person with a BMI of 45 might lose 10% (bringing BMI to ~40.5) on semaglutide, still well into the severe obesity range. As a bariatric specialist, Dr Gounder sees many patients who start on medications and lose some weight, but then plateau with a significant amount of weight still to lose to alleviate their health issues. In fact, research confirms that for patients with a BMI ≥40, the amount of weight lost with GLP-1 drugs alone is often not enough to get them down to a healthy BMI range (Should I Have Bariatric Surgery or Go On Ozempic? | Rochester Regional Health). In such cases, continuing on the medication indefinitely might keep those initial kilos off, but it likely won’t accomplish the substantial weight reduction needed to resolve conditions like diabetes or joint pain.

Another major limitation of relying solely on medication is sustainability. To maintain the weight loss achieved with GLP-1 agonists, one must continue the injections indefinitely. If the medication is stopped, the appetite hormones and metabolism revert, and most patients experience weight regain – often returning to their original weight within a year or so after discontinuation (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery) (Ozempic weight loss plateau: What is it and how to get past it). In other words, these drugs don’t “cure” obesity; they only control it while taken. This was clearly shown in trials: when participants went off semaglutide, they regained about half of the weight they had lost within 12 months (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery). This means a lifelong commitment to medication is required, which raises issues of cost and long-term safety. Many patients also report side effects on GLP-1 therapy, most commonly nausea, vomiting, diarrhoea or constipation, and sometimes more serious issues like gallstones. While these side effects are manageable for many, a significant number of people discontinue the drug due to tolerability or health concerns.

Finally, we must consider that medications, unlike surgery, do not fundamentally change the body’s anatomy or permanently alter the complex mechanisms regulating weight. GLP-1 drugs are a tool to reduce appetite, but patients still need to follow a healthy diet and lifestyle for best results. If a patient relies on the injection yet continues an unhealthy diet (just less of it), they may lose weight but could still have nutritional imbalances or less improvement in metabolic health than expected. There is also much we are still learning about these drugs’ effects beyond 2-3 years of use, since they are relatively new in the weight loss arena. In summary, Ozempic and similar GLP-1 medications are not a cure-all for obesity – they are one tool in the toolbox, helpful for some patients, but with important drawbacks if used as the sole long-term strategy (Should I Have Bariatric Surgery or Go On Ozempic? | Rochester Regional Health).

Bariatric Surgery vs. Medication: Comparing Outcomes

When we compare bariatric surgery and GLP-1 medications head-to-head, the differences in outcomes become clear. In terms of sheer weight loss and durability, surgery has a decisive edge. As noted, continued semaglutide therapy tends to level off at around a 10–15% total body weight reduction (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery) (Ozempic weight loss plateau: What is it and how to get past it) (with the newer tirzepatide approaching 20% in some cases (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery). Bariatric surgery, on the other hand, commonly achieves 25–35% weight loss within a year (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery), with a significant portion of that maintained even five, ten, or fifteen years later (Weight loss maintenance after bariatric surgery – PMC) (Weight loss maintenance after bariatric surgery – PMC). Put simply, an individual weighing 120 kg might slim down to ~100–108 kg with medication (if they respond well), but that same individual might reach 80–90 kg after surgery and, crucially, stay closer to that range in the long term.

Beyond weight loss percentages, the impact on health conditions often favors surgery. Bariatric surgery is sometimes called “metabolic surgery” because it induces hormonal changes that can resolve diseases like type 2 diabetes, not just manage them. Weight-loss medications certainly improve blood sugar and other metrics while the patient is on them (after all, semaglutide began as a diabetes drug). However, if the medication is stopped, any medical benefits can be lost along with the weight regain. Surgery offers a more definitive metabolic reset. Many patients with diabetes see their blood sugar normalise within days of a gastric bypass, allowing them to discontinue insulin and other medications – a profound remission that diet pills cannot mimic. Long-term studies have found surgery leads to higher rates of diabetes remission and better blood pressure control than standard medical therapy, even when medications (including older weight-loss drugs) are optimized (Type 2 Diabetes and Metabolic Surgery – American Society for Metabolic and Bariatric Surgery) (Type 2 Diabetes and Metabolic Surgery – American Society for Metabolic and Bariatric Surgery). There is also evidence that surgery patients have lower long-term incidence of heart attacks, strokes, and cancer compared to equally obese patients on usual care (Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study – PubMed). These differences stem from the greater magnitude of weight loss and perhaps the unique physiological effects of surgery (like changes in gut hormones, bile acids, and the microbiome) that go beyond what medications can do.

Another area of comparison is patient experience and psychology. For some, taking a weekly injection may seem far less daunting than undergoing surgery. There is no doubt that bariatric surgery requires a certain level of commitment and courage – it’s an invasive procedure with a recovery period and permanent changes to one’s anatomy. The early post-op diet of tiny portions and strict limitations can be challenging. However, patients often report that after recovering from surgery, they enjoy a much more “normal” life in terms of eating and hunger than they did while on medication. The constant gnawing hunger or fixation on food that plagues many with obesity is usually dramatically reduced post-surgery (thanks to reduced ghrelin and enhanced satiety hormones). By contrast, if one stops a GLP-1 shot even for a short time (due to travel, illness, or lapse in prescription), appetite can roar back. Some patients on medication describe feeling as though their improved control is more fragile – it relies on remembering to take that shot and hoping it continues to work with each dose. Surgery, in essence, internalises the treatment: the tool is now built into your body. There’s no worry about a prescription running out or the pharmacy having a shortage. This psychological relief – not being dependent on a medication forever – is a frequently cited benefit among those who choose surgery after trying other methods.

That said, it’s not an either/or proposition in many cases. Bariatric surgery and medications can be complementary. Some patients start a GLP-1 medication to lose a moderate amount of weight to improve their fitness for surgery (a safer surgical experience) or to build confidence in making lifestyle changes, then proceed with a bariatric procedure for a greater total weight loss. Others might have surgery first and later, years down the line, use a medication as an adjunct if they experience some weight regain. In fact, recent studies suggest that using GLP-1 drugs after surgery can help touch up results for those who need an extra tool to maintain success (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS). Dr Gounder advocates an individualised approach: each patient’s situation is unique, and the best outcome often involves using all available tools wisely. For someone with mild obesity and no major health issues, a medication combined with lifestyle changes might suffice. But for those with severe obesity or obesity-related illnesses, surgery offers a level of benefit that medication alone is unlikely to achieve. The key is to tailor the treatment plan to the patient’s needs, always with an emphasis that healthy diet and lifestyle remain central whether one uses medications, surgery, or both.

Long-Term Cost and Sustainability

A practical consideration in the discussion of surgery versus ongoing medication is cost and long-term sustainability. On the surface, taking a weight-loss drug might appear simpler and less expensive than a one-time surgery. However, the numbers tell a different story. GLP-1 medications are expensive, especially when used for weight management without subsidies. In Australia, Ozempic (semaglutide) is government-subsidised through the Pharmaceutical Benefits Scheme (PBS) only for people with type 2 diabetes – not for weight loss in people without diabetes (Why isn’t Ozempic on Australia’s Pharmaceutical Benefits Scheme for weight loss? And should it be? | Health | The Guardian). This means that if an individual without diabetes wants semaglutide for obesity, they pay privately. A single Ozempic pen (which contains a month’s worth of doses at the typical starting schedule) costs roughly A$150 with a private prescription (Why isn’t Ozempic on Australia’s Pharmaceutical Benefits Scheme for weight loss? And should it be? | Health | The Guardian). As the dose escalates for weight loss (Wegovy’s higher doses), the monthly cost rises further – often around A$500 to $700 per month out-of-pocket for the full treatment. Novo Nordisk, the manufacturer, has indicated the recommended dose (2.4 mg weekly) of Wegovy costs about $460 per month in Australia (RACGP – Wegovy launches in Australia), and patient reports indicate similar drugs like Saxenda or Mounjaro fall in the same range. Over a year, that’s roughly $5,000–$6,000; over a decade, easily tens of thousands of dollars spent on medication. In the United States, where insurance coverage for obesity medications is patchy, the costs can be even higher – an estimated $800–$1,200 per month if paying out-of-pocket (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS).

By contrast, bariatric surgery involves a one-time upfront cost (or a few upfront costs including the surgery and initial aftercare). In Australia, many private insurance plans cover bariatric surgery if the patient meets criteria, though there can be out-of-pocket expenses for hospital fees or consultations. For uninsured patients, the surgery can cost on the order of $20,000 or more in a private hospital. While this is significant, it is often comparable to just a few years’ worth of obesity-drug prescriptions. Importantly, analyses that look at the value over a patient’s lifetime have found that surgery is more cost-effective in the long run for managing obesity than perpetual medication use (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS). One recent study modeled 50 years of treatment and concluded that undergoing bariatric surgery saved more quality-adjusted life years and was ultimately less costly than staying on GLP-1 therapy for life (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS) (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS). The only scenario where medications might approach cost parity is if drug prices were to drop drastically (researchers estimated a drop of nearly 75% would be required) (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS).

The financial strain of paying $500+ per month indefinitely is simply not feasible for many patients, leading to discontinuation and, consequently, weight regain. This is an often overlooked aspect of new anti-obesity meds: they work, but only as long as you can afford to stay on them. By highlighting the long-term cost, Dr Gounder encourages patients and healthcare policymakers to consider investment in bariatric surgery and multidisciplinary obesity clinics, which may have higher upfront costs but confer lifelong benefits and reduce downstream healthcare expenses (through improved diabetes, fewer cardiac events, etc.). Indeed, the broader economic perspective is that effective obesity treatment (surgical or otherwise) saves healthcare systems money in the long run by preventing expensive chronic diseases. But for an individual patient, the arithmetic of pay once for surgery versus pay every month for life often makes surgery the more sensible choice if they are a suitable candidate.

Empowering Patients and Practitioners: A Comprehensive Approach

While bariatric surgery is a powerful tool, it is not a standalone magic bullet – and neither is any medication. The most successful outcomes in weight management come from a comprehensive approach: a partnership between patient and healthcare team, utilising medical, surgical, nutritional, and psychological strategies together. Dr Siva Gounder champions a patient-centred model where education and empowerment are paramount. Patients need to understand that surgery, for instance, is not an end point but the beginning of a new chapter of healthy living. After the procedure, the support of dietitians, exercise physiologists, psychologists, and support groups becomes invaluable to reinforce positive changes. Regular follow-ups help catch any issues early – whether nutritional deficiencies or weight creep – and allow timely interventions (like nutritional counseling or considering adjunct therapies such as medications for appetite control if needed). This team-based, long-term follow-up approach is the standard of care in modern bariatric practice (Weight loss maintenance after bariatric surgery – PMC) (Weight loss maintenance after bariatric surgery – PMC), and it’s one reason surgery today has such high success rates compared to decades past.

From the perspective of referring healthcare professionals (GPs, endocrinologists, etc.), it’s important to recognise when a patient may benefit from surgical evaluation. Historically, there has been a hesitation to refer to bariatric surgery until a patient’s obesity is “extreme” or after all other attempts have failed over many years. However, that paradigm is shifting. Given the safety and efficacy of modern minimally invasive bariatric procedures, surgery should be considered earlier for patients who meet the criteria, rather than as a last resort (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery). Waiting too long can mean patients spend additional years suffering the complications of obesity (heart disease, immobility, social stigma, etc.) and potentially developing irreversible damage (like advanced joint arthritis or organ damage from diabetes). Today’s thought leaders in obesity management, including Dr Gounder, encourage a proactive stance: if a patient has a high BMI and weight-related health issues, open the conversation about all effective options, including surgery. At the same time, encourage use of tools like GLP-1 analogues for those who are not ready or who have contraindications to surgery, or as bridges to help in the weight loss journey.

For patients reading this, the key message is one of hope and empowerment. Bariatric surgery is not about taking the “easy way” – it is about giving yourself a powerful tool to finally achieve a healthier life when moderate dieting and medications haven’t been enough. The surgery by itself sets the stage, but you rewrite the script through the dietary choices and lifestyle you adopt afterward. Many patients who undergo these procedures describe it as the best decision of their lives – not only do they shed weight, but they gain energy, confidence, and freedom from many health problems. They can play with their children again, embark on careers or hobbies they thought were lost to them, and reduce or eliminate many daily medications. Likewise, those who choose a medical therapy path can succeed if they combine it with permanent lifestyle changes, though knowing the potential need to maintain therapy. In all cases, knowledge is power: understanding the pros and cons of each approach allows one to make informed decisions.

Leadership in the Evolving Field of Obesity Care

In the journey of treating obesity, there is no one-size-fits-all answer – but there is a clear trend in what yields the most substantial and sustained results. Bariatric surgery, accompanied by dedicated dietary and lifestyle change, stands out as an effective long-term solution, especially for patients who have struggled to achieve adequate results through diet, exercise, or newer medications alone. The evidence is overwhelming that surgery can produce greater weight loss and maintain it, improving or resolving many health conditions in the process (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery) (Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study – PubMed). On the other hand, breakthrough medications like Ozempic offer new hope for weight management, but come with caveats of plateauing efficacy, high cost, and the need for indefinite use (Ozempic weight loss plateau: What is it and how to get past it) (Ozempic weight loss plateau: What is it and how to get past it).

Dr Siva Gounder’s perspective, reflecting a leadership voice in bariatric surgery, is that we must integrate these therapies wisely. Medications can be an entry point or adjunct, but for eligible patients, metabolic surgery provides a more profound metabolic reset and a platform for lasting lifestyle change. The goal is not to pit surgery against medication, but to use each in the right context to maximise patient health. Crucially, neither approach absolves the need for healthy eating and regular physical activity – these remain the bedrock of sustainable weight management and wellbeing.

As obesity rates continue to challenge Australia and the world, thought leaders in healthcare are calling for greater accessibility and utilisation of effective treatments. This means reducing stigma and misconceptions around bariatric surgery, expanding insurance coverage or subsidies for proven interventions, and encouraging collaboration across specialties. By doing so, we can shift from the frustrating cycle of transient weight loss to a model of care that delivers long-term, life-changing results for patients. Bariatric surgery, combined with empowered dietary change, exemplifies this paradigm – one where patients not only lose weight, but gain health, longevity, and a better quality of life. The evidence and experiences to date make a compelling case that, when it comes to sustainable weight management, surgery (with the right support) is an investment in a healthier future, often succeeding where pills and diets alone fall short (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery) (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS).

In summary, the path to overcoming obesity is a marathon, not a sprint. With tools like bariatric surgery enabling a strong start and lifelong dietary habits providing the endurance, patients can cross the finish line of their weight-loss goals and keep going, living fuller and healthier lives for years to come. The medical community – led by surgeons and physicians dedicated to obesity treatment – stands ready to guide patients on this journey, armed with both advanced surgical solutions and supportive care to ensure that sustainable weight management and improved health are achievable realities, not distant dreams.

Sources:

1. Ghaferi AA et al. Weight loss maintenance after bariatric surgery. World J Gastroenterol. 2023 – Bariatric surgery is considered the best treatment for severe obesity; outcomes superior to lifestyle or drugs (Weight loss maintenance after bariatric surgery – PMC) (Weight loss maintenance after bariatric surgery – PMC).
2.  ASMBS 2024 Annual Meeting, Press Release – Bariatric surgery produces greater and more sustained weight loss than GLP-1 medications or lifestyle changes (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery) (Bariatric Surgery More Effective and Durable Than New Obesity Drugs and Lifestyle Intervention – American Society for Metabolic and Bariatric Surgery).
3. Kheterpal S et al. Annals of Surgery, 2023 – 10-year follow-up of gastric bypass patients shows durable >20% total weight loss maintenance in most patients (Weight loss maintenance after bariatric surgery – PMC).
4. Sjöström L et al. Int J Obes, 2008 (Swedish Obese Subjects study) – Bariatric surgery associated with long-term weight loss, improved risk factors, and ~30% reduction in overall mortality (Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study – PubMed).
5. Rochester Regional Health, 2023 – Dr. Weerasinghe on bariatric surgery vs Ozempic: GLP-1 injections yield ~5–10% weight loss; not enough for BMI ≥40 (Should I Have Bariatric Surgery or Go On Ozempic? | Rochester Regional Health).
6. Medical News Today, 2024 – GLP-1 drugs often plateau at ~10–15% weight loss after ~1 year; require lifelong use to prevent regain (Ozempic weight loss plateau: What is it and how to get past it) (Ozempic weight loss plateau: What is it and how to get past it).
7.  ABC News (Australia), 2024 – Patient story highlighting cost of Wegovy (semaglutide) at $460/month per person in Australia (Ozempic and similar medications are revolutionising weight loss, with far-reaching economic effects – ABC News).
8. RACGP News, 2023 – Novo Nordisk confirms Wegovy pricing in Australia: $460 per month at full dose (RACGP – Wegovy launches in Australia).
9. The Guardian (Australia), 2025 – Ozempic on PBS only for diabetes; off-label for weight costs ~$150 per pen (multiple doses), making long-term use costly (Why isn’t Ozempic on Australia’s Pharmaceutical Benefits Scheme for weight loss? And should it be? | Health | The Guardian).
10. American College of Surgeons, 2024 – Economic analysis: Bariatric surgery is more cost-effective long-term than lifelong GLP-1 medication therapy (would require ~75% price reduction in meds to equalise) (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS).
11.  ASMBS, 2016-2022 Guidelines – Multidisciplinary aftercare (dietary, physical activity, psychological support) is critical for bariatric patients, emphasising lifestyle change for weight maintenance (Weight loss maintenance after bariatric surgery – PMC).
12. Weeraratna AT et al. Lancet Diabetes Endocrinol, 2021 – Combined approach recommended: use pharmacotherapy as adjunct to surgery for weight regain as needed (Bariatric Surgery Is More Cost Effective Than Newer Weight Loss Drugs Alone | ACS). (And other relevant studies supporting content above.)