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You've been reading everywhere about Ozempic and the other new injectable medications that can tame cravings and appetite, lower blood sugar, and protect your heart. Several new options can help you shed as much as 20 percent of your body weight—compared to older drugs that promise only about an 8 percent loss.

Are these drugs for you? The best candidates are people with type 2 diabetes who are significantly heavier than doctors advise and at risk for heart disease. You might be eager to try one of these drugs simply because you are tired of struggling with your weight.

However, they cost more than $1,000 for each weekly injection, and Medicaid, Medicare, and private insurers cover them only if you have diabetes. Assuming you do, you can get coverage for medications at BMIs between 27 and 35.

If you've been putting off weight loss surgery, you have a different calculation. If your doctor recommended it, for insurance coverage purposes, that means you have a BMI of 35 or greater with a significant related health problem, like type 2 diabetes, sleep apnea, or high blood pressure. One of the new medications might do just as good a job of fighting diabetes—as long as you keep getting injections. However, they won't get your weight down where you need it to be.

Surgery normalizes most of the hormones that have become dysregulated with obesity, while the medications target only one, GLP-1, explains Texas bariatric surgeon Brandon Fadner,

Both bariatric surgery and GLP-1 medications, like semaglutide, are effective because they address the underlying problem. Surgery offers a more comprehensive solution...with fewer needle sticks.

If you're optimistic that with a boost from medication, you'll change your eating style and other habits and lose more weight than most people do, that's a case to give medication a try. Tell your doctor what you have in mind.

The Evidence Surgery Fights Diabetes

The chances are high that surgery will beat your diabetes. Consider a 2022 weight-loss study with data from more than 1,350 patients, covering the three most popular procedures. A year after the procedure, 75 percent of patients who had type 2 diabetes had blood sugar levels considered safe—they were out of the diabetic range. That number jumped to 79 percent after three years.

Does it matter which type of surgery you get? Your doctors will advise you. However, when it comes to reversing diabetes, this study, and another review, found that the most common procedures have about the same success rate.

Over time, systematic reviews have found that these surgeries can reverse type 2 diabetes for 58 percent to 95 percent of patients.

As you’d expect, the chances of remission are higher in patients with fewer or less severe diabetes risk factors. Your doctors now have a number of scoring systems to use when advising you. In general, it helps to be younger, have relatively low blood sugar levels, and have had Type 2 diabetes for a shorter period.

As more teenagers have become obese and developed diabetes, doctors have noticed that their diabetes can be harder to treat. As a parent, you may hear that they should have surgery before their diabetes becomes intractable.

Interestingly, the drop in blood sugar often occurs about 48 hours after the surgery before significant weight loss. And it seems to last. In one long-term study of the Roux-en-Y procedure, more than half of the patients were still out of the diabetic range 12 years later.

As for weight loss—which brings multiple health benefits—you can expect to lose much more with surgery. Let's say your goal is to shed 205 pounds.

With the adjustable gastric band procedure, you might lose 40 percent to 50 percent of the excess weight (80-102 lbs); 60 percent to 65 percent with a gastric sleeve (about 120 lbs); or 75 percent to 80 percent with a gastric bypass (about 160 lbs), notes El Paso, Texas surgeon Benjamin Clapp.

Will You Live Longer?

Obese, diabetic adults may hear that the surgery could keep them alive longer. In a 2019 Scandinavian study with data for 32 years, people who had weight-loss surgery cut their mortality rate by more than 60 percent compared to obese people who did not. In part, that’s because these surgeries also seem to protect patients from cardiovascular disease, a major killer when you’re carrying extra weight.

The surgically treated group was dramatically less likely to die of heart disease, diabetes, and, for up to 15 years, cancer. However, their mortality was still higher than that of the general population and increased over time.

Neither of these treatments means you will be free to eat and live in ways that promote obesity. However, you are likely to feel much better and be healthier.

Beat Diabetes

You may be comfortable with your weight. However, beating diabetes is no small matter: More than 130,000 Americans have an amputation every year because of diabetes-related injuries. The worst choice is to let life go on and leave your type 2 diabetes unaddressed. It can be managed with diet and attention, but it's essential not to neglect the problem.