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Mounjaro Vs Gastric Sleeve: Tirzepatide Vs Weight Loss Surgery

Mounjaro Vs Gastric Sleeve

Mounjaro Vs Gastric Sleeve have been compared in this article to see if a drug can compete with a surgical procedure for weight loss, diabetes, or other weight-related comorbid conditions.

Mounjaro is “Twincretin“. It is the brand name of “Tirzepatide” marketed by Eli Lilly Pharmaceuticals. Because Tirzepatide blocks endogenous incretins, GLP-1 and GIP, it is called “Twincretin”.

Mounjaro (Tirzepatide) is the most potent diabetes medicine currently available. It is more effective than Ozempic and Insulin for lowering the A1C.

In addition, it is one of the most highly potent weight loss medicines currently available. It has also been observed to be more effective for weight loss than Semaglutide (Wegovy).

Gastric Sleeve or Sleeve Gastrectomy or Laparoscopic Sleeve Gastrectomy (LSG) is one of the safest and most effective weight loss surgical procedures.

It has been observed to “cure diabetes” and other weight-related complications.

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Mounjaro Vs Gastric Sleeve: General Comparison

Mounjaro (Tirzepatide) is a drug that is available as a prefilled pen injection. It is administered once weekly.

Candidates for Mounjaro (Tirzepatide):

  • All individuals with Type 2 Diabetes who are non-responsive or intolerant to metformin, diet, and lifestyle interventions.
  • It has been recently approved by the FDA for the treatment of obesity.

Gastric Sleeve or Laparoscopic Sleeve Gastrectomy is a weight loss surgical procedure. It involves removing about 80% of the stomach, making it “banana-shaped“.

Candidates for Gastric Sleeve include:

  • All obese individuals who have a BMI of 40 kg/m² or more and have failed to lose weight despite adequate exercise and reduced caloric intake.
  • All obese individuals who have a BMI of 35 kg/m² or more and one weight-related health condition such as diabetes, hypertension, or dyslipidemia and who have failed to lose weight despite exercise and a low-calorie diet.

Mounjaro has not been compared with Gastric Sleeve in clinical trials, however, the table below summarizes the comparison between the two interventions:


Tirzepatide (Mounjaro)

Gastric Sleeve

What is it?Medication for weight loss and glycemic control in type 2 diabetesA restrictive weight loss surgery that reduces stomach capacity by up to 80%
Weight lossUp to 15-20% body weight lossRapid and up to 60-70% excess weight loss within 1-2 years
ComplicationsGastrointestinal issues, injection site reactions, and pancreatitisFewer complications than gastric bypass. GERD and GI complications are common
Surgery timeNot applicableUsually shorter than gastric bypass
Recovery timeNot applicableTypically shorter than gastric bypass
Long-term resultsData not availableSustained weight loss
Effect on comorbiditiesImproves type 2 diabetes, high blood pressure, and sleep apneaCan improve or resolve conditions like type 2 diabetes, high blood pressure, and sleep apnea
ReversibilityCan discontinue the medicine anytimeIrreversible
Dietary changesDietary changes are needed to prevent side effects and ensure good resultsRequires significant dietary changes to ensure success and prevent complications
CostExpensiveExpensive, but the cost is one-time only (less expensive than gastric bypass)
EligibilityType 2 diabetes patients who are obese or are overweightGenerally recommended for patients with a BMI over 40 or a BMI over 35 with obesity-related health issues



Mounjaro Vs Gastric Sleeve: Comparing Efficacies:

Mounjaro (Tirzepatide) is an FDA-approved drug for the treatment of Diabetes. It has just been approved for obesity, under a different brand name, Zepbound.

However, it has not yet been approved for weight loss.

The 2023 ADA recommendations label Mounjaro (Tirzepatide) as the most potent of all the diabetes medications available nowadays.

Likewise, it has superior efficacy as a weight loss drug compared to all other FDA-approved weight loss drugs including Semaglutide (Wegovy).

Bariatric surgical procedures including gastric sleeve surgery, however, have been shown to reverse or cure diabetes in most patients.

A small minority of patients who are not cured have significant improvement in their diabetes and other comorbid conditions.

The table below summarizes the efficacies of Mounjaro Vs Gastric sleeve:


Gastric Sleeve Surgery


A1C reduction1.5 to 2.0%1.9 to 2.4%
Body weight60-70% of excess body weight over 1-2 years15 – 20% of baseline body weight
Fasting blood glucose50-100 mg/dL106 mg/dL
Prandial glucose50-100 mg/dL109 mg/dl

Mounjaro (Tirzepatide) is good for temporary improvement in diabetic parameters while Gastric Sleeve is a better option in the long run.

The effect of Mounjaro (Tirzepatide) on various health outcomes has not been studied because the drug is new in the market.

However, Gastric Sleeve surgery is being practiced worldwide and it has been proven to reverse diabetes in the majority of obese patients.

Here are the various health outcomes of Gastric Sleeve Surgery Vs Mounjaro (Tirzepatide):

Health Outcome

Gastric Sleeve Surgery


DiabetesDiabetes remission in 50-80% and improvement in 95% of the patients.Data is limited on “Diabetes Remission”, However, it is the most potent diabetes medicine.
Weight LossWeight loss of 60-70% of excess body weight over 1-2 years15 to 20% of excess body weight loss over 6 – 12 months.
HypertensionResolution of hypertension in 50-70% of patients.a 7 to 10 mmHg reduction in BP has been observed.
Sleep ApneaResolution of sleep apnea in 60-90% of patientsStudies are ongoing to see the effects of Mounjaro or sleep apnea [Ref]
OsteoarthritisResolution of symptoms of osteoarthritis in up to 70% of patients.Data is limited.
Heart DiseaseReductions in the risk of heart attack, stroke, and risk factors for heart diseases have been observed in some studies.15% risk reduction vs Placebo in the SURPASS-CVOT Trial
Liver DiseaseImprovement or resolution of nonalcoholic fatty liver disease (NAFLD) in up to 90% of patients.significant improvement in liver fat, visceral fat, and abdominal fat.
Renal DiseaseHas been shown to improve GFR and the resolution of kidney disease in a significant number of patients.slows the progression of kidney disease.
DyslipidemiaResolution of dyslipidemia in up to 70% of patients, with reductions in LDL cholesterol, triglycerides, and total cholesterol/HDL ratio often seen within the first few months after surgery.Reduced Triglycerides by 28%, LDL by 7.9%, and improves HDL by 24%.


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Mounjaro Vs Gastric Sleeve: Safety Concerns

The safety of Mounjaro Vs Gastric Sleeve surgery has been compared here. However, these two interventions have not been directly assessed in clinical trials.

Both Mounjaro and Gastric sleeve surgery primarily affect the absorption and digestion of food.

Therefore most long-term side effects are related to intolerance to food, constipation, diarrhea, abdominal fullness, and pain.

Here is a table comparing the side effects of Mounjaro vs gastric sleeve surgery: 

Side Effects

Gastric Sleeve Surgery


Surgery-related complicationsPossible risks include:

  • Bleeding,
  • infection,
  • blood clots,
  • leaks at the surgical site,
  • side effects of anesthesia
  • Pancreatitis
  • Hypoglycemia
  • Abdominal fullness
  • Constipation or diarrhea
Nutrient deficienciesDeficiencies of:

  • Vitamin B12,
  • Iron, and
  • Calcium
Dehydration and multiple nutritional deficiencies may occur.
Dumping syndromeDumping syndrome is common, especially after a high-sugar diet.

Patients can develop nausea, vomiting, diarrhea, and flatulence.

Not associated with dumping syndrome
Weight regainWeight regain is possible after 5 to 10 yearsWeight regain can occur soon after discontinuation of the drug

Availability of Mounjaro vs Gastric Sleeve Surgery?

Since Mounjaro is a newly approved Diabetes drug, it is not readily available everywhere. It has been made available in the US, UK, Australia, and a few other countries.

Gastric sleeve is widely practiced. Here are some of the best centers for Gastric Sleeve surgery in the world:




SpainCentro Médico TeknonBarcelona, Spain
UAEBariatric & Metabolic InstituteCleveland Clinic Abu Dhabi, UAE
South KoreaSaint Mary’s HospitalSeoul, South Korea
MexicoAlmater HospitalMexicali, Mexico
USCleveland ClinicCleveland, Ohio
USMayo ClinicRochester, Minnesota
USNew York-Presbyterian HospitalNew York, New York
UKThe London ClinicLondon, England
UKNuffield Health Bristol HospitalBristol, England
AustraliaSydney Bariatric ClinicSydney, New South Wales
AustraliaMelbourne Gastro SurgeryMelbourne, Victoria
UAEDr. Sulaiman Al Habib HospitalDubai, UAE
Saudi ArabiaKing Fahd Medical CityRiyadh, Saudi Arabia
BahrainRoyal Bahrain HospitalManama, Bahrain


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In Conclusion:

Health Outcome

Mounjaro (Tirzepatide)

Gastric Sleeve Surgery

% Weight LossModerate (up to 15-20%)Rapid (up to 60-70%)
% A1C Reduction1.9% – 2.4%1.5% – 2.0%
HypertensionMay improve or resolveMay improve or resolve
Sleep ApneaMay improve or resolveMay improve or resolve
OsteoarthritisMay improve or resolveMay improve or resolve
Heart DiseaseMay reduce riskMay reduce risk
Liver DiseaseNo data availableMay improve or resolve
Renal DiseaseNo data availableMay improve or resolve
DyslipidemiaNo data availableMay improve or resolve
DeathsNo data availableLow risk


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Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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