Why Are People Stuck on Debating Surgery vs Meds for Obesity?

At the annual meeting of the American College of Surgeons this week, six smart people debated the future of metabolic surgery versus medicines in the treatment of obesity. The interest in this debate is unmistakable. Our newsfeed is full of it. The undercurrent seems to be an implicit contest. Which is best? Which will prevail? What is the future for surgery when we have such potent medicines?

But the real answer is that these are wrong questions. The fundamental reason that so many people are stuck on this question is simple. People resist thinking about obesity as a serious, complex, chronic disease that requires comprehensive care. Like cancer.

Both/And Not Either/Or

Nobody wastes their time debating whether surgical or medical oncology is better. Because everyone takes cancer seriously. Both medicine and surgery have important roles to play in helping a person overcome it.

And in the debate at the ACS meeting, Shanu Kothari put this idea on the table:

“We need to embrace this cancer model. We know it’s a chronic disease, and we need to treat it as such.”

Yet people seem unable to let go of the either/or thinking. In the course of this great debate, for example, researcher and surgeon David Harris described his work on obesity medicines as “trying to put us all out of business in bariatric surgery.” But he noted “we’re nowhere close.”

The Implicit Debate Continues

The answer is blindingly obvious. People need care in many forms for obesity. Medicines help. More people are taking them before they have surgery, says research presented at the ACS meeting. And more people are taking them after surgery.

But the prevailing bias is also blinding. Which is cheaper? How can we get by with a minimal intervention? A new study in JAMA Surgery tells us surgery yields more effective, durable treatment than medicines at a lower cost.  People debate ways to put patients on an off-ramp from obesity medicines.

All of this comes from the same place – a bias that obesity ought not to be a chronic disease. People ought to just lose the weight and keep it off through good behavior and strong willpower. Treatment should be minimal and hard to get.

But human biology doesn’t care if you believe in it. It keeps doing its thing. Sometimes in a disordered way. When that happens, people have a condition that requires treatment if they want to enjoy good health.

Click here and here for more about the great debate at the ACS meeting.

The Debate, photograph from the George H.W. Bush Presidential Library / Wikimedia Commons

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October 9, 2025