It has been newly shown in recent systematic reviews of the literature that, among treatment options, there are marked differences in weight-loss. Presented at the 2024 Annual Scientific Meeting of the American Society for Metabolic and Bariatric Surgery, Rutgers University research drives home that metabolic or weight-loss surgery is time and again associated with the greatest and most lasting degree of weight loss in comparison with interventions using GLP-1 receptor agonists or lifestyle intervention.
Studies from 2020-2024 for weight loss strategies mainly based on lifestyle intervention, including diet and exercise, typically result in an average weight loss of approximately 7.4%. However, the amount regained in an average of 4.1 years revealed major downsides to these diets. In contrast, more promising results were brought about with pharmacological treatment applying GLP-1 receptor agonists such as semaglutide and tirzepatide. For semaglutide, dosed by weekly injections for five months, the average body weight lost was 10.6 percent; tirzepatide dosed for nine months dropped an impressive 21.1 percent in body weight. In both cases, however, this lost approximately half of the returned weight after a year of maintenance—once treatment had ended—which was independent of the drug used. At this point, patients who continued treatment saw those on tirzepatide leveling off at 22.5% in weight loss and, comparably, those on semaglutide leveling off at 14.9% over the same period.
Metabolic and bariatric surgeries, in particular, had even greater weight loss outcomes than others; gastric bypass surgery logged an average total weight loss of 31.9%, while sleeve gastrectomy recorded 29.5% one year after surgery. These surgical interventions, in fact, proved that a 25% loss of weight could be maintained in excess of ten years post-intervention, hence their long-term efficacy.
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Dr. Marina Kurian, co-author and noted bariatric surgeon at NYU Langone Health, observed that metabolic and bariatric surgery remains the most effective and durable treatment modality for severe obesity but is underutilized. She pushed for consideration of these procedures earlier in the treatment continuum for obesity, rather than as a last resort, and said they have evolved toward increased safety and efficacy over time: “…metabolic and bariatric surgery remains the most effective and durable treatment modality for severe obesity, but it’s underutilized. Procedures should be considered earlier in the treatment continuum for obesity, rather than a last resort, and have evolved toward increased safety and efficacy over time.”.
Tirezpatide is a new dual GLP-1 and GIP receptor agonist developed for the treatment of type 2 diabetes and obesity. It not only improved glucose control in patients but also induced important weight reduction. Although this surgery yields very promising results, an ASMBS 2022 report revealed that only about 1% of the eligible population in the U.S. underwent metabolic and bariatric surgery, indicating the underutilization of effective interventions to reduce health risks due to obesity.
The systematic review conducted at Rutgers University represented an all-inclusive analysis of several studies and clinical trials involving nearly 20,000 patients. In this study, the researchers investigated and comparatively assessed the efficacy of lifestyle interventions, GLP-1 RA, and metabolic and bariatric surgery in ensuring long-term weight loss. This very tight review exists to be underscored with very strong evidence of proof about the preeminence of bariatric surgery over the other weight-loss interventions, despite their variable efficacy and limitations.
This paper emphasizes the need for individualized approaches in fighting obesity, based on the assessment of individual needs of patients and efficacy profiles of treatments. The findings support the fact that while lifestyle interventions and pharmacological treatments achieve initial weight loss by such interventions, most of them tend to fail in terms of long-term outcomes. In contrast, metabolic and bariatric surgeries have time and again shown better durability to bring about significant weight reduction and improvement of health status for people who are severely obese.
In the future, considerations will have to be given to the growing imperative of increasing awareness among health providers and patients of metabolic and bariatric surgeries’ efficacy and safety, as well as their incorporation early in the possible treatment algorithm of obesity if there has to be an improvement in outcomes both in health and quality of life for affected persons. Further, ongoing research into newer techniques of bariatric surgery and pharmacologic treatments holds promise for still better treatments and harvesting the complex challenges associated with the management of obesity.
This study from Rutgers University, besides the comparisons of weight loss between different interventions, also investigates related metabolic benefits. Not only do metabolic and bariatric surgeries decrease body weight, but they also significantly improve or resolve various comorbid conditions, including type 2 diabetes, hypertension, and obstructive sleep apnea. Metabolic improvements after surgery are mainly rapid and hence provide improved health and quality of life for patients.
For instance, gastric bypass surgery is highly effective in improving glycemic control among diabetic patients. Studies have described that in the immediate postoperative period, many patients show a significant fall in blood sugar, thereby enhancing the remission of diabetes. This metabolic effect occurs as a result of alterations in gut hormone secretion and increased insulin sensitivity during the surgical alteration of the gastrointestinal tract.
GLP-1 receptor agonists, however, like semaglutide and tirzepatide, exert beneficial actions on parameters of metabolism quite independent of weight reduction. This latter group of drugs increases insulin sensitivity, lowers fasting blood glucose levels, and enhances feelings of satiety, all mechanisms that could underlie their success in treating both obesity and type 2 diabetes. GLP-1 receptor agonists have important dual benefits of weight reduction and improvement in metabolic health, thus leading to the conclusion that GLP-1 receptor agonists are valuable therapeutic options in the treatment of obesity-associated metabolic disorders in affected persons.
Though the results with metabolic and bariatric surgeries, as well as with GLP-1 receptor agonists, were very promising, this Rutgers study has also brought out some considerations and challenges with these interventions. All surgical procedures come with a potential for risks related to the surgery itself, such as anesthesia, infections, and long-term nutritional deficiencies. In addition, patient selection criteria and rigorous post-operative care protocols are critical in optimizing chances of success and minimizing risks with these invasive procedures.
It is also the case that major high-order obstacles to bariatric surgeries and pharmacological treatments exist for many who suffer from obesity. Notably, surgical interventions are expensive in most cases and certainly not within the budget of health insurance for people to whom they would otherwise be recommended. Likewise, GLP-1 receptor agonists quite often come with a high price tag and demand continuous refills via prescription throughout life, raising adherent barriers.
These issues, therefore, show that there is still much research and advocacy to be done to redress the imbalance in access to obesity-effective therapy, and hence better outcomes for various patient populations. The agenda shall emphasize cooperation among healthcare professionals, decision-makers, and advocacy organizations toward fine access to comprehensive care for obesity through lifestyle interventions, pharmacotherapy, or surgical options. It is in addressing these challenges and broadening the treatment options that the healthcare community can most enable the support of the individual towards a sustainable weight loss goal corresponding to improved health outcomes.
Source: SciTechDaily
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