A new study finds that gastric sleeve surgery was more effective than GLP-1 medications at achieving and maintaining weight loss over one year.
A large real-world study in the United States found that bariatric weight loss surgery was associated with the highest likelihood of achieving significant weight loss and regaining blood sugar control in adults with obesity and type 2 diabetes, followed by terizatide and semaglutide.
Compare one year results
This retrospective cohort study surveyed data from a de-identified electronic health record database covering 1,633 hospitals and 37,900 clinics across 280 health systems in the USA.
The researchers compared outcomes between adults with a BMI of at least 35 kg/m2 and an HbA1c above 6.4% who received at least 12 months of semaglutide or terzebatide at maintenance doses, or who underwent gastric sleeve surgery — during which 75% to 80% of the stomach is typically removed.
Participants were assessed on whether they achieved a composite endpoint of 20% body weight loss and an HbA1c of less than 5.7% per year after completion of surgery or start of GLP-1 therapy.
The researchers found that the adjusted probability of meeting the composite endpoint was 24.0% among those who underwent gastric sleeve surgery, compared with 13.2% of those who took tirezpatide and 3.0% of those who took semaglutide.
More old school surgery than modern weight loss potions?
The results suggest that in routine clinical practice, surgical treatment may provide the most effective way for some patients to achieve significant weight loss and nearly normal blood sugar, despite the recent rise in popularity of GLP-1 drugs.
However, safety outcomes also differed between treatment groups, with emergency department visits within 1 year being more frequent for those who underwent gastric sleeve surgery.
While new prescriptions for gastroesophageal reflux disease and nausea were observed in all three groups, higher absolute rates were also reported for those who underwent surgery.
Investigators stressed that the results should not be interpreted as a direct causal comparison because patients who undergo gastric sleeve surgery differ from those receiving drug therapy, including having a higher BMI, being younger, and lower baseline HbA1c.
Despite adjustment for several clinical and sociodemographic factors, residual confounding remains possible.
Overall, the study provides a broad, real-world comparison of contemporary treatments for obesity and diabetes, and its findings may help inform shared decision-making as clinicians increasingly consider highly effective incretin-based treatments alongside metabolic surgery.
reference
Leslie D et al. One-Year Outcomes of Semaglutide, Tirzepatide, and Gastric Sleeve Surgery in Obesity in Patients with Type 2 Diabetes: A Retrospective Cohort Study, The Lancet Diabetes & Endocrinology, 2026; 14, 638-648
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