Pharmacological vs. Surgical Approaches to Obesity: Are GLP-1 Inhibitors an Alternative to Bariatric Surgery?

INTRODUCTION Obesity is a chronic disease associated with significant metabolic and cardiovascular complications. Bariatric surgery remains the most effective treatment for severe obesity, achieving substantial and sustained weight loss while improving glycemic control and reducing cardiovascular risk. Glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as a pharmacological alternative, offering weight reduction and metabolic benefits with a lower risk of immediate complications. However, differences in long-term efficacy, safety, and adherence raise questions about their potential to replace metabolic surgery.  OBJETIVE This study aims to compare the effectiveness, safety, and long-term outcomes of GLP-1 receptor agonists and bariatric surgery in obesity management. The analysis includes weight loss results, metabolic improvements, treatment adherence, complication rates, and cost-effectiveness. Additionally, the study explores whether a combined approach could enhance obesity treatment outcomes.  METHODS A narrative review was conducted using articles published in the last five years from PubMed, Cochrane, Medline, Embase, and SciELO databases. The descriptors used included “Obesity treatment” OR “Bariatric surgery” OR “GLP-1 receptor agonists” OR “Pharmacological weight loss” OR “Metabolic surgery.” Studies comparing pharmacological and surgical interventions in terms of weight loss, metabolic effects, cardiovascular outcomes, and patient adherence were analyzed. RESULTS AND DISCUSSION Bariatric surgery resulted in greater long-term weight loss and higher rates of type 2 diabetes remission compared to GLP-1 receptor agonists. While pharmacotherapy provided significant metabolic improvements, its efficacy depended on continuous use, with weight regain frequently occurring after discontinuation. GLP-1 receptor agonists demonstrated cardiovascular benefits, but adherence was limited due to gastrointestinal side effects and financial burden. In contrast, surgery carried higher initial risks but produced sustained metabolic benefits and reduced long-term medication dependence.    CONCLUSION Bariatric surgery remains the superior intervention for obesity management, particularly in patients with severe obesity and metabolic syndrome. GLP-1 receptor agonists offer a viable non-surgical alternative but require continuous therapy for sustained effects. A personalized approach, integrating pharmacological and surgical strategies, may optimize outcomes in select patients. Future research should focus on refining combined treatment models to maximize long-term success.