Updated January 2026

If you’re considering weight loss options in 2026, you’ve probably noticed that medications like Ozempic, Wegovy, Mounjaro, and Zepbound are everywhere. Social media is flooded with transformation stories. Celebrities are dropping weight seemingly overnight. And you might be wondering: should I just get a prescription and skip the surgery?

I understand the appeal. A weekly injection sounds simpler than an operation. But when my patients ask me about GLP-1 medications versus gastric sleeve surgery, I tell them the same thing: let’s look at the actual numbers. Not the headlines. Not the celebrity endorsements. The real, long-term financial picture.

What I’m about to share might completely change how you think about your weight loss investment.

The Monthly Price Tag Nobody Talks About

Let’s start with what these medications actually cost in 2026.

Ozempic and Wegovy (both semaglutide) have a list price of approximately $997 per month. That’s the 28-day supply price directly from Novo Nordisk.

Mounjaro and Zepbound (both tirzepatide) cost slightly more at around $1,080 to $1,086 per month.

Now, you might have heard that insurance covers these medications. Here’s the reality check: according to the latest KFF survey, only 19% of employers with 200 or more workers cover GLP-1 drugs for weight loss. Even among the largest companies (5,000+ employees), only 43% offer this coverage.

What about Medicare? Medicare explicitly does not cover weight loss medications. The Trump Administration confirmed in 2025 that this policy will continue through 2026.

Medicaid? Only 13 states cover GLP-1s for weight loss treatment.

So what does this mean for most Americans? You’re paying out of pocket.

The 5-Year Math That Changes Everything

Let me walk you through a simple calculation that I do with my patients.

Scenario 1: GLP-1 Medication for 5 Years

Monthly cost without insurance: $997-$1,086

Annual cost: $11,964 to $13,032

5-year total: $59,820 to $65,160

And that’s assuming prices don’t increase (they typically do), you don’t need a higher dose, and you never miss a month of coverage.

But here’s the number that really matters: this isn’t a one-time investment. These medications are designed to be taken indefinitely. Stop taking them, and research shows the weight comes back. Fast.

Scenario 2: Enhanced Gastric Sleeve Surgery with Me in Tijuana

One-time surgical cost: $4,000 to $4,500 (depending on BMI)

5-year total: $4,000 to $4,500

That’s it. One payment. A permanent anatomical change that works for years, not months.

The Difference

Over 5 years, choosing medication over surgery could cost you an additional $55,000 to $61,000.

Let me put that another way: the cost of 5 years of Ozempic or Wegovy could pay for gastric sleeve surgery 15 times over.

“But My Insurance Covers Ozempic”

Some of my patients tell me their insurance does cover GLP-1 medications. That’s great, but let’s look at what that really means.

With insurance and manufacturer coupons, you might pay as low as $25 per month. Let’s run those numbers too.

5 years at $25/month: $1,500

That sounds much better, right? But there’s a catch that insurance companies don’t advertise.

Coverage can change at any time. In fact, a recent Peterson-KFF report found that many employers who initially covered GLP-1s for weight loss are now restricting or eliminating that coverage due to skyrocketing costs. One benefits manager quoted in the report said they “had to make the business decision to pull the whole category.”

If your coverage disappears mid-treatment, you’re suddenly looking at that $1,000/month bill. And if you stop the medication, the research is clear about what happens next.

The Weight Regain Problem Nobody Wants to Discuss

This is the part of the GLP-1 story that doesn’t make it into the glossy magazine articles.

Semaglutide (Ozempic/Wegovy) Weight Regain Data

The STEP 1 trial extension study, published in Diabetes, Obesity and Metabolism, followed patients who stopped taking semaglutide after 68 weeks of treatment.

The results? Participants regained two-thirds of their lost weight within one year of stopping the medication.

Let me repeat that. Two-thirds of the weight. Back. In just 12 months.

The study authors were blunt in their conclusion: “Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.”

A separate real-world study from Epic Research found that 17.7% of semaglutide users who stopped the medication regained ALL their lost weight or exceeded their starting weight.

Tirzepatide (Mounjaro/Zepbound) Weight Regain Data

If you thought tirzepatide might be different, the SURMOUNT-4 trial tells a similar story.

Published in JAMA Internal Medicine, this landmark study found that 82.5% of participants who stopped tirzepatide regained at least 25% of their lost weight within one year.

The researchers noted that this weight regain was “associated with a greater reversal of their initial cardiometabolic parameter improvements.” Translation: the health benefits disappeared too.

Why Does This Happen?

These medications work by suppressing appetite and slowing gastric emptying. When you stop taking them, your hunger signals come roaring back. One researcher described it as “like a dam breaking.”

Your body hasn’t fundamentally changed. It’s been temporarily overridden by medication. Remove the medication, and your biology does what it’s designed to do: make you eat.

The Gastric Sleeve Difference: Permanent Change

Gastric sleeve surgery works differently at a fundamental level.

When I perform the enhanced gastric sleeve, I remove approximately 75-80% of the stomach, including the fundus, where most of the hunger hormone ghrelin is produced.

This creates multiple permanent changes:

Ghrelin reduction: Studies show up to 60% reduction in the hunger hormone, and this effect persists at 5-year follow-up. You’re not fighting constant hunger.

Anatomical restriction: Your new stomach holds approximately 4-6 ounces versus the original 40+ ounces. You physically cannot overeat the way you once did.

Hormonal optimization: Surgery triggers increases in GLP-1 and PYY (the same hormones that injectable medications mimic) naturally, through changes in how food moves through your digestive system.

The key difference? These changes are structural. They don’t require a weekly injection. They don’t depend on insurance coverage. They don’t disappear when you miss a dose.

Long-Term Weight Loss: What the Research Shows

Let’s look at what happens to gastric sleeve patients over time.

A systematic review of long-term studies found:

5 years post-surgery: Average excess weight loss of 62.3%

6 years post-surgery: Average excess weight loss of 53.8%

8+ years post-surgery: Average excess weight loss of 54.8%

A Kaiser Permanente study following 31,000+ bariatric surgery patients found that at 5 years, patients who had gastric bypass maintained 20% weight loss compared to just 5% in those with usual medical care. The study noted that “regain to within 5% of baseline was rare” in surgical patients.

Yes, some weight regain happens. That’s true of any weight loss intervention. But the degree of regain is dramatically different from medication discontinuation.

Consider this comparison:

Stop semaglutide: Regain 2/3 of lost weight within 1 year

Gastric sleeve at 5 years: Maintain approximately 55-62% excess weight loss

Gastric sleeve at 10 years: Maintain approximately 42-58% excess weight loss

The surgery creates lasting change. The medication creates temporary suppression.

The Discontinuation Crisis

Here’s a statistic that should concern anyone considering GLP-1 medications as a long-term solution.

According to research published in JAMA and presented at the European Association for the Study of Diabetes, 50-75% of people who start GLP-1 medications stop taking them within one year.

A Prime Therapeutics analysis found that only 24% of Wegovy patients were still taking the medication at 2 years. For Ozempic (when used for weight loss), that number was just 22%.

By 3 years? Only 14% are still on therapy.

Why do people stop?

Side effects (28.2% of discontinuations): Nausea, vomiting, diarrhea, and constipation are common. For some patients, these effects never fully resolve.

Cost (12.8% of discontinuations): When insurance doesn’t cover the medication or coverage changes, many people simply can’t afford to continue.

Medication unavailability: During 2023-2024, shortages were so severe that many patients couldn’t get their prescriptions filled even if they could afford them.

Reaching goal weight and stopping: Some patients assume they can stop once they’ve lost weight. As we’ve discussed, the research shows this approach leads to regain.

Compare this to bariatric surgery, where the “treatment” can’t be discontinued. Your stomach doesn’t grow back. The anatomical changes persist whether you want them to or not. In many ways, that’s the point.

But What About Surgery Risks?

I wouldn’t be honest with you if I didn’t address the elephant in the room: surgery carries risks that a weekly injection doesn’t.

Here’s what the data shows.

According to the American Society for Metabolic and Bariatric Surgery, the mortality rate for bariatric surgery is approximately 0.03-0.1%. That’s comparable to gallbladder surgery or hip replacement. Modern laparoscopic techniques have made these procedures remarkably safe.

My enhanced gastric sleeve technique incorporates additional safety measures:

Double buttress reinforcement: This technique strengthens the staple line to minimize the already low risk of leaks.

Drain-free surgery protocol: Reduced complications and faster recovery.

Advanced pain management: Most patients describe post-operative discomfort as mild to moderate.

The vast majority of my patients are walking the same day as surgery and return home within 24-48 hours. Most return to normal activities within 1-2 weeks.

GLP-1 medications aren’t risk-free either. Common side effects include:

• Nausea and vomiting (often severe enough to cause discontinuation)
• Gastroparesis (stomach paralysis)
• Pancreatitis
• Gallbladder problems
• Potential thyroid tumor risk (carries FDA black box warning)
• Muscle loss (particularly concerning for long-term use)

Clinical trials found that 7% of patients in the Wegovy trial stopped treatment specifically due to side effects.

The Hidden Costs of Medication

When calculating the true cost of GLP-1 therapy, many people forget to include:

Doctor visits: Monthly or quarterly appointments for prescription management, monitoring, and dose adjustments.

Lab work: Regular blood tests to monitor for side effects and ensure safety.

Travel and time: For many patients, especially those in rural areas, accessing these medications requires significant effort.

Supplemental treatments: Many patients also take anti-nausea medication, proton pump inhibitors for acid reflux, or other drugs to manage side effects.

The psychological toll: Knowing that your weight loss depends on continuous medication can create significant anxiety. What if there’s another shortage? What if my insurance changes? What if I lose my job?

With surgery, there’s a defined recovery period, and then you move forward with your life. The tool is built in. You’re not dependent on a supply chain, insurance company, or pharmaceutical manufacturer.

Who Is GLP-1 Medication Right For?

I’m not against GLP-1 medications. They represent a genuine advancement in obesity medicine. In fact, I recommend tirzepatide to some of my own patients when it makes sense for their situation. These medications can be valuable tools in the right circumstances.

Medication might make sense if:

• You have a relatively modest amount of weight to lose (BMI 27-30)
• You have reliable, long-term insurance coverage for these medications
• You understand and accept the need for lifelong treatment
• You’ve been advised against surgery for medical reasons
• You prefer a non-surgical approach despite the long-term costs and commitment

However, for patients with significant obesity (BMI 35+) who are surgical candidates, the math strongly favors bariatric surgery in terms of both outcomes and cost-effectiveness.

Who Is Gastric Sleeve Right For?

Gastric sleeve surgery is typically recommended for patients who:

• Have a BMI of 40 or higher (severe obesity)
• Have a BMI of 35-39.9 with at least one obesity-related health condition (diabetes, hypertension, sleep apnea, etc.)
• Have tried other weight loss methods without long-term success
• Are committed to the lifestyle changes that support surgical success
• Want a permanent solution rather than ongoing medication dependency

If you’re reading this article and researching your options, you’re probably in this category.

Why Tijuana? Why Me?

I know what you’re thinking. “Surgery in Mexico? Is that safe?”

Let me address this directly.

The cost of gastric sleeve surgery in the United States averages $15,000 to $25,000. Even with insurance (which requires extensive documentation, months of supervised diet programs, and pre-authorization), you might still pay $5,000-$10,000 out of pocket.

My enhanced gastric sleeve surgery costs $4,000 to $4,500.

This isn’t because we cut corners. It’s because:

Lower overhead: Operating costs in Tijuana are significantly lower than in the United States. This doesn’t affect the quality of care; it affects the bills we pay.

No insurance bureaucracy: I don’t need a billing department of 50 people to fight with insurance companies. Those savings go to patients.

Focused practice: I perform bariatric surgery every day. This specialization creates efficiency.

My qualifications: I am double board-certified with an M.D. and Ph.D., a Fellow of the American College of Surgeons (FACS), and hold the designation of Master Surgeon in Metabolic & Bariatric Surgery. I’m a member of both the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity.

My facility is located just 15-20 minutes from the San Diego border. Many of my patients drive down from California, Arizona, Nevada, and Texas. Others fly into San Diego and take a quick ride across.

The procedure, recovery, and follow-up care meet or exceed U.S. standards. The only difference is the price.

The 5-Year Comparison: A Complete Picture

Let me put everything together in one clear comparison.

GLP-1 Medication Path (Without Insurance)

Year 1: $12,000-$13,000 in medication costs. You lose 15-20% of body weight. Side effects may require additional medications.

Year 2: Another $12,000-$13,000. Weight loss plateaus or may begin slight regain as tolerance develops. 75-78% of people who started with you have already quit.

Year 3: Another $12,000-$13,000. Only 14% of original users remain. If you’re still taking the medication, you’re in the minority.

Year 4: Another $12,000-$13,000. Continued costs with no end in sight.

Year 5: Another $12,000-$13,000. Total: $60,000-$65,000

If you stop at any point, expect to regain approximately 2/3 of lost weight within a year.

Gastric Sleeve Path

Year 0: $4,000-$4,500 for surgery. Recovery takes 1-2 weeks.

Year 1: Rapid weight loss, typically 60-70% of excess weight. Minimal ongoing costs (vitamins, follow-up appointments).

Year 2: Weight loss stabilizes. Most patients have lost 65-70% of excess weight.

Year 3: Maintenance phase. Some patients experience minor regain, but most maintain 55-65% excess weight loss.

Year 4: Continued maintenance. Surgery works around the clock without your active intervention.

Year 5: Long-term success. Average 55-62% excess weight loss maintained. Total cost: $4,000-$4,500 plus approximately $500/year for vitamins and annual check-ups = approximately $6,500-$7,000

5-Year Savings Choosing Surgery: $53,000-$58,000

What Could You Do With $55,000?

Let’s make this concrete.

The money you’d save choosing surgery over 5 years of medication could:

• Pay off a significant portion of your mortgage
• Fund your children’s education
• Take your family on a dream vacation every year for a decade
• Start a business
• Create an emergency fund that provides genuine financial security
• Invest for retirement

Or you could send that money to pharmaceutical companies. It’s your choice.

Making the Decision

I’ve presented you with the data. The financial comparison. The research on outcomes. The reality of discontinuation rates and weight regain.

What I can’t do is make this decision for you.

What I can tell you is this: every week, I meet patients who spent years (and tens of thousands of dollars) on diets, programs, and now medications, only to end up in my office anyway.

They tell me variations of the same story: “I wish I had done this years ago.”

The patients who come to me first, before spending years and money on approaches with lower success rates, are the ones who express the most satisfaction. They got their lives back sooner. They stopped the financial bleeding sooner. They started living sooner.

Your Next Step

If you’re ready to explore whether gastric sleeve surgery is right for you, I offer free consultations. We can review your health history, discuss your goals, and determine if you’re a candidate.

There’s no pressure. No hard sell. Just honest information so you can make the best decision for your life.

You can reach my office at [phone number] or visit my website to schedule a virtual consultation.

The investment you make in your health should actually be an investment, with lasting returns. Not an endless subscription with returns that vanish the moment you stop paying.

I look forward to helping you take control of your weight, your health, and your financial future.

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Dr. Gabriela Rodríguez Ruiz, M.D., Ph.D., FACS Master Surgeon in Metabolic & Bariatric Surgery Double Board Certified Tijuana, Baja California, Mexico

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Sources and References

1. Novo Nordisk. Ozempic List Price Information. NovoCare, 2025.
2. Eli Lilly. Mounjaro and Zepbound Pricing Information, 2025.
3. KFF Employer Health Benefits Survey, 2025.
4. Peterson Center on Healthcare and KFF. “Perspectives from employers on the costs and issues associated with covering GLP-1 agonists for weight loss.” October 2025.
5. Wilding JPH, et al. “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension.” Diabetes, Obesity and Metabolism, 2022.
6. Horn DB, et al. “Cardiometabolic Parameter Change by Weight Regain on Tirzepatide Withdrawal in Adults With Obesity.” JAMA Internal Medicine, November 2025.
7. Aronne LJ, et al. “Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial.” JAMA, 2024.
8. Epic Research. “Many Patients Maintain Weight Loss a Year After Stopping Semaglutide and Liraglutide.” January 2024.
9. Prime Therapeutics. GLP-1 Persistence Analysis, 2024.
10. Northwestern Medicine/JAMA Viewpoint. “Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists.” November 2024.
11. Thomsen RW. “Discontinuation of semaglutide therapy for weight loss.” EASD 2025.
12. ASMBS. Long-term Outcomes of Bariatric Surgery.
13. Kaiser Permanente Washington Health Research Institute. “Weight loss lasts long after bariatric surgery.” Annals of Surgery, 2020.
14. O’Brien PE, et al. “Long-Term Outcomes After Bariatric Surgery.” Obesity Surgery, 2019.
15. American College of Gastroenterology. “Anti-Obesity Drugs Will Not be Covered by Medicare and Medicaid in 2026.” April 2025.
16. CareCredit. Gastric Sleeve Surgery Cost Guide, 2024.
17. ASMBS. “Metabolic and Bariatric Surgery.” Cost and Outcomes Data, 2024.