GLP-1 receptor agonists and bariatric surgery: complement, not competition: An integrated framework for contemporary...

Incretin-based pharmacotherapy has rapidly reshaped obesity management, influencing patient expectations, referral patterns, and treatment algorithms for metabolic and bariatric surgery (MBS). Framing pharmacologic and surgical therapies as competing modalities risks delaying definitive intervention and fragmenting longitudinal care. This narrative review synthesizes current evidence supporting the integrated use of glucagon-like peptide-1 (GLP-1)-based therapies and MBS within a chronic disease framework. Available data demonstrate that GLP-1-based therapies produce approximately 15%-21% total body weight loss in randomized clinical trials but require sustained administration to maintain effect. In contrast, MBS typically achieves 25%-35% total body weight loss with durable long-term metabolic benefits. Emerging evidence supports the use of GLP-1-based agents both preoperatively and postoperatively as adjuncts rather than substitutes for surgery, highlighting the complementary nature of these treatment modalities. Despite increasing adoption, key gaps remain regarding optimal timing, patient selection, duration of therapy, and cost-effectiveness of combined treatment strategies. Furthermore, fragmentation between medical and surgical obesity care continues to limit coordinated implementation. GLP-1-based pharmacotherapy and MBS should be conceptualized as integrated components of a longitudinal treatment strategy for obesity. Bariatric surgery programs are uniquely positioned to serve as the multidisciplinary "medical home," coordinating pharmacologic, endoscopic, and surgical therapies to optimize durability of outcomes and continuity of care.