The growing popularity of Ozempic and other weight-loss medicines has changed how obesity is treated and discussed, but bariatric surgery continues to have an important role for people living with severe obesity. Dr Ashish Gautam, Principal Director of Robotic and Laparoscopic Surgery at Max Super Speciality Hospital, Patparganj, New Delhi, said the increasing use of medication has not eliminated the need for surgical treatment, with bariatric specialists continuing to see patients who require more substantial and durable interventions for obesity.
Medicines such as semaglutide, the active ingredient in Ozempic, and other GLP-1-based treatments can help patients lose weight by affecting appetite and food intake. Their growing use has provided an additional non-surgical option for obesity management. However, the response to these medicines can vary between individuals, and treatment generally requires ongoing medical management. Recent evidence presented by the American Society for Metabolic and Bariatric Surgery (ASMBS) found that bariatric surgery continued to produce greater weight loss than GLP-1 medicines in large real-world comparisons, although both approaches can be effective for appropriate patients.
For people with severe obesity, surgery can provide substantial and sustained weight loss while also addressing obesity-related health problems. Procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass remain established options in metabolic and bariatric care. Current ASMBS-IFSO guidance recommends metabolic and bariatric surgery for people with a BMI of 35 or higher, regardless of whether obesity-related complications are present. The guidance also says surgery should be considered for selected people with a BMI between 30 and 34.9 when non-surgical approaches fail to produce substantial or durable weight loss or improvement in obesity-related conditions.
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Importantly, the emergence of GLP-1 medicines does not necessarily mean medication and surgery must be viewed as competing treatments. New research presented in 2026 found that patients who received GLP-1 medicines before bariatric surgery were still able to achieve substantial additional weight loss after undergoing an operation. In that study, patients who used semaglutide or tirzepatide before surgery lost about 8% of their body weight before the procedure, with total weight loss rising to more than 25% among those who subsequently underwent gastric bypass and about 20% among those who had sleeve gastrectomy.
The role of surgery can also extend beyond initial weight reduction. Obesity is a chronic condition associated with metabolic and other health complications, and bariatric procedures can contribute to improvement or remission of conditions linked to excess weight. At the same time, surgery is not appropriate for everyone and requires assessment of medical history, obesity severity, nutritional status, surgical risks and the patient's ability to follow long-term care. Likewise, GLP-1 medicines can be valuable for patients who are suitable for pharmacological treatment, making individualised medical evaluation important rather than assuming one approach is appropriate for everyone.
As obesity care continues to evolve, the growing availability of weight-loss medicines is expanding treatment choices rather than making established interventions obsolete. Bariatric surgery remains an evidence-based option for eligible patients with severe obesity, while GLP-1 medicines offer another tool that can be used independently or, in selected cases, alongside surgical care. Recent evidence also suggests that prior GLP-1 treatment does not prevent patients from benefiting from subsequent bariatric surgery, reinforcing the importance of choosing treatment according to individual clinical needs rather than treating medication and surgery as mutually exclusive approaches.
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