SLEEVE GASTRECTOMY was more effective than GLP-1 medications at achieving and\u00a0maintaining\u00a0weight loss over one year, a new study has found.\u00a0<\/p>\n
A large real-world study in the US\u00a0found that\u00a0the bariatric weight loss surgery\u00a0was associated with\u00a0the highest likelihood of achieving substantial weight loss alongside normalisation of glycaemic control in adults with obesity and type 2 diabetes, followed by tirzepatide and semaglutide.\u00a0<\/p>\n
Comparing One-Year Outcomes\u00a0<\/p>\n
The retrospective cohort study\u00a0surveyed\u00a0data from a de-identified\u00a0electronic health record database spanning 1633 hospitals and 37,900 clinics across 280 health systems in the USA.\u00a0\u00a0<\/p>\n
Researchers\u00a0compared outcomes among adults with a BMI of at least 35 kg\/m\u00b2 and HbA1c above 6.4% who received at least 12 months of semaglutide or tirzepatide at maintenance doses, or underwent sleeve gastrectomy\u00a0\u2013 during which\u00a075% to 80% of the stomach\u00a0is typically removed,\u00a0<\/p>\n
Participants were assessed on whether they had achieved a\u00a0composite endpoint of\u00a020% bodyweight loss and HbA1c below 5.7%\u00a0a year after the completion of surgery or the beginning of treatment with\u00a0either GLP-1.\u00a0\u00a0<\/p>\n
Researchers found that the\u00a0adjusted probability of achieving the composite endpoint was 24.0% among those undergoing sleeve gastrectomy, compared with 13.2%\u00a0of those on\u00a0tirzepatide and 3.0%\u00a0taking\u00a0with semaglutide.\u00a0<\/p>\n
Old School Surgery Over Modern Weight Loss Jabs?\u00a0<\/p>\n
The findings suggest that in routine clinical practice, surgical treatment may offer the\u00a0most effective method for\u00a0some\u00a0patients to\u00a0simultaneously achieve\u00a0substantial weight loss and near-normoglycaemia, despite the recent rise in popularity of GLP-1 medications.\u00a0<\/p>\n
However, safety outcomes\u00a0also differed between\u00a0treatment groups, with emergency department visits within\u00a0one\u00a0year more frequent\u00a0for those who underwent\u00a0sleeve gastrectomy.\u00a0\u00a0<\/p>\n
While new prescriptions for gastro-oesophageal reflux disease and nausea were\u00a0observed\u00a0across all three groups, higher absolute rates\u00a0were also\u00a0reported\u00a0for those who had undergone\u00a0surgery.\u00a0<\/p>\n
Investigators emphasised that the results should not be interpreted as a direct causal comparison\u00a0as patients undergoing sleeve gastrectomy differed from those receiving pharmacological treatment, including having a higher BMI, being younger, and having a lower baseline HbA1c.\u00a0\u00a0<\/p>\n
Despite adjustment for multiple clinical and sociodemographic factors, residual confounding\u00a0remains\u00a0possible.\u00a0<\/p>\n
Overall, the study provides a large-scale real-world comparison of contemporary\u00a0treatments for\u00a0obesity and diabetes,\u00a0and its\u00a0findings may help inform shared decision-making as clinicians increasingly consider highly effective incretin-based therapies alongside metabolic surgery.\u00a0<\/p>\n
Reference\u00a0<\/p>\n
Leslie D et al.1-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in obesity in type 2 diabetes: a retrospective cohort study, The Lancet Diabetes & Endocrinology, 2026; 14, 638-648\u00a0<\/p>\n
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