Surgery beats Ozempic for long-term health, Cleveland Clinic finds

Over a 10-year period, patients who underwent weight-loss surgery (also called bariatric or metabolic surgery) lost more weight, maintained better blood sugar control, and needed fewer prescriptions for diabetes and heart conditions. The study was published in Nature Medicine.

"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 primary investigator of the study. "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."

GLP-1 (glucagon-like peptide-1) receptor agonists are a group of medications commonly prescribed to manage type 2 diabetes and obesity and to lower related health risks. Both GLP-1 drugs and metabolic surgery are known to improve cardiovascular and metabolic health.

The M6 study (Macrovascular and Microvascular Morbidity and Mortality after Metabolic Surgery versus Medicines) tracked 3,932 adults with obesity and diabetes who received care at Cleveland Clinic for up to a decade. Of these, 1,657 underwent metabolic surgery (such as gastric bypass or sleeve gastrectomy) while 2,275 were treated with GLP-1 medicines (including liraglutide, dulaglutide, exenatide, semaglutide, and tirzepatide).

After 10 years, those who had surgery showed significantly better outcomes, including a:

• 32% lower risk of death
• 35% lower risk of major heart problems (such as heart attack, heart failure, or stroke)
• 47% lower risk of serious kidney disease
• 54% lower risk of diabetes-related eye damage (retinopathy)

On average, surgical patients lost 21.6% of their body weight, compared with 6.8% among those taking GLP-1 medicines. Blood sugar control, measured by hemoglobin A1c, improved more with surgery (-0.86%) than with medication (-0.23%). People who had surgery also needed fewer prescriptions for diabetes, blood pressure, and cholesterol management.

"Even in the era of these powerful new drugs to treat obesity and diabetes, metabolic surgery may provide additional benefits, including a survival advantage," said Steven Nissen, M.D., Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior author of the study.

"Our findings indicate that surgery should remain an important treatment option for obesity and diabetes," said Dr. Aminian. "These long-term benefits are harder to achieve with GLP-1 medicines alone, as many patients stop using the medications over time."

According to the authors, the study has some limitations. It was observational rather than a randomized comparison of drugs and surgery, and it did not focus exclusively on the newest and most effective GLP-1 medicines. The researchers note that future studies should directly compare surgery with newer GLP-1 therapies, such as semaglutide and tirzepatide, to further guide treatment decisions.