Article Reviews Great Debate over Surgery versus GLP-1 Medications

Brosnihan P, Luce MS, Yetasook AK, et al. Great Debates: Undergoing the Knife versus Pill-Popping—The Comparative Efficacy and Cost-Effectiveness of Bariatric Surgery and GLP-1 Receptor Agonists in the Management of Obesity. Am Surg. 2025:31348251337145.

This article reported a review of the literature comparing effectiveness of bariatric surgery and use of weight loss drugs such as glucagon-like peptide-1 receptor agonists (GLP-1 RA).

According to data cited in the article, bariatric surgery is an effective intervention for treatment of morbid obesity; long-lasting weight loss of approximately 25% has been documented for both Roux-y gastric bypass and sleeve gastrectomy. Surgical intervention is underutilized, with less than 1% of eligible patients undergoing bariatric surgical procedures.

GLP-1 receptor agonists have provided pharmacologic treatment that results in similar weight loss percentages, but adverse effects, cost, and limited insurance coverage have been barriers to long-term success because of high rates of drug discontinuation that precipitates weight regain.

Available evidence has shown that GLP-1 RA drugs are useful for patients who are reluctant to have surgery or are ineligible. The drugs may also serve as a bridge to bariatric surgery.

Based on the evidence reviewed, the authors recommended a multidisciplinary approach for optimizing management of morbid obesity that integrates surgery, pharmacologic interventions, and lifestyle changes. Strategies for improving access to pharmacologic and surgical management are also needed.