Bariatric Surgery Beats GLP-1 RAs for Sustained Weight Loss
Patients who underwent bariatric surgery experienced an approximately five times greater weight loss over 3 years than those who used weekly injections of GLP-1 receptor agonists (RAs) such as semaglutide and tirzepatide.
METHODOLOGY:
The use of GLP-1 RAs has surged over the years, but semaglutide and tirzepatide have rarely been directly compared with bariatric surgery, the gold standard for obesity and diabetes treatment.
Researchers conducted a retrospective study using electronic health records to compare the weight-loss effects of injectable GLP-1 RAs (semaglutide or tirzepatide) with those of bariatric surgery on adults with BMI ≥ 35.
They analyzed data of 38,545 patients who received GLP-1 RAs and 12,540 patients who underwent bariatric surgery via minimally invasive sleeve gastrectomy or Roux en-Y gastric bypass between 2018 and 2024.
Percent total weight loss was compared over a 3-year follow-up period.
TAKEAWAY:
Patients who received GLP-1 RAs had significantly higher rates of diabetes, hyperlipemia, and chronic obstructive pulmonary disease than those who underwent surgery.
After 3 years, patients who underwent bariatric surgery experienced a 23.3% total weight loss (95% CI, -23.5 to -23.1), whereas those who used GLP-1 RAs had a 4% total weight loss (95% CI, -4.1 to -3.8).
Patients who used GLP-1 RAs continuously for 1 year lost 5.9% of their total weight, but weight loss was still significantly greater in those who underwent bariatric surgery (22.2%).
IN PRACTICE:
'Clinical trials show weight loss between 15% to 21% for GLP-1s, but this study suggests that weight loss in the real world is considerably lower even for patients who have active prescriptions for an entire year. We know as many as 70% of patients may discontinue treatment within 1 year. GLP-1 patients may need to adjust their expectations, adhere more closely to treatment, or opt for metabolic and bariatric surgery to achieve desired results,' said the lead author in a news release.
SOURCE:
This study was led by Avery Brown, MD, a surgical resident at NYU Langone Health in New York City. It was presented on June 17, 2025, at the American Society for Metabolic and Bariatric Surgery 2025 Annual Scientific Meeting at the Gaylord National Resort & Convention Center in National Harbor, Maryland.
LIMITATIONS:
The authors did not report any specific limitations.
DISCLOSURES:
This study received support from a NYU Clinical and Translational Science Awards grant from the National Center for Advancing Translational Sciences and another grant from the National Institute of Allergy and Infectious Diseases.
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