SLEEVE GASTRECTOMY was more effective than GLP-1 medications at achieving and maintaining weight loss over one year, a new study has found.
A large real-world study in the US found that the bariatric weight loss surgery was associated with the 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.
Comparing One-Year Outcomes
The retrospective cohort study surveyed data from a de-identified electronic health record database spanning 1633 hospitals and 37,900 clinics across 280 health systems in the USA.
Researchers compared outcomes among adults with a BMI of at least 35 kg/m² and HbA1c above 6.4% who received at least 12 months of semaglutide or tirzepatide at maintenance doses, or underwent sleeve gastrectomy – during which 75% to 80% of the stomach is typically removed,
Participants were assessed on whether they had achieved a composite endpoint of 20% bodyweight loss and HbA1c below 5.7% a year after the completion of surgery or the beginning of treatment with either GLP-1.
Researchers found that the adjusted probability of achieving the composite endpoint was 24.0% among those undergoing sleeve gastrectomy, compared with 13.2% of those on tirzepatide and 3.0% taking with semaglutide.
Old School Surgery Over Modern Weight Loss Jabs?
The findings suggest that in routine clinical practice, surgical treatment may offer the most effective method for some patients to simultaneously achieve substantial weight loss and near-normoglycaemia, despite the recent rise in popularity of GLP-1 medications.
However, safety outcomes also differed between treatment groups, with emergency department visits within one year more frequent for those who underwent sleeve gastrectomy.
While new prescriptions for gastro-oesophageal reflux disease and nausea were observed across all three groups, higher absolute rates were also reported for those who had undergone surgery.
Investigators emphasised that the results should not be interpreted as a direct causal comparison as patients undergoing sleeve gastrectomy differed from those receiving pharmacological treatment, including having a higher BMI, being younger, and having a lower baseline HbA1c.
Despite adjustment for multiple clinical and sociodemographic factors, residual confounding remains possible.
Overall, the study provides a large-scale 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 therapies alongside metabolic surgery.
Reference
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
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