IS THIS MY LAST DIET?

Why Bariatric Surgery Is the Metabolic Reset Many Australians Seek

Ashleigh Gale, Accredited Practising Dietitian – Nutrition Solutions Victoria

Weight has a unique way of affecting many Australians: quietly, when finding clothes that fit, or loudly, in the breathlessness of climbing stairs or at a doctor’s suggestion to lose weight for health reasons. There’s often a defining moment before someone types “bariatric surgery Australia” into Google. It might follow a diagnosis, or strike at 2 am. It may come after another failed diet, or when the seatbelt simply won’t click. For many, the choice is not just medical; it’s deeply personal, emotional and tangled in decades of struggle with weight, shame and frustration.

“Am I Not Trying Hard Enough?”

Before making that first enquiry about surgical options, patients often ask themselves: “Why can’t I just lose weight like everyone else?” Many feel guilt, assuming their weight reflects a lack of effort or discipline. The reality is far more complex.

Most have already tried everything: keto to juice cleanses, Weight Watchers to intermittent fasting. In recent years, weight-loss medications such as Ozempic (semaglutide) and Mounjaro (tirzepatide) have offered new hope. These can work well for many, but they’re not universally effective. Some people lose 5, 10 or even 20 kg, only to see the weight creep back.

This isn’t a failure of willpower. Set-point theory explains why the body fights back. Each person has a biologically determined weight range that the body naturally attempts to maintain, governed by the brain, hormones and metabolism. When weight falls below this set point, metabolism slows and hunger increases to restore balance. This is why weight regain is common after diets, and why significant long-term change often requires more than willpower alone.

Why Bariatric Surgery Works

Bariatric surgery tackles weight at a deeper biological level. It doesn’t just restrict food intake; it alters how the body regulates hunger, satiety and metabolism. By changing the structure of the gut, the surgery modifies the release of hormones that affect appetite, fullness and blood-sugar regulation. This leads to reduced hunger, earlier satiety and improved insulin sensitivity.

This “reset” of the body’s weight-regulating system can make it easier to achieve and maintain a lower weight. Patients typically find they no longer feel consumed by hunger or cravings in the same way. Beyond weight loss, surgery often leads to lasting improvements in metabolic conditions such as type 2 diabetes, sleep apnoea, high blood pressure and polycystic ovary syndrome (PCOS).

Why Bariatric Surgery Isn’t “The Easy Way Out”

Bariatric surgery is far from easy. It requires lifelong changes to diet, lifestyle and mindset. Patients must learn new eating behaviours, increase physical activity and commit to adequate protein intake and daily vitamin supplementation. These changes support ongoing weight loss and prevent muscle loss and nutritional deficiencies.

Long-term success also depends on a strong support network, typically a multidisciplinary team of healthcare professionals: surgeon, dietitian, psychologist, GP, nurse and exercise physiologist. Many patients must unlearn habits developed over decades—an emotionally demanding process as much as a physical one. But for those who fully engage, surgery offers a sustainable path forward.

Surgery vs Injections: What Works Best?

Sustained diet and lifestyle changes can lead to weight loss, but long-term maintenance is often challenging. GLP-1 medications such as Ozempic, Wegovy and Mounjaro have introduced a powerful, non-invasive option and shifted the treatment landscape. However, bariatric surgery remains more effective, particularly for those with more significant weight concerns or metabolic conditions.

On average, gastric sleeve and gastric bypass procedures result in a total body-weight loss of 20–35 percent. In comparison, semaglutide (Ozempic and Wegovy) typically produces around 15 percent total body-weight loss, while tirzepatide (Mounjaro) shows results closer to 20 percent. Medication responses vary depending on genetics, metabolism and hormone sensitivity. Some people’s appetite-regulation pathways are less responsive to GLP-1 stimulation, and others may struggle with weight gain driven by insulin resistance, underlying hormonal conditions or the side-effects of psychiatric medications—all factors that surgery can address more fully.

Access in Australia: A Growing Gap

In Australia, the most commonly performed procedures are gastric sleeve (about 80 percent of cases) and gastric bypass. However, access is not equal. More than 90 percent of bariatric surgeries occur in the private sector, with limited options in the public system. Currently, the healthcare system can accommodate approximately 41,500 bariatric surgeries each year. To meet the needs of the eligible population within five years, this would need to rise to over 341,000 surgeries per year—more than eight times current capacity.

This shortfall leaves many Australians without timely or affordable access to life-changing treatment. Given obesity’s chronic nature and its impact on physical and mental health, this represents a major public-health concern.

Obesity Is Not a Character Flaw

Obesity is a chronic, complex medical condition, not a reflection of a lack of effort. The sooner we treat it as such, the faster we can remove shame and guilt from the conversation. Bariatric surgery is not “giving up” or taking the easy way out; it’s a medical treatment for people who have exhausted all other practical (and often impractical) options. For many, it finally offers the freedom to stop dieting and start living.

Disclaimer:

This article is provided for general informational purposes only and does not constitute medical or professional advice. Individual circumstances vary, and the suitability of bariatric surgery depends on factors such as your medical history, current health status and personal needs. Always seek the guidance of a qualified healthcare professional—such as your GP, bariatric surgeon or dietitian—before making any decisions about treatment.