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| Feature | Gastric Bypass | Gastric Sleeve | Gastric Band | Endoscopic Sleeve Gastroplasty | Gastric Balloon | Plenity | Orlistat | Phentermine | Qsymia (Phentermine/Topiramate) | Contrave (Bupropion/Naltrexone) | Saxenda (Liraglutide) | Wegovy (Semaglutide) | Tirzepatide (Mounjaro) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Expected Weight Loss | 70-80% of excess weight in 12-18 months | 60-70% of excess weight in 12-18 months | 40-50% of excess weight in 2 years | 50-60% of excess weight in 12-18 months | 30-40% of excess weight in 6 months | 25-35% of excess weight in 6-12 months | 5-10% of body weight loss in 1 year | 8-10% of body weight loss in 3-6 months | 10-12% of body weight loss in 1 year | 5-10% of body weight loss in 1 year | 10-15% of total body weight in 12 months | 15-20% of body weight loss in 1 year | 15-20% of body weight loss in 1 year |
| Major Risks | Dumping syndrome, nutritional deficiencies, bowel obstruction | Nutritional deficiencies, acid reflux, staple line leaks | Band slippage, erosion, infection | Gastrointestinal bleeding, infection, suture failure | Gastric perforation, nausea, vomiting | Gastrointestinal discomfort, bloating, diarrhea | Gastrointestinal side effects, fat-soluble vitamin deficiencies | Increased heart rate, insomnia, nervousness | Paresthesia, dry mouth, constipation, teratogenic risk | Nausea, headache, constipation, risk of suicidal thoughts | Nausea, vomiting, pancreatitis risk, gallbladder disease | Gastrointestinal symptoms, potential thyroid tumors, pancreatitis risk | Nausea, vomiting, diarrhea, risk of hypoglycemia |
| Major Benefits | Significant and rapid weight loss; improvement in obesity-related conditions | Substantial weight loss; no foreign object left in the body | Less invasive; adjustable and reversible | Minimally invasive; reduced recovery time | Temporary weight loss aid; non-surgical option | Oral capsule; non-invasive; aids in satiety | Reduces fat absorption; modest weight loss | Appetite suppressant; short-term weight loss | Combined mechanism for weight loss; improved metabolic profile | Targets central nervous system to reduce hunger and cravings | GLP-1 receptor agonist; improved glycemic control along with weight loss | High efficacy; significant weight loss and metabolic benefits | Dual receptor agonist; remarkable weight loss and glycemic improvements |
| Indications for Use | BMI ≥ 40, or BMI ≥ 35 with comorbidities | BMI ≥ 40, or BMI ≥ 35 with comorbidities | BMI ≥ 40, or BMI ≥ 35 with comorbidities; reversible option | BMI 30-40 with obesity-related comorbidities | BMI 30-40; as a bridge to surgery or for temporary weight loss | Overweight adults with BMI 25-40 (with diet and exercise) | BMI ≥ 30 or BMI ≥ 27 with risk factors | BMI ≥ 30 or BMI ≥ 27 with risk factors (short-term use) | Adults with BMI ≥ 30 or BMI ≥ 27 with weight-related conditions | Adults with BMI ≥ 30 or BMI ≥ 27 with comorbidities | Adults with BMI ≥ 30 or BMI ≥ 27 with weight-related conditions | Adults with BMI ≥ 30 or BMI ≥ 27 with comorbidities | Adults with obesity or overweight with type 2 diabetes |
| Mechanism of Action | Reduces stomach size and bypasses part of the small intestine to limit absorption | Resects a large portion of the stomach to limit food intake | Adjustable band restricts food intake around the upper stomach | Endoscopic suturing reduces stomach volume without incisions | Temporary space-occupying device to induce satiety | Swells in the stomach to promote a feeling of fullness | Inhibits pancreatic lipase to block fat absorption | Suppresses appetite through central nervous system stimulation | Combines appetite suppression with increased satiety | Targets central nervous system to reduce hunger and cravings | GLP-1 receptor agonist that slows gastric emptying and increases satiety | GLP-1 receptor agonist with potent appetite reduction | Dual agonist for GIP and GLP-1 receptors enhancing insulin secretion and satiety |
| Age of Indication | 18 and older | ||||||||||||
| Contraindications | Severe heart/lung disease, uncontrolled psychiatric disorders, substance abuse | Severe cardiopulmonary disease, active gastric ulcer, substance abuse | Severe GERD, previous gastric surgery, bleeding disorders | Inflammatory bowel disease, bleeding disorders, severe cardiopulmonary issues | Pregnancy, previous gastric surgery, gastrointestinal obstruction | Pregnancy, severe gastrointestinal disorders | Chronic malabsorption, cholestasis | Uncontrolled hypertension, cardiovascular disease, hyperthyroidism | Pregnancy, glaucoma, hyperthyroidism | Seizure disorders, uncontrolled hypertension, opioid use | History of medullary thyroid carcinoma, MEN 2 | History of medullary thyroid carcinoma, MEN 2 | Severe gastrointestinal disease, history of pancreatitis |
| Black Box Warning | None | None | None | None | Risk of balloon deflation and intestinal obstruction | None | May reduce absorption of fat-soluble vitamins | Potential for abuse and dependency | Teratogenic risk; contraindicated in pregnancy | Risk of suicidal thoughts; contraindicated in seizure disorders | Risk of thyroid C-cell tumors | Potential thyroid tumors; pancreatitis risk | Risk of gastrointestinal side effects and hypoglycemia |
| Common Use Cases | Severe obesity with metabolic syndrome, type 2 diabetes | Morbid obesity seeking significant weight loss | Patients preferring a reversible, adjustable option | Moderate obesity seeking a non-surgical intervention | Short-term weight loss as a bridge to surgery | Overweight individuals needing additional satiety support | Patients requiring modest weight loss with diet control | Short-term management of obesity | Patients with obesity seeking a pharmacological solution | Patients with obesity and comorbid depression or eating disorders | Patients with obesity and type 2 diabetes or prediabetes | Patients needing significant weight loss and metabolic improvements | Patients with obesity and type 2 diabetes seeking dual benefits |
| Caution in Patients With | Malabsorption syndromes, osteoporosis, anemia | Gastroesophageal reflux disease (GERD) | Risk for band-related complications; need for close follow-up | History of peptic ulcer disease, severe GERD | Nausea, vomiting, intolerance to foreign objects | Bloating and gastrointestinal discomfort | Fat-soluble vitamin deficiencies; monitor vitamin levels | Cardiovascular disease; potential increased blood pressure | History of cardiovascular issues; monitor side effects | Mental health conditions; seizure disorders | History of pancreatitis; monitor thyroid function | History of thyroid issues; monitor pancreatic enzymes | History of gastrointestinal disorders; risk of hypoglycemia |
