Key result
Bariatric surgery reduces MACE risk compared with GLP-1 RAs in adults with obesity.
Why the study?
Metabolic bariatric surgery is the reference treatment for obesity complications, while GLP-1 RAs have emerged as highly effective alternatives expanding the therapeutic landscape, warranting a comparison of their effectiveness and safety in adults with obesity.
Does metabolic bariatric surgery improve BMI, cardiovascular risk factors, and reduce major adverse cardiovascular events compared to GLP-1 receptor agonist therapy in adults with obesity?
Meta-Analysis (n=15,594)
Does metabolic bariatric surgery improve BMI, cardiovascular risk factors, and reduce major adverse cardiovascular events compared to GLP-1 receptor agonist therapy in adults with obesity?
Metabolic bariatric surgery provides superior weight loss (BMI reduction) and protection against major adverse cardiovascular events compared to GLP-1 receptor agonists in adults with obesity, though no significant differences were observed in blood pressure or lipid profiles.
Background Glucagon-like peptide-1 receptors agonists (GLP-1 RAs) are highly effective alternatives, achieving optimal clinical response in recent clinical trials. Metabolic bariatric surgery (MBS) remains the current reference treatment for durable improvement of obesity complications, but incretin-based therapies are expanding the therapeutic landscape. Purpose This meta-analysis aimed to compare effectiveness and safety of BMS versus GLP-1 RAs in adults with obesity. Methods PubMed, Embase, and Cochrane Library databases were searched from inception until February 2025. Randomized clinical trials (RCT) and observational studies comparing any type of MBS with any GLP-1 RA therapy in adults with obesity, reporting changes in body mass index (BMI); glycade hemoglobin (HbA1c); major adverse cardiovascular events (MACE) systolic blood pressure (SBP); diastolic blood pressure (DBP); triglycerides (TG); high-density lipoprotein (HDL); low-density lipoprotein (LDL) were included. A random-effects meta-analysis was conducted with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. Results Of 5,842 screened studies, seven articles (n = 15,594) were included. Regarding BMI, MBS resulted in a significantly greater reduction (SMD 1.61 kg/m²; 95% CI 1.04, 2.18; p<0.01). In the HbA1c, overall analysis showed no difference (SMD 0.03%; 95% CI -0.14, 0.20; p=0.73), though MBS showed a significant reduction after sensitivity analysis (SMD 0.16%; 95% CI 0.08, 0.24; p<0.01). For MACEs, MBS was associated with a significantly lower risk (RR 1.41; 95% CI 1.11, 1.78; p<0.01).P tends to present lower risk with MBS, but not significant (MD 1.95 mmHg; 95% CI -1.98, 5.88; p=0.33), such as DBP (MD 0.91 mmHg, 95% CI -0.21, 2.04; p=0.11). For TG (SMD 0.33 mg/dL; 95% CI -0.64, 1.31; p=0.5), HDL (SMD 0.02 mg/dL; 95% CI -1.05, 1.09; p=0.97) and LDL (SMD 0.33 mg/dL; 95% CI -0.39, 0.39; p=1) no significant difference were found. Conclusions Although GLP-1 RAs represent a highly effective pharmacological treatment, MBS currently provides superior outcomes in terms of magnitude of optimal clinical response in weight loss and protection against MACEs. These findings can assist clinicians and patients in shared decision-making, balancing the greater effectiveness of surgery against its invasiveness relative to pharmaceutical approaches.
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Lima et al. (2026) conducted a meta-analysis in Obesity (n=15,594). Metabolic bariatric surgery (MBS) vs. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was evaluated on Major adverse cardiovascular events (MACE) (RR 1.41, 95% CI 1.11, 1.78, p=<0.01). Metabolic bariatric surgery resulted in greater BMI reduction (SMD 1.61 kg/m²) and lower MACE risk (RR 1.41; 95% CI 1.11-1.78; p<0.01) compared with GLP-1 RAs in adults with obesity.
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