Bariatric Surgery Shows Greater Weight Loss than GLP-1 Receptor Agonists

Dr. Abhishek Katakwar, Associate Director, Center for Obesity and Metabolic Therapy, AIG Hospitals, Gachibowli, Hyderabad

Metabolic and bariatric surgery (MBS) led to greater weight loss and BMI reduction than GLP-1 receptor agonist therapy in adults with obesity.

A systematic review and meta-analysis published in Obesity Surgery compared weight loss outcomes between MBS and GLP-1 receptor agonist therapy in adults with obesity. It included studies comparing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with GLP-1 receptor agonist therapy.

Researchers searched PubMed, Scopus, and the Cochrane Library for studies up to September 22, 2025. They included 5 retrospective studies with a total of 5,944 participants, of whom 3,489 underwent MBS, while 2,455 received GLP-1 receptor agonist therapy.

Pooled results showed greater total weight loss with MBS, with a mean difference of −18.15%. MBS was also associated with a larger reduction in body mass index (BMI), with a mean difference of 8.73 kg/m² (95% CI 5.87–11.58; p = 0.0001).

Sensitivity analyses supported the main findings. However, the overall risk of bias was moderate, mainly because of non-randomized study designs and treatment selection bias. It was noted that the certainty of evidence was moderate.

Overall, MBS was associated with greater reductions in total body weight and BMI than GLP-1 receptor agonist therapy in the studies included in this analysis. While GLP-1 RAs are useful noninvasive or additional treatment options, surgery remains the benchmark for long-term weight loss and metabolic outcomes.

(Reference: Delgado LM, Barone G, Garcia G, Pilon G, Viana P, Marques FI, Bueno CB, Del Grande L, Theis C, Poli de Figueiredo S, Pompeu BF. Metabolic bariatric surgery versus GLP-1 receptor agonists for obesity management: A systematic review and meta-analysis. Obesity Surgery. 2026 Apr;36(4):1899-908.)