Among adults with obesity and T2D, MBS was associated with greater %TWL, higher glycaemic normalization, and lower 5-year risks of nephropathy, retinopathy, MACE, and all-cause mortality compared with real-world initiation of OMMs among patients in clinical equipoise.
Metabolic bariatric surgery was associated with a lower 5-year cumulative incidence of nephropathy than obesity management medications.
MBS was associated with a lower 5-year cumulative incidence of retinopathy than OMMs.
MBS was associated with a lower 5-year risk of major adverse cardiovascular events (MACE) than OMMs.
MBS was associated with lower 5-year all-cause mortality than OMMs.
One-year weight loss was substantially greater after MBS than after OMMs.
Among patients with baseline HbA1c ≥6.5%, a higher proportion reached HbA1c <6.5% at 1 year after MBS than after OMMs.
The findings were consistent across multiple sensitivity analyses, and baseline covariates were well balanced after overlap weighting.
This large U.S. nationwide study compared two ways of treating adults who have both obesity and type 2 diabetes: metabolic bariatric (weight-loss) surgery and obesity medications, including newer incretin-based drugs. It included about 380,000 people, of whom roughly 32,000 had surgery and 347,000 started medications. Researchers used a statistical method called overlap weighting to make the two groups as similar as possible at the start, and followed people for about 4 to 5 years. Over five years, people who had surgery were less likely to develop kidney disease (4.5% vs 8.3%), eye disease (3.6% vs 7.4%), major cardiovascular events such as heart attack or stroke (6.1% vs 8.1%), or die from any cause (2.1% vs 3.7%). At one year, surgery patients lost about 25% of their body weight versus about 6% with medications. Among those with elevated blood sugar at the start, about 77% of surgery patients reached an HbA1c below 6.5%, compared with about 47% of medication patients. The results held up across several additional checks. This research suggests that surgery may offer larger and longer-lasting benefits than medications as typically used in real-world practice. However, this is an observational study, so it cannot prove that surgery caused these differences, and real-world medication use (including adherence and dosing) may differ from clinical-trial use. The authors frame surgery as one durable option within multimodal obesity care.
Gillikin A, Rabinovich E, Nimeri A, Tavakkoli A, Shin T. (2026). Cardiovascular and diabetes outcomes after metabolic bariatric surgery versus obesity management medications: nationwide overlap-weighted cohort study of 379 858 patients.. The British journal of surgery. https://doi.org/10.1093/bjs/znag139