Long-Term Benefits of Bariatric Surgery Outperform GLP-1 Medications
- Sep 16
- 2 min read
A groundbreaking large-scale study by Cleveland Clinic has revealed compelling evidence that metabolic surgery offers superior and lasting health benefits for individuals living with obesity and type 2 diabetes, compared to treatment exclusively with GLP-1 receptor agonist medications. The research, published in Nature Medicine, highlights the fundamental role of bariatric surgery not only in weight loss but also in reducing mortality and serious cardiovascular and microvascular complications over a decade.
The study, known as the M6 study (Macrovascular and Microvascular Morbidity and Mortality after Metabolic Surgery versus Medicines), tracked nearly 4,000 adults treated at Cleveland Clinic. Of these, 1,657 underwent metabolic surgery procedures, such as gastric bypass or sleeve gastrectomy, while 2,275 patients were treated with GLP-1 receptor agonists, a class of drugs that includes liraglutide, dulaglutide, exenatide, semaglutide, and tirzepatide.
The findings are remarkably positive for surgery. Operated patients showed a 32% lower risk of death. Furthermore, a 35% reduction in major cardiovascular events (such as heart attacks, heart failure, and strokes) was observed. Kidney health also significantly improved, with a 47% decrease in the incidence of serious kidney disease. Strikingly, there was a 54% reduction in diabetic retinopathy, a serious microvascular complication that can lead to vision loss.
From a metabolic standpoint, surgical patients lost an average of 21.6% of their initial body weight over ten years, far exceeding the 6.8% achieved with GLP-1 therapy. They also achieved better glycemic control and required fewer medications for diabetes, hypertension, and hyperlipidemia.
Dr. Ali Aminian, director of Cleveland Clinic’s Bariatric & Metabolic Institute and the study’s primary investigator, emphasized that "even with today's best medicines, metabolic surgery offers unique and lasting benefits for people with obesity and diabetes." Dr. Steven Nissen, senior author, highlighted the "survival advantage" provided by surgery, considering the durability of its effects compared to pharmacological treatments that some patients may discontinue over time.
While the study is observational and not a randomized controlled trial, and it did not focus exclusively on the newest GLP-1 agonists, researchers suggest that surgery should remain an important treatment option. Future research is recommended to directly compare metabolic surgery with new-generation GLP-1 therapies in randomized controlled trials to refine treatment algorithms.
This Cleveland Clinic study stresses that metabolic surgery is a powerful tool to reduce mortality and protect vital organ systems from chronic complications, challenging physicians to consider it earlier in the therapeutic timeline.
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