A Mayo Clinic study found that both metabolic and bariatric surgery and GLP-1 medications improve cardiovascular health in people with obesity, but surgery was associated with significantly greater reductions in long-term cardiovascular risk. The findings were published in Annals of Surgery.
The study is a direct comparison of two leading obesity treatments, evaluating how each approach affects overall risk of cardiovascular disease.
"Both treatments are effective, but surgery appears to provide a greater reduction in long-term cardiovascular risk, especially when it leads to larger and more sustained weight loss," says Wissam Ghusn, M.D., a Mayo Clinic research collaborator and first author of the study.
Researchers analyzed outcomes for 812 adults with obesity, including 579 who underwent metabolic and bariatric surgery and 233 who received GLP-1 medications.
Key findings:
- Lifetime cardiovascular risk decreased more with surgery (declining 8.6% versus 1.7%).
- Weight loss was significantly greater with surgery, averaging nearly 28% of total body weight compared with about 11% among those treated with medications.
Obesity is a major contributor of heart disease, stroke and diabetes, making effective treatment critical for long-term health. While GLP-1 medications have gained attention for their role in weight management, the findings highlight differences in how treatment options may affect long-term outcomes.
Importantly, researchers say the findings are not about choosing one treatment over another, but about better aligning treatment decisions with long-term health goals.
"This study reinforces that obesity treatment should be viewed as a strategy to reduce cardiovascular risk, not just body weight," says Omar Ghanem, M.D., a metabolic surgeon and chair of the Division of Metabolic and Abdominal Wall Reconstructive Surgery at Mayo Clinic in Rochester. "It supports a more individualized, patient-centered approach where treatment decisions are based on long-term health impact."
The study also found that greater weight loss was closely linked to larger reductions in lifetime cardiovascular risk, particularly among patients who lost more than 20% of their body weight after surgery.
The findings may encourage earlier and more balanced discussions about treatment options, including considering surgery as a front-line option for some patients, rather than a last resort, while continuing to support the growing role of effective medications.
"Rather than thinking of these treatments as competing options, we should view them as complementary tools," says Dr. Ghanem. "Both surgery and medications play important roles in reducing long-term cardiovascular risk, and the right approach depends on the individual patient."
Researchers note that longer-term studies are needed to evaluate clinical outcomes such as heart attacks, strokes and survival, as well as the durability of medication-based therapies and the potential benefits of combining surgical and medical approaches.
For a complete list of authors, disclosures and funding, review the study.
