Metabolic and bariatric surgery delivers significantly greater weight loss and higher rates of obesity-related disease remission than glucagonlike peptide-1 receptor agonists (GLP-1s), according to one of the largest and most comprehensive real-world comparisons of the two treatments. The findings were presented in May at the American Society for Metabolic and Bariatric Surgery Annual Meeting.
The systematic review and real-world analysis of 30 clinical studies involving more than 430,000 patients found that while both treatments produced meaningful results, metabolic and bariatric surgery consistently exceeded GLP-1 drugs across every outcome measured. The research was conducted by investigators from Yale School of Medicine, Coreva-Scientific, Vanderbilt University, and UT Health San Antonio.
After 12 months, patients who underwent metabolic and bariatric surgery achieved more than 20% greater weight loss than those treated with GLP-1 therapy. Surgery was also associated with significantly higher remission rates of key obesity-related conditions, including type 2 diabetes (+42%), hypertension (+12.8%), and high cholesterol (+20.8%).
“While GLP-1 medications are an important advance, they do not match the magnitude or durability of outcomes achieved with metabolic and bariatric surgery, which remains one of the most underutilized treatments in medicine,” says study coauthor John M. Morton, MD, MPH, FASMBS, a professor of surgery and vice chair of surgical quality at Yale School of Medicine, and a consultant to Teleflex, Olympus, Novo Nordisk, Regeneron, and Boehringer Ingelheim. “Once the medications are discontinued, whether due to side effects, cost, or other factors, their benefits often diminish or disappear, whereas the benefits of surgery endure.”
The review included a comprehensive search of PubMed and EMBASE databases and focused exclusively on studies directly comparing bariatric surgery and GLP-1 receptor agonists, excluding those that combined therapies. The primary endpoint was weight loss at 12 months, with secondary endpoints including remission of obesity-related conditions such as type 2 diabetes, hypertension, and hyperlipidemia.
“Despite the explosive growth of GLP-1 drugs, no randomized controlled trials have directly compared them to bariatric surgery. This analysis helps fill that evidence gap,” says John Scott, MD, FACS, FASMBS, clinical professor of surgery at the University of South Carolina School of Medicine Greenville and metabolic and bariatric surgery director for Prisma Health, who was not involved in the study. “GLP-1s have expanded evidence-based treatment options, but they should not be seen as a replacement for surgery, especially for patients who require the level of outcomes that only metabolic and bariatric surgery can provide.”
— Source: American Society for Metabolic and Bariatric Surgery