A Cleveland Clinic study has found that weight-loss surgery provides greater long-term health benefits than GLP-1 medications like Ozempic for people with obesity and type 2 diabetes. Over 10 years, surgery patients experienced lower risks of death, heart problems, kidney disease, and eye damage. The research highlights surgery's advantages even amid advances in obesity drugs.
The Cleveland Clinic's M6 study, published in Nature Medicine, compared outcomes for 3,932 adults with obesity and type 2 diabetes treated at the clinic over up to a decade. Of these, 1,657 underwent metabolic surgery such as gastric bypass or sleeve gastrectomy, while 2,275 received GLP-1 receptor agonist medications, including semaglutide (Ozempic, Wegovy), liraglutide (Victoza, Saxenda), dulaglutide (Trulicity), exenatide (Byetta, Bydureon), and tirzepatide (Mounjaro, Zepbound).
After 10 years, surgery patients showed a 32% lower risk of death, 35% lower risk of major heart problems like heart attack, heart failure, or stroke, 47% lower risk of serious kidney disease, and 54% lower risk of diabetes-related eye damage (retinopathy). They also lost 21.6% of their body weight on average, compared to 6.8% for those on GLP-1 drugs. Blood sugar control improved more with surgery, with hemoglobin A1c dropping by 0.86% versus 0.23% for medication users. Surgical patients required fewer prescriptions for diabetes, blood pressure, and cholesterol management.
"Even with today's best medicines, metabolic surgery offers unique and lasting benefits for people with obesity and diabetes," said Ali Aminian, M.D., director of Cleveland Clinic's Bariatric & Metabolic Institute and the study's primary investigator. "The benefits we observed went beyond weight loss. Surgery was linked to fewer heart problems, less kidney disease, and even lower rates of diabetes-related eye damage."
Steven Nissen, M.D., Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior author, added: "Even in the era of these powerful new drugs to treat obesity and diabetes, metabolic surgery may provide additional benefits, including a survival advantage."
The authors noted limitations: the study was observational, not randomized, and did not focus exclusively on the newest GLP-1 medicines. They called for future research comparing surgery directly with drugs like semaglutide and tirzepatide.
Dr. Aminian emphasized: "Our findings indicate that surgery should remain an important treatment option for obesity and diabetes. These long-term benefits are harder to achieve with GLP-1 medicines alone, as many patients stop using the medications over time."