Researchers analyzed data from many observational studies to compare the long-term health effects of two major weight-loss treatments for adults with obesity: bariatric surgery and GLP-1 receptor agonist drugs (like Wegovy or Ozempic). The review included information from over 39,000 people, pulling data from national and hospital databases. The goal was to see how these treatments related to serious heart problems and death over time.
The analysis found that, in this data, people who had bariatric surgery had lower risks of several major health events compared to those treated with GLP-1 drugs. Specifically, surgery was linked to a 43% lower risk of death, a 35% lower risk of major heart events (like heart attack or stroke), and a 55% lower risk of heart failure. The researchers estimated this could mean about 25 fewer deaths and 25 fewer major heart events per 1,000 people treated with surgery.
It is very important to understand what this study does and does not show. The results come from observational data, not a controlled clinical trial. This means the people who got surgery and those who got drugs may have started with different health profiles, which could influence the results. The researchers note that 'residual confounding and selection bias'—unmeasured differences between the groups—cannot be ruled out. Therefore, this review shows an association or link, not proof that surgery is the direct cause of better outcomes. The certainty of the evidence was rated as low to moderate.
Readers should take from this that, in real-world observational data, bariatric surgery appears associated with better long-term heart and survival outcomes than GLP-1 drug therapy for obesity. This is useful information for understanding the landscape of treatment options. However, it does not mean surgery is the right choice for everyone. Treatment decisions are personal and complex, and should be made with a doctor based on individual health, risks, and preferences.