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Mounjaro Vs Gastric Sleeve: Tirzepatide Vs Weight Loss Surgery

Mounjaro Vs Gastric Sleeve

mounjaro vs gastric sleeve surgery tirzepatide

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

Aspect

Tirzepatide (Mounjaro)

Gastric Sleeve

What is it? Medication for weight loss and glycemic control in type 2 diabetes A restrictive weight loss surgery that reduces stomach capacity by up to 80%
Weight loss Up to 15-20% body weight loss Rapid and up to 60-70% excess weight loss within 1-2 years
Complications Gastrointestinal issues, injection site reactions, and pancreatitis Fewer complications than gastric bypass. GERD and GI complications are common
Surgery time Not applicable Usually shorter than gastric bypass
Recovery time Not applicable Typically shorter than gastric bypass
Long-term results Data not available Sustained weight loss
Effect on comorbidities Improves type 2 diabetes, high blood pressure, and sleep apnea Can improve or resolve conditions like type 2 diabetes, high blood pressure, and sleep apnea
Reversibility Can discontinue the medicine anytime Irreversible
Dietary changes Dietary changes are needed to prevent side effects and ensure good results Requires significant dietary changes to ensure success and prevent complications
Cost Expensive Expensive, but the cost is one-time only (less expensive than gastric bypass)
Eligibility Type 2 diabetes patients who are obese or are overweight Generally recommended for patients with a BMI over 40 or a BMI over 35 with obesity-related health issues

 

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Mounjaro Vs Gastric Sleeve: Comparing Efficacies:

Mounjaro (Tirzepatide) is an FDA-approved drug for the treatment of Diabetes. The manufacturers have submitted it for approval as a weight loss drug. 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:

Outcome

Gastric Sleeve Surgery

Mounjaro

A1C reduction 1.5 to 2.0% 1.9 to 2.4%
Body weight 60-70% of excess body weight over 1-2 years 15 – 20% of baseline body weight
Fasting blood glucose 50-100 mg/dL 106 mg/dL
Prandial glucose 50-100 mg/dL 109 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.

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

Health Outcome

Gastric Sleeve Surgery

Mounjaro

Diabetes Diabetes 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 Loss Weight loss of 60-70% of excess body weight over 1-2 years 15 to 20% of excess body weight loss over 6 – 12 months.
Hypertension Resolution of hypertension in 50-70% of patients. a 7 to 10 mmHg reduction in BP has been observed.
Sleep Apnea Resolution of sleep apnea in 60-90% of patients Studies are ongoing to see the effects of Mounjaro or sleep apnea [Ref]
Osteoarthritis Resolution of symptoms of osteoarthritis in up to 70% of patients. Data is limited.
Heart Disease Reductions 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 Disease Improvement 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 Disease Has been shown to improve GFR and the resolution of kidney disease in a significant number of patients. slows the progression of kidney disease.
Dyslipidemia Resolution 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

Mounjaro

Surgery-related complications Possible risks include:

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

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

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

Not associated with dumping syndrome
Weight regain Weight regain is possible after 5 to 10 years Weight 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:

Region Center Location
Spain Centro Médico Teknon Barcelona, Spain
UAE Bariatric & Metabolic Institute Cleveland Clinic Abu Dhabi, UAE
South Korea Saint Mary’s Hospital Seoul, South Korea
Mexico Almater Hospital Mexicali, Mexico
US Cleveland Clinic Cleveland, Ohio
US Mayo Clinic Rochester, Minnesota
US New York-Presbyterian Hospital New York, New York
UK The London Clinic London, England
UK Nuffield Health Bristol Hospital Bristol, England
Australia Sydney Bariatric Clinic Sydney, New South Wales
Australia Melbourne Gastro Surgery Melbourne, Victoria
UAE Dr. Sulaiman Al Habib Hospital Dubai, UAE
Saudi Arabia King Fahd Medical City Riyadh, Saudi Arabia
Bahrain Royal Bahrain Hospital Manama, Bahrain

 

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In Conclusion:

Health Outcome

Mounjaro (Tirzepatide)

Gastric Sleeve Surgery

% Weight Loss Moderate (up to 15-20%) Rapid (up to 60-70%)
% A1C Reduction 1.9% – 2.4% 1.5% – 2.0%
Hypertension May improve or resolve May improve or resolve
Sleep Apnea May improve or resolve May improve or resolve
Osteoarthritis May improve or resolve May improve or resolve
Heart Disease May reduce risk May reduce risk
Liver Disease No data available May improve or resolve
Renal Disease No data available May improve or resolve
Dyslipidemia No data available May improve or resolve
Deaths No data available Low risk

 

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What do you think?

Written by Dr. Ahmed

Dr. Ahmed is an experienced Internist with over fifteen years of practice in the medical field. He strongly believes that true medical practice is about helping people, not just prescribing pills.
He has found that the best results come from motivating patients to make small lifestyle changes in addition to prescribing medications when necessary.
With a focus on managing obesity, diabetes, hypertension, asthma, depression, arthritis, migraine, high cholesterol levels, and many more medical conditions in his patients, he shares his knowledge and expertise through writing health-related articles for dibesity.com.
He is committed to helping patients achieve optimal health outcomes and improve their quality of life. For direct contact, he can be reached at contact@dibesity.com

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