Long-Term Benefits of Bariatric Surgery Surpass GLP-1 Medications for Obesity and Diabetes

A comprehensive study conducted by Cleveland Clinic has demonstrated that individuals with obesity and type 2 diabetes who undergo weight-loss surgery, also known as bariatric or metabolic surgery, tend to live longer and develop fewer severe health complications compared to those exclusively treated with GLP-1 receptor agonist medications. Published in Nature Medicine, the research highlights significant differences in outcomes over a decade-long follow-up.

Participants who had weight-loss surgery experienced greater and more sustained weight reduction, improved blood sugar control, and a decreased reliance on various medications for diabetes and cardiovascular conditions. Specifically, those who underwent surgery lost an average of 21.6% of their body weight, while individuals on GLP-1 medicines lost about 6.8%. Moreover, blood sugar levels, measured by hemoglobin A1c, improved more markedly in the surgical group.

The study followed 3,932 adults with obesity and diabetes, with 1,657 opting for metabolic surgery (including gastric bypass and sleeve gastrectomy) and 2,275 treated with GLP-1 drugs like liraglutide, dulaglutide, and semaglutide. Results revealed that surgical patients faced a 32% lower risk of death; a 35% reduction in major cardiovascular events such as heart attacks and strokes; a 47% lower risk of kidney disease; and a 54% decrease in diabetes-related eye damage.

Beyond weight loss, surgery was associated with fewer prescriptions needed for managing diabetes, hypertension, and high cholesterol. Dr. Ali Aminian, lead investigator and director of Cleveland Clinic's Bariatric & Metabolic Institute, emphasized that metabolic surgery offers unique long-term benefits even amidst the availability of new medications. Senior author Dr. Steven Nissen highlighted that these findings suggest surgery should remain a vital treatment option for obesity and related metabolic conditions.

Despite these promising results, the study acknowledged limitations, including its observational design and not focusing exclusively on the newest GLP-1 therapies such as tirzepatide. Future research aims to directly compare newer drug regimens with surgical interventions to provide clearer treatment guidance.

This research reinforces that surgical options may provide lasting advantages that are challenging to achieve with medications alone, particularly in reducing mortality and serious health risks associated with obesity and diabetes.

Source: https://medicalxpress.com/news/2025-09-bariatric-surgery-weight-loss-greater.html