Beyond Drugs or Surgery: Precision and Equity in Obesity Care

Key Messages GLP‐1 receptor agonists and metabolic bariatric surgery are complementary tools in chronic obesity care, not simple substitutes. Trial efficacy, real‐world effectiveness, durability, affordability, indirect costs and implementation capacity need separate assessment. Surgery can produce durable weight loss and cardiometabolic benefit in selected patients, but requires operative capacity, multidisciplinary preparation, recovery time and lifelong nutritional and metabolic follow‐up. Incretin‐based pharmacotherapy has transformed obesity treatment, but real‐world persistence, price, supply and clinical support remain central determinants of value. Effective obesity pharmacotherapy usually requires long‐term continuation to sustain clinical benefit; inadequate response or treatment discontinuation should prompt an individualised transition plan rather than passive observation. Policy should be tailored to local disease burden, primary‐care capacity, surgical services, medicines access, financing and equity constraints.