Weight Loss Outcomes Between GLP-1 Receptor Agonists and Bariatric Surgery in Adults
Bariatric Surgery vs GLP-1 Medications: Which Produces Greater Long-Term Weight Loss?
What You’ll Learn
- How weight loss from bariatric surgery compares to GLP-1 receptor agonists across 6-month, 1-year, and multi-year follow-up windows
- Which patient characteristics , age, sex, and baseline BMI , predict the greatest BMI reduction from bariatric surgery
- How glycemic outcomes, lipid profiles, and blood pressure differ between the two interventions
- Where the evidence is genuinely strong and where significant heterogeneity demands caution
TL;DR: Across 20,594 participants and 15 studies, bariatric surgery produced significantly greater and more durable reductions in weight, BMI, and long-term glycemic control than GLP-1 receptor agonists, with both interventions showing comparable effects on lipid profiles and blood pressure.
Abstract
Background: The comparative effectiveness of bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight loss among patients with obesity remains uncertain.
Methods: MEDLINE, EMBASE, and CENTRAL were searched to October 5, 2025. Pooled mean differences (MDs) for change in weight, body mass index (BMI), glycemic indices, lipid profile, and blood pressure were calculated using random-effects models with heterogeneity quantified by I². Outcomes were assessed separately according to time duration. Meta-regression was performed for the primary outcome of change in BMI.
Results: Fifteen studies (20,594 participants) were included. Weight loss did not differ significantly at 6 months (MD −12.19 kg; p=0.13), but favored BS at ≤1 year (MD −16.97 kg; p=0.02) and >1 year (MD −19.78 kg; p<0.001). BMI reduction consistently favored BS at 6 months (MD −6.77 kg/m²; p=0.02), ≤1 year (MD −5.10 kg/m²; p<0.001), and >1 year (MD −6.61 kg/m²; p<0.001). HbA1c reduction was greater with BS beyond one year (MD −1.69%; p<0.001), and fasting glucose was lower overall with BS (MD −1.22 mmol/L; p=0.03). Serum lipids and blood pressure showed no significant between-group differences. Meta-regression demonstrated larger BMI reductions with BS in older patients, male patients, and those with higher baseline BMI.
Conclusion: Although substantial heterogeneity was present, BS was associated with greater and sustained reductions in weight, BMI, and glycemic indices compared to GLP-1 RAs, with similar effects on serum lipids and blood pressure, supporting its use in appropriately selected adults with obesity.
Source: Tahir M, Meghani MA, Uddin MS, et al. Weight Loss Outcomes Between GLP-1 Receptor Agonists and Bariatric Surgery in Adults With Obesity: A Systematic Review, Meta-Analysis and Meta-Regression. Diabetes, Obesity and Metabolism. 2026;28:4901–4914.
Study at a Glance
| Design | Systematic review, meta-analysis, and meta-regression (PRISMA-compliant; PROSPERO ID: CRD420251160138) |
| Population | Adults ≥18 years with obesity (BMI >30 kg/m²), with or without type 2 diabetes; mean age 52.12 years; 35.9% male |
| Total N | 20,594 (11,876 GLP-1 RA; 8,718 bariatric surgery) |
| Studies Included | 15 studies (4 RCTs, 11 observational); follow-up windows: 6 months, ≤1 year, >1 year |
| Primary Endpoints | Absolute change in body weight (kg) and absolute change in BMI (kg/m²) |
| Key Finding | Bariatric surgery produced significantly greater BMI and weight reduction at every measured time point beyond 6 months, with the advantage widening over multi-year follow-up |
Study Snapshot
| Outcome | Time Point | MD (BS vs GLP-1 RA) | p-value | I² |
|---|---|---|---|---|
| Weight (kg) | 6 months | −12.19 kg | 0.13 (NS) | 98% |
| Weight (kg) | ≤1 year | −16.97 kg | 0.02 | 97% |
| Weight (kg) | >1 year | −19.78 kg | <0.001 | 74% |
| BMI (kg/m²) | 6 months | −6.77 kg/m² | 0.02 | 99% |
| BMI (kg/m²) | ≤1 year | −5.10 kg/m² | <0.001 | 97% |
| BMI (kg/m²) | >1 year | −6.61 kg/m² | <0.001 | 79% |
| HbA1c (%) | ≤1 year | −2.13% | 0.07 (NS) | 97% |
| HbA1c (%) | >1 year | −1.69% | <0.001 | 97% |
| Fasting glucose (mmol/L) | Overall | −1.22 mmol/L | 0.03 | 86% |
| Triglycerides | Overall | −0.38 mmol/L | 0.11 (NS) | 93% |
| Systolic BP (mmHg) | Overall | −1.18 mmHg | 0.53 (NS) | 0% |
| Diastolic BP (mmHg) | Overall | +0.11 mmHg | 0.93 (NS) | 0% |
MD = mean difference (negative value favors bariatric surgery); NS = not significant; BP = blood pressure.
Study Facts Table
| Full Study Summary | |
| Authors | Tahir M, Meghani MA, Uddin MS, Talib A, Binte Ahmad Z, Ali Khan A, Ahmed M, Dinsmore L, Nasser A, Ahmed R, Basit A, Khan TM |
| Journal | Diabetes, Obesity and Metabolism |
| Year | 2026 |
| DOI | 10.1111/dom.70676 |
| Study Design | Systematic review, meta-analysis, and meta-regression; 4 RCTs + 11 observational studies |
| Total Participants | 20,594 (GLP-1 RA: 11,876; bariatric surgery: 8,718) |
| Intervention | FDA-approved GLP-1 receptor agonists (liraglutide, semaglutide, exenatide, dulaglutide, lixisenatide, albiglutide) |
| Comparator | Bariatric surgery: RYGB, sleeve gastrectomy, gastric banding, biliopancreatic diversion, endoscopic sleeve gastroplasty, intragastric balloon |
| Primary Endpoints | Absolute change in weight (kg) and absolute change in BMI (kg/m²) |
| Primary Results | Weight loss not significantly different at 6 months (p=0.13); BS superior at ≤1 year (MD −16.97 kg; p=0.02) and >1 year (MD −19.78 kg; p<0.001). BMI reduction favored BS at all three time points (6 months: MD −6.77; ≤1 year: MD −5.10; >1 year: MD −6.61 kg/m²; all p≤0.02). |
| Secondary Results | HbA1c favored BS at >1 year (MD −1.69%; p<0.001); fasting glucose favored BS overall (MD −1.22 mmol/L; p=0.03); no significant differences in total cholesterol, LDL-C, HDL-C, triglycerides, or blood pressure in primary analysis |
| Adverse Events | Not formally assessed in this meta-analysis; no comparative safety analysis was conducted |
| Funding | None reported |
| Conflicts of Interest | Dr. Abdul Basit reports advisory board roles for Novo Nordisk, Getz Pharma, and Ferozsons; all other authors declare no conflicts |
What Researchers Actually Did
Tahir and colleagues conducted a PRISMA-compliant systematic review and meta-analysis with prospective PROSPERO registration, searching MEDLINE, EMBASE, and Cochrane CENTRAL through October 5, 2025. From an initial pool of 15,220 records, 15 studies met eligibility criteria: adults aged 18 or older with a BMI above 30 kg/m², receiving any FDA-approved GLP-1 receptor agonist, compared against a recognized bariatric surgical procedure. Studies examining combined or sequential use of both therapies were excluded. Four of the 15 studies were randomized controlled trials; the remaining 11 were observational. Sample sizes ranged from 18 to 10,960 participants.
Pooled mean differences were calculated using random-effects models. Outcomes were stratified by follow-up duration: 6 months, ≤1 year, and >1 year. When only baseline and endpoint data were available, change-from-baseline standard deviations were estimated using a conservative correlation coefficient of r=0.7. Heterogeneity was quantified using the I² statistic, and leave-one-out sensitivity analyses were performed for outcomes where I² exceeded 50%. Meta-regression using Meta Essentials v1.5 was applied specifically to the BMI outcome to evaluate study-level moderators: mean age, baseline BMI, percentage of male participants, and baseline HbA1c percentage.
Key Findings: Primary Outcomes
- Weight loss at 6 months: Bariatric surgery produced a numerically greater reduction (MD −12.19 kg; 95% CI −28.08 to 3.71; p=0.13; I²=98%) but this did not reach statistical significance. After excluding one outlier study (Masrur 2025), heterogeneity was eliminated and the difference became significant (MD −4.54 kg; 95% CI −7.39 to −1.69; p=0.002; I²=0%).
- Weight loss at ≤1 year: Bariatric surgery produced significantly greater weight reduction (MD −16.97 kg; 95% CI −31.59 to −2.36; p=0.02; I²=97%).
- Weight loss at >1 year: The advantage of bariatric surgery increased further (MD −19.78 kg; 95% CI −24.55 to −15.00; p<0.001; I²=74%).
- BMI reduction at 6 months: Bariatric surgery produced a significantly greater BMI reduction (MD −6.77 kg/m²; 95% CI −12.28 to −1.27; p=0.02; I²=99%).
- BMI reduction at ≤1 year: The between-group difference remained significant (MD −5.10 kg/m²; 95% CI −8.00 to −2.21; p<0.001; I²=97%).
- BMI reduction at >1 year: Persistent and significant advantage for bariatric surgery (MD −6.61 kg/m²; 95% CI −7.67 to −5.54; p<0.001; I²=79%).
Key Findings: Secondary Outcomes and Subgroup Analyses
- HbA1c at ≤1 year: No statistically significant difference (MD −2.13%; 95% CI −4.46 to 0.20; p=0.07; I²=97%). After removing Stenberg 2024, this became significant (MD −0.83%; 95% CI −1.37 to −0.29; p=0.002; I²=46%).
- HbA1c at >1 year: Bariatric surgery achieved a significantly greater reduction (MD −1.69%; 95% CI −2.56 to −0.82; p<0.001; I²=97%).
- Fasting blood glucose (overall): Bariatric surgery was associated with significantly greater reduction (MD −1.22 mmol/L; 95% CI −2.29 to −0.15; p=0.03; I²=86%). After removing Capristo 2018, the effect strengthened with reduced heterogeneity (MD −1.53 mmol/L; p<0.001; I²=17%).
- Lipid profile: No significant between-group differences for triglycerides (p=0.11), total cholesterol (p=0.81), HDL-C (p=0.07), or LDL-C (p=0.64) in primary analysis. Sensitivity analysis excluding Capristo 2018 revealed a significant reduction in triglycerides (MD −0.50 mmol/L; p=0.02) and HDL-C (MD −0.24 mmol/L; p<0.001) favoring bariatric surgery.
- Blood pressure: No significant difference in systolic (MD −1.18 mmHg; p=0.53; I²=0%) or diastolic BP (MD +0.11 mmHg; p=0.93; I²=0%) , notably, these were the only outcomes with no measurable heterogeneity.
- Liraglutide subgroup (3 studies): No significant BMI difference (MD −5.95 kg/m²; p=0.07; I²=98%), but significantly greater weight loss favored bariatric surgery (MD −16.99 kg; p<0.001; I²=97%).
- Semaglutide subgroup (3 studies): Bariatric surgery produced significantly greater BMI reduction (MD −4.58 kg/m²; p<0.001; I²=98%) and weight loss (MD −16.83 kg; p<0.001; I²=99%).
- Meta-regression (BMI primary outcome): Higher mean age (coefficient 0.42; p=0.01), higher proportion of male participants (coefficient 0.16; p=0.006), and higher baseline BMI (coefficient −0.52; p<0.001) were each independently associated with greater BMI reduction from bariatric surgery. Baseline HbA1c was not a significant moderator (p=0.896).
Adverse Events and Safety Profile
This meta-analysis did not include a formal comparative safety analysis. No pooled data on surgical complication rates, GLP-1 RA-associated gastrointestinal adverse effects, postoperative nutritional deficiencies, or thyroid neoplasm risk were reported. The authors explicitly acknowledge this as a study limitation. Clinicians should not use this paper to make comparative safety determinations between the two interventions.
Statistical Approach and Rigor
The analysis used random-effects models for continuous outcomes and quantified heterogeneity with the I² statistic. That choice matters because the included studies differed substantially in design, follow-up duration, procedures, medication exposure, baseline BMI, diabetes status, and sample size. A fixed-effect model would have implied a level of uniformity that this evidence base does not support.
The authors also performed leave-one-out sensitivity analyses when heterogeneity exceeded 50%, which was important because several primary and secondary endpoints had very high I² values. In several places, removing a single influential study meaningfully changed either heterogeneity or statistical significance. That does not erase the overall signal favoring bariatric surgery for weight and BMI outcomes, but it does mean the pooled estimates should be read as directional evidence rather than precise clinical forecasts.
The meta-regression adds a useful but limited layer. Older mean age, higher baseline BMI, and a higher proportion of male participants were associated with larger BMI reduction after bariatric surgery, while baseline HbA1c was not a significant moderator. Because these are study-level moderators, they should not be treated as individual prediction rules for a specific patient.
Read This Paper Through Nine Different Lenses
The same evidence can produce very different conclusions depending on what question is being asked. Explore this study through multiple physician-guided interpretive frameworks.
Overview
This paper is not merely saying that one intervention produced more weight loss than another. It is showing how the obesity treatment conversation changes when outcomes are separated by time horizon. At 6 months, weight loss did not differ significantly in the primary pooled analysis, but by 1 year and beyond 1 year, the advantage moved clearly toward bariatric surgery for weight and BMI outcomes.
The structural meaning is that durability matters. A short-window comparison can make pharmacologic and procedural approaches appear closer than they look when the follow-up window lengthens. That does not make GLP-1 receptor agonists weak treatments. It does remind readers that “effective” and “most durable in pooled long-term comparisons” are not the same claim.
The study also keeps the institutional conversation honest by reporting where surgery did not clearly outperform GLP-1 receptor agonists. Lipids and blood pressure did not show significant between-group differences in the primary analysis, and safety was not formally compared.
- The central signal is stronger for weight, BMI, and longer-term glycemic outcomes than for lipids or blood pressure.
- The findings are shaped by high heterogeneity, especially in several weight, BMI, and HbA1c analyses.
- The paper compares outcomes, but it does not solve patient selection, safety tradeoffs, access, or preference-sensitive decision-making.
- Its strongest public value is framing obesity care as longitudinal rather than episodic.
Patient Takeaway
For a patient, the most reasonable takeaway is that bariatric surgery produced greater average long-term weight and BMI reduction in this pooled evidence base. That is meaningful, especially for people trying to understand why clinicians may still discuss surgery even in the era of powerful GLP-1 medications.
But this paper cannot tell an individual patient which path is right. It does not formally compare surgical complications, nutritional deficiencies, medication side effects, quality of life, cost, adherence, reversibility, recovery time, or how a person feels living with either intervention. Those are not minor details. They are often the details that determine whether a treatment is tolerable and sustainable.
A careful patient should read this as an expectation-setting paper rather than a decision-making shortcut. It supports the idea that surgery can produce larger durable changes in selected adults with obesity, while also showing why personal medical context remains essential.
- Average results do not predict an individual person’s outcome.
- Longer-term weight loss favored surgery, but safety was not pooled or compared.
- Some patients may value reversibility, recovery profile, or medication flexibility differently than maximum weight loss.
- A thoughtful consultation should include metabolic goals, risk tolerance, prior treatment history, and follow-up capacity.
Clinician’s POV
Clinically, this paper supports a more disciplined treatment conversation. For patients with obesity who are comparing medication-based and procedural pathways, the data suggest that bariatric surgery remains a highly potent option for sustained weight and BMI reduction. It also shows longer-term glycemic advantages in the pooled analysis, while lipid and blood pressure outcomes were not significantly different.
The operational task for clinicians is not to convert the paper into a blanket recommendation. It is to use the findings to structure informed consent and shared decision-making. Patients need to understand the magnitude and durability of expected benefit, but they also need a transparent discussion of what this meta-analysis did not evaluate, especially comparative safety.
The meta-regression findings may help frame population-level expectations, but they should not be used as bedside prediction rules. Older mean age, higher baseline BMI, and male proportion were study-level moderators, not validated patient-level selection criteria.
- Documentation should distinguish weight, BMI, glycemic outcomes, lipids, blood pressure, and safety rather than compressing them into one global claim.
- High heterogeneity should temper certainty when counseling about expected magnitude of benefit.
- The absence of comparative safety pooling is clinically important, not a footnote.
- The paper may be most useful in referral conversations and long-term expectation setting.
A Skeptical Read
A skeptical reader would start with the heterogeneity. Several pooled outcomes had I² values in the high range, meaning the included studies were not all estimating the same effect in the same way. The overall direction may favor bariatric surgery, but the spread across studies matters because it signals variability in populations, interventions, follow-up, or measurement.
The comparison also rests on a difficult clinical reality: surgery and GLP-1 receptor agonists are not interchangeable exposures. Surgery involves a procedural event, a perioperative pathway, dietary changes, follow-up structures, and often a different threshold for patient selection. GLP-1 therapy involves ongoing adherence, dose tolerance, access, discontinuation risk, and medication-specific adverse effects. A pooled mean difference can flatten those differences.
Skepticism here does not mean dismissing the findings. It means resisting the temptation to treat the pooled estimate as if it came from one clean, head-to-head, uniformly designed clinical trial.
- High heterogeneity weakens precision even when the direction of effect is consistent.
- Selection effects may influence which patients receive surgery versus medication.
- Follow-up intensity may differ between surgical and medication pathways.
- Outlier removal changed some sensitivity results, which deserves attention.
- Safety absence limits any full benefit-risk comparison.
Study Critic
As a methods critique, the paper has real strengths. It used a PRISMA-compliant design, prospective PROSPERO registration, major database searches, random-effects pooling, duration-stratified outcomes, sensitivity analyses, and meta-regression for BMI. Those choices are appropriate for a mixed and heterogeneous comparative evidence base.
The central vulnerability is that most included studies were observational, and the interventions being compared are structurally different. Randomization was limited, and patient selection may have differed meaningfully between groups. The analysis also combines several GLP-1 receptor agonists and several bariatric or bariatric-endoscopic procedures, which increases clinical breadth but reduces interpretive specificity.
The missing safety analysis is the most important technical omission for clinical translation. Without pooled adverse events, the study can compare selected efficacy outcomes but cannot establish which option has the better overall risk-benefit profile.
- Four RCTs and 11 observational studies create mixed internal validity.
- Multiple GLP-1 agents and multiple procedures make subgroup interpretation harder.
- Several endpoints showed high I², reducing confidence in precise pooled estimates.
- Change-score standard deviations were estimated when not reported, which adds modeling assumptions.
- Safety, quality of life, cost, and adherence were not formally synthesized.
Compared to Past Research
This paper sits inside a rapidly changing obesity treatment landscape. For years, bariatric surgery occupied a category of its own for large and durable weight loss. GLP-1 receptor agonists changed the conversation because pharmacologic therapy began producing weight reductions large enough to invite direct comparison with procedural approaches.
The value of this review is that it does not rely on the broad cultural impression that “the new drugs are catching up.” It organizes available comparative evidence by time point and outcome. That time structure matters because early weight change and longer-term durability are different questions.
The article’s own framing describes the comparative effectiveness question as uncertain, which is the right posture. This analysis narrows some uncertainty for weight, BMI, and glycemic outcomes, but it does not close the broader literature question because safety, adherence, discontinuation, procedure type, medication type, and patient-centered outcomes remain incompletely handled.
- The paper reflects a shift from single-treatment enthusiasm to comparative effectiveness analysis.
- Its time-stratified approach helps separate short-term response from longer-term durability.
- The evidence base remains mixed across RCTs and observational studies.
- The comparison still needs more direct, harmonized, patient-centered research.
Practical Considerations
The practical layer is where a clean statistical finding becomes complicated. Bariatric surgery requires surgical evaluation, perioperative coordination, postoperative nutrition monitoring, complication surveillance, and long-term follow-up. GLP-1 therapy requires prescribing oversight, dose titration, side-effect management, affordability planning, access continuity, and monitoring for discontinuation or weight regain.
The study does not tell health systems which pathway is easier, cheaper, safer, or more acceptable to patients. It also does not answer how to sequence the two approaches, whether one should follow inadequate response to the other, or when combination strategies deserve consideration. Those are the questions that often determine real-world care.
For CED-style interpretation, the practical message is that obesity care cannot be reduced to an endpoint table. Systems must be prepared to support the intervention they recommend.
- Long-term follow-up capacity matters for both surgery and medication.
- Insurance coverage and out-of-pocket costs may shape access more than efficacy data.
- Side-effect counseling differs substantially between procedural and pharmacologic care.
- Patients may need nutritional, behavioral, metabolic, and medication support across the full treatment arc.
- Primary care coordination remains central, even when specialists are involved.
Future Directions
The next useful studies should move beyond broad intervention labels. “Bariatric surgery” includes different procedures with different mechanisms and risk profiles. “GLP-1 receptor agonists” includes different agents, doses, tolerability profiles, adherence patterns, and real-world access barriers. More precise comparisons would help clinicians counsel patients with less abstraction.
Future research also needs to integrate outcomes that this meta-analysis could not fully answer. Comparative safety, nutritional consequences, quality of life, medication discontinuation, weight regain, cost, access, patient preference, and sequencing all matter clinically. Without those outcomes, efficacy remains only one part of the decision.
The strongest next step would be prospective comparative research that follows patients long enough to assess durability and collects adverse events in a standardized way. Registry-based studies could also help if they are designed carefully enough to address confounding and follow-up bias.
- Procedure-specific and medication-specific analyses would improve clinical precision.
- Longer follow-up is needed for durability, regain, and metabolic maintenance.
- Standardized safety and adverse-event reporting should be built into future comparisons.
- Patient-centered outcomes should include function, quality of life, treatment burden, and preference.
- Research on sequencing and combination strategies remains clinically important.
Misreadings & Bad-Faith Takes
The easiest misreading is “bariatric surgery is better than GLP-1 drugs.” That is too blunt. The paper found greater pooled reductions in weight and BMI with surgery at key follow-up windows, and stronger longer-term glycemic outcomes. It did not prove that surgery is better for every patient, every outcome, or every risk-benefit calculation.
A second distortion is “GLP-1 medications do not work.” That is not what the study shows. The comparison favors surgery in several outcomes, but a treatment can be clinically meaningful even when another intervention produces larger average changes in a pooled analysis.
A third distortion is “the safety question is settled.” It is not. The authors did not conduct a formal comparative safety analysis, so this paper should not be used to claim that either approach is safer overall. Surgical complications, nutritional deficiencies, gastrointestinal adverse effects, and other treatment burdens require separate evaluation.
The most dangerous bad-faith version would use the study to push a one-size-fits-all agenda. Obesity care is not a scoreboard. It is a longitudinal medical decision involving physiology, risk, access, preference, and follow-up.
- Do not convert pooled average differences into personal guarantees.
- Do not imply comparative safety when safety was not formally analyzed.
- Do not treat high heterogeneity as a trivial technical detail.
- Do not erase the role of patient preference, access, and clinical suitability.
- Do not use the findings to shame patients for choosing either pathway.
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Frequently Asked Questions
What did this GLP-1 bariatric surgery meta-analysis compare?
It compared weight, BMI, glycemic markers, lipid outcomes, and blood pressure between adults with obesity treated with GLP-1 receptor agonists and adults treated with bariatric surgery across 15 studies.
Which intervention produced greater long-term weight loss?
Bariatric surgery produced significantly greater weight loss at 1 year or less and beyond 1 year, while the 6-month weight difference was not statistically significant in the primary pooled analysis.
How did BMI outcomes compare?
BMI reduction favored bariatric surgery at 6 months, 1 year or less, and beyond 1 year in the pooled analysis.
Did bariatric surgery improve HbA1c more than GLP-1 medications?
HbA1c reduction favored bariatric surgery beyond 1 year. At 1 year or less, the primary pooled comparison did not reach statistical significance, although sensitivity analysis changed that finding after one study was removed.
Were cholesterol and blood pressure outcomes different?
In the primary analysis, serum lipids and blood pressure did not show significant between-group differences. This is important because the strongest signal in the paper was not uniform across every cardiometabolic marker.
Does this study prove bariatric surgery is safer than GLP-1 medication?
No. The meta-analysis did not perform a formal comparative safety analysis, so it should not be used to make broad safety claims about surgery versus GLP-1 receptor agonists.
Why does heterogeneity matter in this paper?
High heterogeneity means the included studies varied substantially. That does not erase the overall pattern, but it does make precise pooled estimates less stable and calls for more careful interpretation.
Which patient characteristics were associated with greater BMI reduction after bariatric surgery?
In study-level meta-regression, older mean age, higher baseline BMI, and a higher proportion of male participants were associated with greater BMI reduction after bariatric surgery. These should not be treated as individual prediction rules.
Should this study change obesity treatment decisions by itself?
No. It can inform counseling, but treatment decisions still require individualized assessment of medical history, risk tolerance, access, preferences, safety, and long-term follow-up capacity.
What research is still needed after this meta-analysis?
Future studies should compare specific procedures and specific GLP-1 agents, standardize safety reporting, include patient-centered outcomes, and clarify sequencing or combination strategies over longer follow-up periods.
