Cleveland Clinic

Bariatric surgery may offer greater long-term benefits than GLP-1 drugs

September 19, 2025

A large observational study from Cleveland Clinic, published in Nature Medicine, compared long-term outcomes of metabolic (bariatric) surgery vs. GLP-1 receptor agonist therapy in 3,932 adults with obesity and T2DM over a 10-year period. Of these, 1,657 underwent surgery (gastric bypass or sleeve gastrectomy), while 2,275 received GLP-1 medications including liraglutide, dulaglutide, exenatide, semaglutide, and tirzepatide. The surgery cohort demonstrated superior outcomes across multiple endpoints, including metabolic control and reduced reliance on medications, as follows:

• 32% lower risk of death
• 35% lower risk of major CV events
• 47% lower risk of serious kidney disease
• 54% lower risk of diabetic retinopathy
• 21.6% average weight loss with surgery vs. 6.8% with GLP-1 therapy
• Greater HbA1c reduction (-0.86% vs. -0.23%)

Despite the emergence of potent GLP-1 agents, the study findings suggest that metabolic surgery confers durable benefits, including survival advantage and reduced comorbidity burden. Authors note limitations due to the observational design and call for future randomized trials comparing surgery with newer GLP-1 therapies.

Source:

Auger, C. [Media Contact]. (2025, September 16). Cleveland Clinic. Cleveland Clinic Study Shows Greater Long-Term Benefits of Bariatric Surgery Compared to GLP-1 Medicines. https://newsroom.clevelandclinic.org/2025/09/16/cleveland-clinic-study-shows-greater-long-term-benefits-of-bariatric-surgery-compared-to-glp-1-medicines