Bariatric surgery shows better results than GLP-1 in a real-life study: the scalpel achieves five times more weight loss than drug treatment after two years.
After two years, bariatric surgery achieves five times greater weight loss than GLP-1 receptor agonists. This is the main conclusion of a real-life study just presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) meeting in Washington.
The study, led by NYU Langone Health in New York , compared the results obtained with sleeve gastrectomy and gastric bypass versus injections with semaglutide or tirzepatide .
They revealed that patients who underwent surgery lost an average of more than 26 kilos after two years, compared to approximately 5.5 kilos for those treated with GLP-1 for at least six months (24% weight loss versus 4.7%).
Patients on continuous GLP-1 treatment for one year lost more weight, but significantly less than those who received bariatric surgery (7% total weight loss).
Juan Carlos Ruiz de Adana , head of the General Surgery and Digestive System Department at Getafe University Hospital in Madrid , told DM, with the caution always observed in a retrospective study, that the results presented are consistent: bariatric surgery also affects the endogenous secretion of GLP-1, molecules that promote weight loss and metabolic control, and on which the mechanism of action of these new drugs is based. “ It is logical that, as shown in this study, surgery achieves more potent and intense effects than drugs. Furthermore, the period in which the action achieved on these incretins is most intense was measured in the two years following the intervention .”
The head of the Esophagogastric Surgery and Obesity Unit, a national benchmark in the treatment of this disease, emphasizes that while the effects achieved are more intense with surgery, ” it must also be considered that surgical intervention carries risks that do not accompany pharmacological treatment .” All of this must be considered when prescribing a treatment for each patient.
“There are patients whose BMI is at the limit of surgical indication , and with medication, surgery can be avoided, or at least delayed . But it’s clear that patients with severe obesity and metabolic disorders, especially if they’re not well controlled, will benefit more from surgery. In terms of both weight loss and metabolic control, as well as psychological aspects—which are analyzed in another study conducted at Tulane University—bariatric surgery achieves more intense effects than drug treatment.”
The surgeon points out that in the United States, since the arrival of GLP-1 drugs, bariatric surgeries have been reduced by 25% , but that the situation in Spain, with the National Health System (NHS), is somewhat different, as patients usually have to wait until they are operated on.
Ruiz de Adana also emphasizes the importance of lifestyle in managing obesity. ” Drugs are effective while they are administered, and surgery loses its effect after a few years. Long-term results will depend greatly on the habits the patient adopts.”
Research data
The study used real-world data on 122,595 patients from electronic medical records at NYU Langone Health and the NYC Health + Hospitals public hospital network. Included patients had a body mass index (BMI) of at least 35 and underwent sleeve gastrectomy or Roux- en -Y gastric bypass, or were prescribed semaglutide or tirzepatide between 2018 and 2024. After adjusting for certain factors, they compared outcomes in 14,152 patients matched to one of the treatments.
“Clinical trials show weight loss of 15% to 21% for GLP-1s, but this study suggests that real-world weight loss is considerably less even for patients with active prescriptions for a full year. We know that up to 70% of patients may discontinue treatment within a year,” said the paper’s lead author, Avery Brown , a surgical resident at NYU Langone Health. “ Patients treated with GLP-1s may need to adjust their expectations, adhere more closely to treatment, or opt for metabolic and bariatric surgery to achieve their desired outcomes. ”
For the paper’s lead author, bariatric surgeon Karan R. Chhabra , a professor at NYU’s Grossman School of Medicine, these results call for further studies, including on the most appropriate patient profile for bariatric surgery rather than drug therapy, to optimize outcomes.
“While both groups of patients lose weight, metabolic and bariatric surgery are much more effective and long-lasting ,” said ASMBS President Ann M. Rogers of Penn State Health, a Pennsylvania hospital network, who was not involved in the study, in a statement released by the society. “ Those who do not achieve sufficient weight loss with GLP-1 inhibitors or have difficulty adhering to treatment because of side effects or cost should consider bariatric surgery as an option or even in combination with it.”
More benefit in mental health
Bariatric surgery has also been shown to be superior to drugs in treating potential psychiatric disorders associated with obesity. Another study, also presented at the ASMBS conference , showed that over a five-year period, people undergoing metabolic and bariatric surgery were much less likely to develop these disorders than those treated with drug therapy.
The risk of developing cognitive deficits was 54% lower; 18% lower for anxiety disorders , and 17% lower for substance use disorders .
A team of researchers from Tulane University School of Medicine in New Orleans conducted a retrospective analysis of patients undergoing metabolic and bariatric surgery and those receiving semaglutide, liraglutide, and dulaglutide using the TriNetX database. After matching data for demographic and clinical characteristics, 33,600 surgical patients and 33,600 patients receiving drug therapy were compared for the incidence of new psychiatric disorders. Follow-up lasted up to five years.
Possible protective effect
Based on these results, “metabolic and bariatric surgery confers a strong protective effect against common mental health disorders in a head-to-head comparison with GLP-1 pharmacotherapy,” said study co-author Shauna Levy , chief of the Division of Minimally Invasive/Bariatric Surgery at Tulane University School of Medicine, in a statement released by ASMBS .
The authors also emphasize the importance of ” considering mental health outcomes when selecting treatment modalities for people with obesity.” They also emphasize the need for research into the “mechanisms underlying these benefits to guide personalized treatment strategies.”
Link: https://www.elmundo.es/ciencia-y-salud/salud/2025/06/20/68542043fc6c8308208b45b2.html
Author: Sonia Moreno Madrid
Date: Updated Friday, June 20, 2025 – 02:35
Source: elmundo.es
PHOTO:PIXABAY
Note: The Nutrigenomics Institute is not responsible for the opinions expressed in this article.
