Introduction
Obesity has emerged as one of the most significant public health challenges of the 21st century, affecting more than 650 million adults worldwide. The condition is associated with numerous comorbidities including type 2 diabetes, cardiovascular disease, certain cancers, and reduced quality of life, substantially increasing healthcare costs and premature mortality. The complex pathophysiology of obesity, involving genetic, environmental, behavioral, and socioeconomic factors, has made its management particularly challenging, with conventional approaches like lifestyle modifications yielding modest and often transient results for those with severe obesity.
Over the past few decades, significant advancements have been made in the treatment landscape for obesity. Bariatric surgery, which encompasses various surgical procedures that alter the digestive system’s anatomy, has been established as an effective intervention for sustainable weight loss and improvement in obesity-related comorbidities. Originally conceived primarily as a restrictive and/or malabsorptive approach, our understanding of bariatric surgery has evolved to recognize its profound metabolic and hormonal effects, leading to the term “metabolic surgery” in many contexts [1].
More recently, pharmacological approaches targeting the glucagon-like peptide-1 (GLP-1) receptor have emerged as promising non-surgical alternatives. GLP-1 receptor agonists were initially developed for type 2 diabetes management but demonstrated significant weight loss effects, leading to specific formulations being approved for obesity treatment. These medications mimic the action of endogenous GLP-1, influencing appetite regulation, gastric emptying, and glucose metabolism.
As both bariatric surgery and GLP-1 receptor agonists gain prominence in clinical practice, healthcare providers and patients face critical decisions regarding the optimal intervention strategy. These decisions require careful consideration of efficacy metrics beyond weight loss alone, including effects on comorbidities, quality of life, sustainability of results, and importantly, the distinct risk profiles associated with each approach. Furthermore, the significant resource implications and lifetime commitment associated with both interventions necessitate a thorough understanding of their comparative benefits and risks [2].
This article aims to provide a comprehensive comparison of bariatric surgery and GLP-1 receptor agonists as interventions for obesity, examining their mechanisms of action, efficacy in weight management, broader health benefits, adverse effect profiles, and considerations for patient selection. By synthesizing current evidence, this review seeks to inform clinical decision-making and highlight areas requiring further investigation in the evolving landscape of obesity treatment.
Mechanisms of Action
Understanding the fundamental mechanisms through which bariatric procedures and GLP-1 receptor agonists exert their effects provides critical insight into their respective efficacy and risk profiles. These mechanisms extend far beyond the traditional paradigms of restriction and malabsorption for surgery or simple appetite suppression for medications.
Bariatric surgery encompasses several procedure types, each with distinct anatomical alterations and consequent physiological effects. Restrictive procedures, such as sleeve gastrectomy (SG), reduce stomach volume, limiting food intake capacity and increasing intragastric pressure, which triggers early satiety. Malabsorptive procedures, including biliopancreatic diversion, limit nutrient absorption by bypassing segments of the small intestine. Combined procedures like Roux-en-Y gastric bypass (RYGB) incorporate both restrictive and malabsorptive elements. However, the effects of these surgeries extend well beyond mechanical alterations to profound hormonal and metabolic changes [3].
Post-surgical rearrangement of the gastrointestinal tract significantly alters the secretion pattern of gut hormones. Procedures that expedite nutrient delivery to the distal intestine, such as RYGB and SG, enhance postprandial secretion of GLP-1 and peptide YY (PYY), hormones that promote satiety and reduce food intake. Concurrently, levels of ghrelin, an orexigenic hormone primarily produced in the stomach fundus, typically decrease following sleeve gastrectomy. These hormonal changes occur rapidly post-surgery, often preceding significant weight loss, suggesting their mechanistic importance in the procedures’ efficacy.
Additionally, bariatric surgery modifies bile acid metabolism and the gut microbiome composition, which further influences energy homeostasis, glucose metabolism, and inflammatory pathways. Enhanced postprandial insulin secretion and improved insulin sensitivity are observed shortly after surgery, contributing to the remarkable effects on glycemic control that often precede substantial weight reduction.
GLP-1 receptor agonists operate through distinct but overlapping pathways compared to bariatric surgery. These medications are synthetic analogs of endogenous GLP-1, modified to resist rapid degradation by dipeptidyl peptidase-4 (DPP-4), thus extending their half-life and therapeutic action. Upon binding to GLP-1 receptors, these agents exert multiple effects throughout the body [4].
Centrally, GLP-1 receptor agonists act on hypothalamic nuclei and the brainstem to decrease appetite and increase satiety, leading to reduced caloric intake. This central action is complemented by delayed gastric emptying, which prolongs the feeling of fullness after meals. Additionally, these medications enhance glucose-dependent insulin secretion from pancreatic β-cells while suppressing glucagon release from α-cells, improving glycemic control without causing hypoglycemia in non-diabetic individuals.
Beyond pancreatic effects, GLP-1 receptor agonists influence adipose tissue metabolism, promoting lipolysis and reducing lipogenesis. They also demonstrate direct and indirect effects on cardiovascular function, including reduced inflammation, improved endothelial function, and beneficial changes in lipid profiles.
When comparing the mechanistic profiles of these interventions, several parallels emerge. Both approaches increase postprandial GLP-1 levels, though bariatric surgery induces more pronounced and sustained elevations. Both modify eating behavior and satiety signaling, though potentially through different neural pathways. However, bariatric surgery produces more extensive changes in the gut hormone milieu and may have more profound effects on bile acid metabolism and the microbiome.
Understanding these mechanistic differences helps explain variations in efficacy, persistence of effects, and side effect profiles between surgical and pharmacological approaches. It also highlights the potential complementarity of these interventions and informs research into novel therapeutic targets that might replicate the beneficial effects of bariatric surgery through less invasive means.
Efficacy in Weight Loss
The primary metric by which obesity interventions are often judged is their ability to produce significant and sustainable weight loss. Both bariatric surgery and GLP-1 receptor agonists have demonstrated effectiveness in this regard, though with notable differences in magnitude, timing, and durability of effects.
Bariatric surgery typically produces substantial weight loss, with variations observed across procedure types. Meta-analyses indicate that patients undergoing RYGB achieve average total body weight loss (TBWL) of 25-30% at one year post-surgery, while sleeve gastrectomy results in approximately 20-25% TBWL. Biliopancreatic diversion with duodenal switch (BPD/DS) produces the most dramatic weight reduction, often exceeding 35% TBWL at the one-year mark. This contrasts sharply with conventional lifestyle interventions, which typically yield 5-10% weight loss that is often difficult to maintain.
The weight loss trajectory following bariatric surgery generally follows a predictable pattern: rapid reduction during the first 3-6 months, continued but slower loss until approximately 12-18 months post-surgery, followed by a plateau and potential modest weight regain. Long-term studies demonstrate that substantial weight loss persists in most patients, with 10-year data showing maintenance of 50-70% of excess weight loss (EWL) for RYGB and similar, though slightly lower, rates for sleeve gastrectomy. However, significant weight regain occurs in 15-35% of patients, particularly beyond the 2-year mark, highlighting the importance of long-term follow-up and support [5].
GLP-1 receptor agonists approved for weight management have evolved considerably, with newer agents demonstrating greater efficacy than earlier generations. Initial GLP-1 medications produced modest weight loss of 5-10% TBWL at recommended doses. However, more recent high-dose formulations, such as semaglutide 2.4 mg weekly, have achieved results approaching those of bariatric procedures in some patients. Clinical trials of semaglutide at this dose demonstrated mean TBWL of 15-18% at 68 weeks, with approximately one-third of participants achieving ≥20% weight reduction. These results substantially exceed those of other anti-obesity medications and approach the lower range of outcomes seen with sleeve gastrectomy.
The weight loss pattern with GLP-1 agonists differs from surgery, typically showing gradual, dose-dependent reduction over 20-60 weeks, depending on the specific agent and dosing protocol. Importantly, weight loss continues as long as the medication is administered at effective doses, but substantial weight regain occurs upon discontinuation, with studies showing recovery of approximately two-thirds of lost weight within one year of stopping treatment.
Several factors predict response to each intervention. For bariatric surgery, younger age, female sex, higher initial BMI, and better adherence to postoperative dietary recommendations are associated with greater weight loss. Certain genetic polymorphisms may also influence outcomes. For GLP-1 agonists, early response within the first 12 weeks strongly predicts long-term efficacy, while the presence of diabetes may attenuate weight loss compared to non-diabetic individuals receiving the same dose.
Direct comparative data between the two approaches remains limited. The GATEWAY trial indirectly compared RYGB to liraglutide (a GLP-1 agonist) in patients with type 2 diabetes, finding significantly greater weight reduction with surgery. However, this study used lower doses of liraglutide than currently recommended for obesity treatment. Emerging real-world data comparing high-dose semaglutide to bariatric procedures suggests that while surgery still produces greater average weight loss, the gap has narrowed considerably with newer GLP-1 formulations.
The comparative cost-effectiveness analysis of these interventions must consider not only the magnitude of weight loss but its sustainability and the resources required for maintenance. Bariatric surgery involves substantial upfront costs but minimal ongoing expenses beyond standard medical care, while GLP-1 agonists require continuous medication costs, often exceeding several thousand dollars annually, for sustained effect.
In summary, bariatric surgery currently offers superior efficacy in terms of magnitude and durability of weight loss compared to GLP-1 agonists, particularly for individuals with severe obesity. However, the gap has narrowed significantly with newer GLP-1 formulations, and the non-invasive nature of pharmacotherapy may outweigh the efficacy advantage of surgery for some patients, especially those with more modest weight loss goals or higher surgical risk profiles.
Metabolic and Health Benefits Beyond Weight Loss
While weight reduction remains a primary goal of obesity interventions, the metabolic and health benefits extending beyond scale measurements often determine the true clinical value of these approaches. Both bariatric surgery and GLP-1 receptor agonists demonstrate significant effects on comorbid conditions, though with important distinctions in their mechanisms, magnitude, and timing.
Type 2 diabetes improvement or remission represents one of the most striking benefits of bariatric surgery. Following RYGB or BPD/DS, 60-80% of patients with diabetes experience complete remission (defined as normal glycemic parameters without medication) within days to weeks, often before significant weight loss occurs. This “diabetes-first” phenomenon underscores the weight-independent metabolic effects of these procedures. Long-term data from the Swedish Obese Subjects study and other cohorts demonstrate diabetes remission rates of approximately 30-50% at 10 years post-surgery. Sleeve gastrectomy produces somewhat lower but still impressive diabetes remission rates, typically ranging from 40-60% at 1-2 years.
GLP-1 receptor agonists were initially developed for diabetes management before their weight loss potential was fully recognized. These medications significantly improve glycemic control through multiple mechanisms: enhanced glucose-dependent insulin secretion, suppressed glucagon release, delayed gastric emptying, and improved insulin sensitivity secondary to weight loss. High-dose semaglutide (2.4 mg weekly) achieves HbA1c reductions of approximately 1.5-2.0 percentage points in patients with diabetes. While complete diabetes remission occurs less frequently than with surgery, approximately 25-35% of patients with diabetes achieve normoglycemia on GLP-1 monotherapy, though medication discontinuation typically leads to glycemic deterioration [1].
Cardiovascular outcomes represent another critical domain for comparison. Bariatric surgery is associated with 40-50% reduction in cardiovascular events and mortality in long-term observational studies, with improvements in multiple risk factors including hypertension, dyslipidemia, and inflammatory markers. The STAMPEDE trial demonstrated superior improvements in cardiovascular risk factors with RYGB compared to intensive medical therapy at 5 years follow-up.
GLP-1 receptor agonists have demonstrated cardiovascular benefits in multiple large-scale clinical trials, primarily in populations with established cardiovascular disease or high risk. Medications such as semaglutide, dulaglutide, and liraglutide reduced major adverse cardiovascular events by approximately 12-26% compared to placebo in these populations. Notably, these benefits appear partially independent of weight loss and glycemic control, suggesting direct cardiovascular effects. However, the magnitude of risk reduction appears smaller than that observed in bariatric surgery cohorts, though direct comparisons are lacking [3].
Both interventions demonstrate beneficial effects on non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH). Bariatric surgery leads to resolution of steatosis in 85-90% of patients and improvement in fibrosis scores in many cases. GLP-1 agonists have shown promise in reducing liver fat content and improving histological features of NASH in clinical trials, though data remains more limited than for surgery.
Sleep apnea, a common and serious obesity complication, shows substantial improvement following bariatric surgery, with resolution rates of 80-85% reported for moderate to severe disease. GLP-1 agonist effects on sleep apnea have been less extensively studied, though semaglutide 2.4 mg weekly demonstrated significant improvements in apnea-hypopnea index compared to placebo in recent trials.
Quality of life improvements, while more subjective, represent crucial outcomes from the patient perspective. Bariatric surgery is associated with substantial enhancements in physical functioning, social interaction, and overall well-being, which typically persist long-term despite some attenuation if weight regain occurs. GLP-1 agonists similarly improve quality of life measures, with effects correlating with the degree of weight loss achieved. However, gastrointestinal side effects may temporarily or persistently diminish these benefits in some patients.
In summary, both interventions offer significant health benefits beyond weight reduction, with bariatric surgery generally producing more pronounced and durable improvements, particularly in diabetes remission and cardiovascular risk reduction. However, the non-invasive nature of GLP-1 therapy and its expanding evidence base for cardiometabolic benefits make it an increasingly viable alternative, especially for patients with moderate obesity or those who cannot or prefer not to undergo surgery.
Risk Profiles and Adverse Effects
A comprehensive comparison of bariatric surgery and GLP-1 receptor agonists must include thorough evaluation of their respective risk profiles, as these considerations often significantly influence treatment decisions despite potentially superior efficacy of one approach over another.
Bariatric surgery carries risks inherent to major surgical procedures, though advances in laparoscopic techniques and perioperative management have substantially improved safety profiles over the past two decades. The 30-day mortality rate for bariatric procedures in high-volume centers is currently estimated at 0.1-0.5%, comparable to gallbladder surgery and considerably lower than earlier eras of bariatric intervention. Early complications include anastomotic leaks (0.5-3%), bleeding (1-4%), venous thromboembolism (0.4-2%), and wound infections (1-3%), with rates varying by procedure type and patient characteristics [2].
Long-term surgical complications include internal hernias (particularly after RYGB), anastomotic strictures, gastroesophageal reflux (more common after sleeve gastrectomy), and marginal ulcers. Reoperation rates range from 7-22% within 10 years of the primary procedure, with higher rates observed after RYGB compared to sleeve gastrectomy. Nutritional deficiencies represent another significant long-term risk, particularly for malabsorptive procedures like RYGB and BPD/DS. Common deficiencies involve vitamin B12, iron, calcium, vitamin D, and protein, necessitating lifelong supplementation and monitoring. Severe malnutrition requiring hospitalization occurs in approximately 1-2% of patients, most commonly after BPD/DS or with poor adherence to supplementation regimens.
GLP-1 receptor agonists present a distinctly different risk profile, dominated by gastrointestinal adverse effects rather than procedural complications. Nausea, vomiting, and diarrhea occur in 30-45% of patients, typically peaking during dose escalation and attenuating over time, though approximately 10-15% of patients discontinue treatment due to persistent symptoms. These effects appear dose-dependent and vary somewhat across specific agents within the class.
More serious concerns associated with GLP-1 agonists include acute pancreatitis (estimated at 0.1-0.3% incidence), though causal relationships remain debated, with some studies suggesting confounding by gallstone disease and other risk factors. Thyroid C-cell hyperplasia and medullary thyroid carcinoma have been observed in rodent models with some GLP-1 agonists, leading to contraindications in patients with personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2. However, human surveillance data has not demonstrated increased thyroid cancer rates with these medications [4].
Recently, additional concerns have emerged regarding potential associations between GLP-1 receptor agonists and gastrointestinal adverse events beyond the well-established nausea and vomiting. These include reports of intestinal obstruction, ileus, and gastroparesis, particularly in patients with predisposing conditions. Cases of acute cholecystitis have also been reported at higher than expected rates, potentially related to rapid weight loss and altered gallbladder motility induced by these medications.
The psychological impacts of both interventions warrant consideration. Bariatric surgery may be associated with increased risk of alcohol use disorders (particularly after RYGB), relationship changes following significant weight loss, and body image concerns related to excess skin. Conversely, GLP-1 agonists have been associated with increased anxiety in some patients, though causality remains unclear. Longitudinal studies suggest overall improvements in depression and anxiety with both interventions, likely related to enhanced physical functioning and social interactions following weight loss.
A critical distinction between the interventions concerns reversibility and discontinuation effects. Bariatric surgery produces anatomical alterations that are largely permanent (though revisional procedures are possible), creating lifelong changes in digestive physiology. In contrast, GLP-1 agonist effects cease upon discontinuation, with substantial weight regain typically occurring unless alternative interventions are implemented. This differential has important implications for patient autonomy and long-term planning.
The risk-benefit calculation also includes consideration of treatment adherence challenges. Bariatric surgery requires strict dietary adherence, particularly in the early postoperative period, and lifelong vitamin supplementation and clinical follow-up. GLP-1 agonists require regular self-injection (typically weekly or daily depending on the specific agent), consistent administration timing, and management of potential gastrointestinal side effects.
In summary, both interventions carry distinct risk profiles that must be weighed against their potential benefits. Bariatric surgery involves significant perioperative risks and potential long-term complications that are partially offset by its one-time nature and more dramatic efficacy. GLP-1 agonists present fewer acute serious risks but require ongoing management of side effects and consideration of the consequences of treatment discontinuation or interruption.
Patient Selection and Personalized Approaches
The expanding therapeutic options for obesity management necessitate thoughtful patient selection and increasingly personalized approaches that account for individual characteristics, preferences, and treatment goals. Current clinical guidelines provide frameworks for decision-making, though considerable nuance exists in their practical application.
Bariatric surgery eligibility has traditionally been defined by body mass index (BMI) thresholds: ≥40 kg/m² or ≥35 kg/m² with obesity-related comorbidities. More recent guidelines have expanded these criteria to include patients with BMI ≥30 kg/m² and poorly controlled type 2 diabetes, recognizing the particular efficacy of metabolic surgery for this population. Contraindications include active substance abuse, uncontrolled psychiatric illness, inability to comprehend the lifelong behavioral changes required, and certain medical conditions that substantially increase surgical risk.
GLP-1 receptor agonists approved for weight management are indicated for individuals with BMI ≥30 kg/m² or ≥27 kg/m² with at least one weight-related comorbidity. Contraindications include personal or family history of medullary thyroid carcinoma, Multiple Endocrine Neoplasia syndrome type 2, pregnancy, and hypersensitivity to the specific agent. Caution is advised in patients with history of pancreatitis, severe gastrointestinal disease, or advanced kidney disease.
Beyond these formal criteria, numerous patient factors influence the selection between surgical and pharmacological approaches. Age represents an important consideration, with evidence supporting bariatric surgery’s safety and efficacy in adolescents with severe obesity and adults up to age 65-70, provided comorbidities are well-managed. Limited data exist for GLP-1 agonist use in adolescents, though clinical trials are ongoing, while these medications appear well-tolerated in older adults, with potential advantages given their non-invasive nature [5].
The presence and severity of comorbidities significantly impact treatment selection. Patients with advanced diabetes, especially with poor glycemic control despite multiple medications, may derive particular benefit from bariatric surgery’s rapid and profound effects on glucose metabolism. Conversely, individuals with moderate obesity and cardiovascular disease might initially consider high-dose GLP-1 therapy, given these medications’ established cardiovascular benefits and lower procedural risk.
Patient preferences regarding intervention intensity, risk tolerance, and lifestyle impact play crucial roles in treatment selection. Some individuals strongly prefer the “definitive” nature of surgery and one-time intervention despite higher acute risks, while others prefer the gradual, non-invasive, and potentially reversible approach of medication therapy despite the need for ongoing administration and cost.
Evolving approaches increasingly recognize that bariatric surgery and GLP-1 agonists need not be viewed as competing alternatives but as potentially complementary interventions within a comprehensive treatment continuum. Several emerging paradigms demonstrate this shift in perspective:
- Sequential therapy: GLP-1 agonists may serve as initial interventions for patients with moderate obesity, with bariatric surgery reserved for those who fail to achieve adequate weight loss or comorbidity improvement.
- Preoperative optimization: Short-term GLP-1 agonist therapy before bariatric surgery may reduce liver volume and visceral fat, potentially facilitating safer laparoscopic approaches and reducing perioperative complications.
- Relapse management: GLP-1 agonists are increasingly utilized to address weight regain following bariatric surgery, potentially avoiding revisional procedures in some patients.
- Hybrid approaches: Combined surgical and pharmacological strategies may offer synergistic benefits, particularly for patients with severe obesity and multiple comorbidities.
Healthcare resource considerations inevitably influence treatment pathways in many settings. Bariatric surgery typically involves higher initial costs ($15,000-$25,000 for the procedure alone) but may prove more cost-effective long-term through sustained comorbidity resolution and avoidance of ongoing medication expenses. GLP-1 agonists for obesity management typically cost $10,000-$15,000 annually, creating substantial cumulative expenses with long-term use, though these costs may be partially offset by reduced utilization of other medications and services.
Equitable access to both interventions remains challenging, with significant disparities observed by race, ethnicity, socioeconomic status, and geographic location. Insurance coverage for bariatric surgery has improved but remains inconsistent, while coverage for GLP-1 agonists specifically for obesity management remains limited in many payer systems despite their proven efficacy.
The optimization of patient selection will continue to evolve as longer-term data emerges for newer high-dose GLP-1 formulations and as predictive models improve our ability to identify which patients are most likely to benefit from specific intervention types. Developing precision medicine approaches that incorporate genetic, metabolic, and behavioral predictors of response may eventually enable more tailored recommendations beyond the current somewhat crude criteria based primarily on BMI and comorbidity presence.
Conclusion
The comparison of bariatric surgery and GLP-1 receptor agonists reveals a complex landscape of benefits and risks, with each approach offering distinct advantages for different patient populations. Rather than positioning these interventions as competing alternatives, contemporary obesity management increasingly recognizes their complementary roles within a comprehensive treatment continuum.
Bariatric surgery, particularly RYGB and sleeve gastrectomy, continues to demonstrate superior efficacy in terms of magnitude and durability of weight loss and metabolic benefits, especially for individuals with severe obesity and established comorbidities. The dramatic improvements in diabetes, cardiovascular risk, and overall mortality observed following these procedures remain unmatched by any pharmacological approach. However, the invasive nature, irreversibility, and potential for serious complications necessitate careful patient selection and long-term follow-up.
GLP-1 receptor agonists, particularly newer high-dose formulations, represent the most effective pharmacological approach to obesity management currently available. Their ability to produce clinically meaningful weight loss with favorable cardiometabolic effects while avoiding surgical risks makes them attractive options for many patients, especially those with moderate obesity or contraindications to surgery. However, the requirement for ongoing administration, substantial cost implications, and limited long-term data on newer formulations present significant considerations.
Several critical gaps in current evidence should guide future research priorities. Long-term comparative effectiveness studies directly evaluating high-dose GLP-1 agonists against bariatric procedures are urgently needed, ideally as randomized controlled trials with extended follow-up. Investigation of sequential and combination approaches may identify optimal treatment pathways for different patient subtypes. Additionally, improved predictive models incorporating genetic, metabolic, and behavioral factors could enhance personalized treatment selection.
As the therapeutic landscape continues to evolve, emerging interventions may further transform obesity management. Novel dual and triple receptor agonists targeting GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and/or glucagon receptors have demonstrated promising results in early clinical trials. Less invasive endoscopic procedures such as endoscopic sleeve gastroplasty and duodenal mucosal resurfacing offer intermediate options between pharmacotherapy and traditional surgery.
The clinical implications of this comparative analysis emphasize the importance of shared decision-making that accounts for individual patient characteristics, preferences, and goals. The expanding therapeutic options for obesity highlight its recognition as a chronic disease requiring potentially lifelong management rather than a singular intervention. For many patients, the optimal approach may involve staged or combined strategies rather than an either/or decision between surgery and medication.
As we advance our understanding of obesity’s complex pathophysiology and heterogeneity, the field continues to move toward more nuanced, personalized approaches to this challenging chronic disease. Both bariatric surgery and GLP-1 receptor agonists represent valuable tools within this evolving paradigm, each with distinctive roles in addressing one of the most significant public health challenges of our time.
References
- Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care
- English WJ, DeMaria EJ, Hutter MM, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surgery for Obesity and Related Diseases
- Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5-Year Outcomes. New England Journal of Medicine
- Nauck MA, Quast DR, Wefers J, Meier JJ. GLP-1 receptor agonists in the treatment of type 2 diabetes – state-of-the-art. Molecular Metabolism
- Shi Q, Wang Y, Hao Q, et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. The Lancet
