With over 40% of Americans classified as obese, the need for effective long-term weight-loss solutions is greater than ever.
Obesity can lead to serious health issues like diabetes, heart disease, stroke, certain cancers, and sleep apnea.
At the UCSF Bariatric Surgery Center, Dr. Jonathan Carter and his team have helped thousands of patients manage obesity through surgical options.
But with the rise of powerful new medications like Ozempic and Wegovy, many people are now asking: Do I still need surgery?
Dr. Carter, a bariatric surgeon for more than a decade, sees obesity as existing on a spectrum. If someone needs to lose just 10 or 20 pounds, diet and exercise changes may be enough.
But for people who need to lose 30, 40, or 50 pounds and are starting to develop related health conditions like high blood pressure or diabetes, medications called GLP-1s can be very helpful. Dr. Carter strongly supports these drugs and says they’ve changed the lives of many patients.
However, for those with severe obesity—people who are 100 to 150 pounds overweight—surgery is often the best choice.
According to Dr. Carter, medications and lifestyle changes alone aren’t enough to reduce the long-term risks of serious diseases like heart disease and cancer. Bariatric surgery leads to more dramatic weight loss—typically 30% to 35% of total body weight in the first year compared to 15% to 20% with medication.
Plus, it comes with other health benefits: half or more of surgery patients with diabetes go into remission, and conditions like asthma, liver disease, sleep apnea, and arthritis often improve or disappear.
The most common surgical procedure is the gastric sleeve, which removes 80% of the stomach and leaves a narrow, tube-shaped pouch. This reduces hunger hormones and speeds up digestion, triggering hormones that help you feel full faster.
A smaller group of patients may have gastric bypass surgery, where a small pouch is created and connected directly to the small intestine. Although bypass might lead to slightly more weight loss, the long-term results are similar. Bypass can be a better choice for people with serious acid reflux, since the sleeve can sometimes make heartburn worse.
At UCSF, patients are considered for surgery if their body mass index (BMI) is 35 or more—or 30 if they also have conditions like high blood pressure or sleep apnea. The process includes lab tests, heart checks, and appointments with a team of specialists, including a nutritionist, psychiatrist, and physician assistant. Surgery takes about an hour, involves one night in the hospital, and most patients recover quickly, with only mild side effects like nausea.
While most patients are successful, some don’t lose as much weight as they’d hoped or regain some over time.
That’s where ongoing support makes a difference. Some people may benefit from adding GLP-1 medications after surgery, while others need help with lifestyle habits like eating late at night, overeating at work events, or not sleeping well. The UCSF team offers long-term support to help patients stay on track.
Looking ahead, Dr. Carter is optimistic. New, more effective GLP-1 medications are in development, and they may be easier to take and more affordable.
If these medications can safely help people lose weight earlier—when their BMI first crosses 30—we might be able to prevent severe obesity and reduce the need for surgery altogether.
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