Comparative Outcomes of Metabolic and Bariatric Surgery Versus GLP-1 Receptor Agonists: An Updated Systematic Review...

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have seen a sharp rise in use for obesity management in recent years. No studies incorporate the latest evidence directing comparing their effectiveness and costs against metabolic and bariatric surgery (MBS).

We performed a systematic review on five different databases. The primary outcome was the difference in percentage of total weight loss (%TWL). Secondary outcomes included differences in glycated hemoglobin (HbA1c), body mass index (BMI), and cots out-of-pockets (OOP) from patients. The random-effects model was used to calculate the pooled odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI).

Of 1763 studies screened, 11 were included, comprising 14,548. The GLP-1 group accounted for 51.1% of patients (n = 7435). There was no significant difference in age or sex distribution between groups. Baseline BMI was lower in GLP-1 RA patients (MD = -1.23; P = .002). GLP-1 RA had a lower %TWL (MD = -19.98; P < .001) and BMI reduction (MD = -7.17; P < .001). Lower %TWL was persistent from 12 months (MD = -23.69) to 24 months (MD = -19.57). Reduction in HbA1c was also lower in GLP-1 RA (MD = -0.99; P < .001), with a similar trend in subgroup of liraglutide 1.2 mg daily versus Roux-en-Y gastric bypass (MD = -1.62). Mean OOP cost at 24 months was significantly higher in the GLP-1 group (MD = +$749.38; P < .001).

MBS achieves greater and more sustained weight loss, superior BMI reduction, and better glycemic control than GLP-1 agonists, while also being associated with lower 24-month OOP costs. GLP-1 therapies do not match the effectiveness of surgery, yet they may serve as a complementary strategy in multidisciplinary obesity management.