Are surgeries more effective than obesity medications? Scientists reveal new research results.
- Patients who underwent bariatric surgery lost more weight and achieved better blood sugar control.
- They were also less likely to require treatment for hypertension and elevated cholesterol levels.
- Even in the era of new, effective drugs for obesity and diabetes, metabolic surgery can bring additional benefits, including prolonging survival, argues Dr. Steven Nissen from the Institute of Cardiology, Vascular System and Thoracic Surgery at the Cleveland Clinic.
A study on this topic was conducted by scientists at the Cleveland Clinic (USA). They found that people with obesity and type 2 diabetes who underwent weight-loss surgery lived longer and had fewer serious health problems (such as heart disease, kidney failure, vision problems) compared to those treated only with GLP-1 receptor agonists.
Patients who underwent weight-loss surgery, also called bariatric or metabolic surgery, lost more weight, achieved better blood sugar control and, over the course of 10 years, were less likely to use medications for diabetes and heart disease.
"Even with the best medications currently available, metabolic surgery offers unique and lasting benefits for people with obesity and diabetes," said Dr. Ali Aminian, director of the Cleveland Clinic Bariatric and Metabolic Institute and lead author of the study. "The benefits we observed extended beyond weight loss. Surgery was associated with fewer heart problems, fewer kidney diseases, and even lower rates of diabetes-related eye damage."
GLP-1 (glucagon-like peptide-1) receptor agonists are a class of medications commonly used to treat type 2 diabetes and obesity and to reduce health risks. Both metabolic surgery and GLP-1 medications improve cardiovascular health and metabolism.
The M6 (Macrovascular and Microvascular Morbidity and Mortality after Metabolic Surgery versus Medicines) study included 3,932 adults with diabetes and obesity who were treated at the Cleveland Clinic for up to 10 years.
Of these, 1,657 underwent metabolic surgery (including gastric bypass or sleeve gastrectomy) and 2,275 were treated with GLP-1 medications (including liraglutide, dulaglutide, exenatide, semaglutide, and tirzepatide).
At the end of the study, patients who underwent metabolic surgery had a 32% lower risk of death, a 35% lower risk of serious heart problems (such as heart attack, heart failure, or stroke), a 47% lower risk of serious kidney disease, and a 54% lower risk of retinopathy, a type of eye damage related to diabetes.
People who underwent metabolic surgery lost an average of 21.6% of their body weight over 10 years, compared with 6.8% weight loss in those taking GLP-1 drugs.
Hemoglobin A1c, a marker of average blood sugar levels, improved more after surgery (-0.86%) than after GLP-1 drugs (-0.23%).
Patients in the surgery group were also less likely to require prescriptions for medications for diabetes, high blood pressure and high cholesterol.
“Even in the era of these new, effective medications for obesity and diabetes, metabolic surgery may offer additional benefits, including improved survival,” said Dr. Steven Nissen, scientific director of the Cleveland Clinic’s Cardiology, Vascular and Thoracic Institute and lead author of the study.
"Our findings indicate that surgery should remain an important treatment option for obesity and diabetes," said Dr. Aminian. "These long-term benefits are more difficult to achieve with GLP-1 medications alone, as many patients discontinue them over time," he added.
According to the authors, the study has some limitations. It was observational in nature and not a randomized comparison of medications and surgery.
It also didn't focus solely on the newest and most effective GLP-1 drugs. According to the authors, future studies should directly compare surgery with newer drugs like semaglutide and tirzepatide to better guide treatment decisions.
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