Faced with obesity, can new weight loss drugs replace surgery?

Faced with obesity can new weight loss drugs replace surgery

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    Guillaume Pourcher (obesity surgeon)

    Faced with obesity, can new drugs replace surgery? To better understand their place in the management of this disease, a study compared their effectiveness. Explanations from our expert, Dr Guillaume Pourcher, obesity surgeon.

    Between 1997 and 2020, overweight increased to the point of affecting 30% of the population, just like obesity, which increased from 8.5% of adults in 1997 to 17% in 2020. Faced with this scourge of public health, the arrival of new drugs has monopolized the headlines of the media… to the point of forgetting that another treatment had already proven itself: bariatric surgery. Researchers wanted to compare the effectiveness of these new drugs to endosleeve, a surgery which involves folding the stomach to reduce its size.

    Surgery versus sematuglide?

    In obesity surgery, the patient is operated on to reduce the size of their stomach or modify their digestive tract, in order to help them lose weight. There are different operating techniques and surgery has been recommended by the High Authority of Health since 2022 for patients whose BMI is greater than 40. Using these techniques, the endosleeve passes through the natural channels (nose or mouth) in order to access the stomach and reduce its size by a fold.

    The study compared the effectiveness of endosleeve versus semaglutide over 5 years to treat patients suffering from grade 2 obesity, which means they had a BMI between 35 and 39.9. The typical example was that of a 45-year-old patient with a BMI of 37. For the others, the researchers drew data from clinical trials to simulate other patient profiles.

    Researchers estimated the benefits and harms of two treatment strategies for these patients: semaglutide and endosleeve, compared to no treatment. Result: mini-surgery wins out over medication, on several levels.

    The more effective and less expensive endosleeve

    To reach this conclusion, the researchers compared the costs of the two techniques, their repetition and the cost of treating possible side effects (stomach aches, nausea, vomiting, etc.) after each of them. They were able to see that semaglutide injections cost more than $53,000 over five years, compared to less than $20,000 for so-called endosleeve surgery.

    Additionally, the medications are less effective, resulting in 4% less weight loss for semaglutide, compared to mini-surgery. “The annual cost of semaglutide would need to be cut by three, from $13,618 to $3,591 per year to make it a competitive alternative.” note the researchers

    NO to diets, YES to WW!

    Dr Guillaume Pourcher: “These treatments should not be opposed, they are complementary”

    Questioned by Doctissimo, Dr Guillaume Pourcher, obesity surgeon and head of the Obesity Center at the Institut Mutualiste Montsouris, in Paris, firstly recalls that obesity is a complex pathology. “In this work, people affected by stage 2 obesity were chosen. This is a stage where they do not have access to the bariatric surgery first of all notes Guillaume Pourcher.

    The study analyzes the effects of an endosleeve, a surgical procedure under general anesthesia, which goes through natural channels to reduce the size of the stomach. “The plication carried out can change over time, generally after a few years, the volume of the stomach will have returned to its initial stage. adds the specialist. “Nevertheless, it is an innovative technique, currently being evaluated, but which, let us remember, is not comparable to bariatric surgery.”

    For the doctor, the techniques to fight obesity must be complementary. “This study shows that semaglutide performs worse than endosleeve in terms of results and price. This is not to say that the treatment is not useful, it might be recommended for people who cannot have surgery, for example. In general, we still need further studies to clearly delineate the framework in which the drugs should be used.” he concludes.