Two Roads From the Same Starting Point
Placeholder: obesity baseline, both options open.
- ≥35: Eligible BMI (surgery) (or ≥30 with comorbidity)
- ≥27: Eligible BMI (GLP-1) (with comorbidity)
- ~42%: US adults w/ obesity (placeholder prevalence figure)
- 3: Decision drivers (efficacy, durability, risk)
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Mechanical Restriction vs Pharmacologic Suppression
Placeholder: two mechanisms diverge from day one.
- ~80%: Stomach removed (sleeve) (greater curvature resected)
- Hypothalamus: GLP-1 receptor target (+ gut, vagal afferents)
- Immediate: Surgery onset (anatomic, permanent)
- Gradual: Drug onset (weekly dose titration)
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Diverging Curves Across the First Year
Placeholder: surgery front-loads loss, drug is steadier.
- ~25%: Surgery %TWL @ 12mo (placeholder curve estimate)
- ~15%: GLP-1 %TWL @ 12mo (placeholder curve estimate)
- ~12–18mo: Surgery plateau (placeholder timing)
- ~12–24mo: GLP-1 plateau (placeholder timing)
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What Happens When Treatment Stops
Placeholder: anatomy persists, drug effect can reverse.
- ~85%: Surgery durability (weight kept, placeholder)
- ~20%: GLP-1 durability off-drug (weight kept, placeholder)
- Fast: Regain after stopping GLP-1 (placeholder timeframe)
- Low: Reoperation rate (sleeve) (placeholder figure)
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Risk, Cost, and Adherence Side-by-Side
Placeholder: final tradeoff summary across both paths.
- 6.1/10: Surgical risk score (placeholder composite)
- 3.4/10: GLP-1 risk score (placeholder composite)
- ~$27k: Surgery 5-yr cost (placeholder estimate)
- ~$68k: GLP-1 5-yr cost (placeholder estimate)
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