A recent study by Clinica Universidad de Navarra (CUN) compared the effectiveness of bariatric surgery with pharmacological treatments for weight loss. The research indicates that weight loss after surgery is greater than that obtained with drugs such as Ozempic, Wegovy, and Mounjaro. The study analyzed data from 20,000 patients using procedures such as sleeve gastrectomy and gastric bypass, in conjunction with the administration of GLP-1 receptor agonists. Crucial parameters such as body composition and body mass index (BMI) were evaluated. Although GLP-1 agonists produce noticeable weight loss, bariatric surgery remains the most effective intervention in the long term, at least two years after the operation. Limitations of the drugs: Dr. Lucas Sabatella, co-author of the research, points out that treatments like Mounjaro have a high dropout rate among patients, which limits their overall effectiveness. Furthermore, there is concern about the rebound effect once treatment is discontinued. On the other hand, specialist Manuel Landecho, from the Internal Medicine Department of the Obesity Area and the Check-up Unit at the clinic, emphasizes that obesity is a chronic disease and that the patient's expectations must be considered when selecting the appropriate treatment approach, reports EFE Health. For those with greater accumulation of adipose tissue, surgery stands as the most favorable option. Risks of both methods: Bariatric surgery carries more serious and invasive surgical risks compared to pharmacological treatments for obesity, which are usually limited to manageable side effects. While drugs like semaglutide (Ozempic) mainly cause temporary nausea, surgery involves potentially life-threatening complications. In the long term,Both can lead to nutritional deficiencies or weight regain, but surgery requires permanent lifestyle changes.

Risks of bariatric surgery. These include immediate complications such as excessive bleeding, infections, blood clots, gastric leaks, and reactions to anesthesia, with a mortality risk of 0.1% and serious complications in 4%. In the long term, nutritional deficiencies arise due to decreased absorption, along with a higher incidence of depression, alcohol abuse, and potential psychological problems. Recovery time is prolonged, and there is a risk of weight regain (15-25%).

Risks of drug treatments. Common side effects are temporary gastrointestinal issues such as nausea, vomiting, diarrhea, and constipation, which are minimized with gradual dosing. In rare cases, side effects include pancreatitis or intestinal paralysis, but these do not require hospitalization. Discontinuing medication can cause rapid weight regain without lifestyle changes.

Criteria for Determining Surgery

The criteria for determining a patient's suitability for bariatric surgery are primarily based on international clinical guidelines such as those of the ASMBS (American Society for Metabolic and Bariatric Surgery) and local societies, focusing on BMI, comorbidities, and comprehensive evaluation.

BMI Criteria. Patients with a BMI ≥40 kg/m² (morbid obesity), or a BMI ≥35 kg/m² with serious comorbidities such as type 2 diabetes, hypertension, sleep apnea, or heart disease, are considered suitable. For uncontrolled type 2 diabetes, the threshold is lowered to a BMI ≥30 kg/m² in some cases.

Multidisciplinary Evaluation.

It requires evaluation by a medical team (surgeons, endocrinologists, psychologists, nutritionists) to confirm failure of conservative treatments (diets, exercise, medications) and commitment to postoperative lifestyle changes.

Other factors. Age generally ≥18 years (individualized in older patients); absence of contraindications such as untreated psychiatric disorders, alcoholism, or inability to follow up; and assessment of surgical risks using scores such as OS-MRS or LABS. Pregnant or breastfeeding women are excluded.

Psychological impact of bariatric surgery

Bariatric surgery generates initial psychological improvements in most patients, such as a reduction in depressive symptoms and greater self-esteem, but in the long term, depression may arise in 10-20% of cases if weight loss is insufficient.

Initial improvements. Studies show that depressive symptoms, anxiety, and low self-esteem decrease significantly in the first three postoperative years, with the greatest benefit occurring in the first year. This improves overall quality of life and self-perception.

Long-term risks. After 4 years, the psychological benefits tend to diminish, especially in patients who do not lose at least 25% of their initial weight, which can lead to depression even in those who did not have it before. Factors such as weight regain cause frustration, shame, and emotional failure.

Common challenges. Patients experience grief over the loss of food, such as coping, temporary regret, discomfort with compliments, or dissatisfaction with excess skin and sagging, increasing anxiety and affecting relationships. Family and social support is key to mitigating these effects.

Recommendations. Regular post-surgery psychological sessions strengthen resilience and healthy habits in the long term. Pre-operative assessments identify risks such as eating disorders for better management.

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