As the use of medications like Wegovy and Mounjaro rapidly increases, a new study published in Nature Medicine offers critical insight into the long-term efficacy of different obesity treatments.Researchers analyzed nearly 4,000 patient records and found bariatric surgery provides a more sustained health benefit than newer weight-loss drugs, particularly concerning long-term survival and the prevention of cardiovascular and diabetes-related complications.The findings raise complex questions about cost, treatment duration, and the potential for a combined medical and surgical approach to obesity care.
Bariatric surgery offers a more sustained health benefit than newer weight-loss medications, according to a recent study published in Nature Medicine. The research, which analyzed data from nearly 4,000 patients, comes as medications like semaglutide (Wegovy) and tirzepatide (Mounjaro) have gained significant attention for their potential in treating obesity. Understanding the long-term effects of different obesity treatments is crucial as rates of obesity continue to rise globally.
“This is the first serious and comprehensive article comparing bariatric surgery to anti-obesity medications,” said Dr. Antonio Iannelli, a digestive and bariatric surgeon at the Parc Impérial clinic in Nice. “It confirms the lasting superiority of bariatric surgery, particularly in terms of survival and associated complications.”
Surgery Provides Better Long-Term Protection
Researchers retrospectively analyzed data from a registry at the Cleveland Clinic, a U.S. academic medical center. The study population specifically included obese patients with diabetes, some of whom were treated with surgery and others with anti-obesity medications.
“The methodologically rigorous conclusions are clear: surgery (combined bypass and sleeve procedures) provides a significant advantage in overall survival [all-cause mortality] over a 10-year period,” Dr. Iannelli explained. “The surgical intervention was also associated with a lower risk of serious cardiovascular events, such as stroke or myocardial infarction. The benefits also extend to the prevention of diabetes-specific complications, such as retinopathy [severe eye damage] and kidney failure.”
The Challenge of Chronic Treatment and Cost
Despite the findings, neither approach offers a definitive cure for obesity. “Obesity is a chronic disease; even if an obese person weighs only 120 pounds, they are considered to be in remission,” Dr. Iannelli noted. “Both surgery and injections, if reversed or stopped, return the patient to their starting point. Therefore, all treatment must be maintained for life to prevent relapse.”
A key difference between the two approaches lies in the duration of treatment effect. “When the effect of a surgical intervention is maintained for a minimum of 5 to 10 years, and can extend up to 20 years, the effect of an injection of an incretin analog medication lasts only 7 days. As soon as the weekly injection is not renewed, hunger returns and the disease recurs.”
The financial implications of these treatments are substantial. “The societal cost of lifelong medication is enormous. A single injection of Mounjaro, for example, costs around $350 per month. In the United States, where these medications are generally not reimbursed, projections show that if incretins were fully covered by the healthcare system, the expenditure would reach $2.4 trillion. This amount, representing half of all U.S. healthcare spending, could ‘bankrupt the country,’ according to some experts.”
This astronomical cost raises questions about why the pharmaceutical industry has not funded randomized, controlled trials (RCTs) directly comparing medications to surgery.
Toward a Complementary Approach to Medicine
The study in Nature Medicine also prompts the question of whether anti-obesity medications should be abandoned. Dr. Iannelli’s answer is a firm no. “They have their place in the modern management of this condition.” He cited several examples: “as preparation for surgery for patients considered too heavy or at very high surgical risk, to treat failures of bariatric surgery, or for obese patients needing weight loss for organ transplantation (kidney, liver, lung) or oncological surgery.”
According to the expert, the growing number of French individuals suffering from obesity should have access to a “360° global care” – similar to the model used in oncology – combining medical and surgical approaches in a complementary, rather than competitive, manner.
1- Intestinal hormones ensuring glycemic control by slowing gastric emptying.
