Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines
Obesity is a chronic, relapsing disease with multifactorial origins and significant global health implications. Historically, bariatric surgery has been the most effective intervention for achieving sustained weight loss and metabolic improvement, especially in individuals with moderate to severe ob...
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MDPI AG
2025-07-01
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| Online Access: | https://www.mdpi.com/1648-9144/61/7/1292 |
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| author | Safi G. Alqatari Abrar J. Alwaheed Manal A. Hasan Reem J. Al Argan Marj M. Alabdullah Mohammed D. Al Shubbar |
| author_facet | Safi G. Alqatari Abrar J. Alwaheed Manal A. Hasan Reem J. Al Argan Marj M. Alabdullah Mohammed D. Al Shubbar |
| author_sort | Safi G. Alqatari |
| collection | DOAJ |
| description | Obesity is a chronic, relapsing disease with multifactorial origins and significant global health implications. Historically, bariatric surgery has been the most effective intervention for achieving sustained weight loss and metabolic improvement, especially in individuals with moderate to severe obesity. However, the therapeutic landscape is rapidly evolving. Recent advances in pharmacotherapy—including GLP-1 receptor agonists, dual and triple incretin agonists, and amylin-based combination therapies—have demonstrated unprecedented efficacy, with some agents inducing 15–25% weight loss, approaching outcomes once exclusive to surgical intervention. These developments challenge the continued applicability of existing bariatric surgery criteria, which were established in an era of limited medical alternatives. In this narrative review, we examine the evolution of surgical eligibility thresholds and critically assess the potential role of novel pharmacotherapies in redefining treatment algorithms. By comparing the efficacy, safety, metabolic benefits, and cost-effectiveness of surgery versus next-generation drugs, we explore whether a more stepwise, pharmacotherapy-first approach may now be justified, particularly in patients with BMI 30–40 kg/m<sup>2</sup>. We also discuss future directions in obesity management, including personalized treatment strategies, perioperative drug use, and the integration of pharmacologic agents into long-term care pathways. As the field advances, a paradigm shift toward individualized, minimally invasive interventions appears inevitable—necessitating a timely re-evaluation of current bariatric surgery guidelines to reflect the expanding potential of medical therapy. |
| format | Article |
| id | doaj-art-293d8b52be36486eaa58e61393ff9abc |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-293d8b52be36486eaa58e61393ff9abc2025-08-20T03:07:58ZengMDPI AGMedicina1010-660X1648-91442025-07-01617129210.3390/medicina61071292Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery GuidelinesSafi G. Alqatari0Abrar J. Alwaheed1Manal A. Hasan2Reem J. Al Argan3Marj M. Alabdullah4Mohammed D. Al Shubbar5Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi ArabiaDepartment of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi ArabiaDepartment of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi ArabiaDepartment of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi ArabiaDepartment of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi ArabiaDepartment of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi ArabiaObesity is a chronic, relapsing disease with multifactorial origins and significant global health implications. Historically, bariatric surgery has been the most effective intervention for achieving sustained weight loss and metabolic improvement, especially in individuals with moderate to severe obesity. However, the therapeutic landscape is rapidly evolving. Recent advances in pharmacotherapy—including GLP-1 receptor agonists, dual and triple incretin agonists, and amylin-based combination therapies—have demonstrated unprecedented efficacy, with some agents inducing 15–25% weight loss, approaching outcomes once exclusive to surgical intervention. These developments challenge the continued applicability of existing bariatric surgery criteria, which were established in an era of limited medical alternatives. In this narrative review, we examine the evolution of surgical eligibility thresholds and critically assess the potential role of novel pharmacotherapies in redefining treatment algorithms. By comparing the efficacy, safety, metabolic benefits, and cost-effectiveness of surgery versus next-generation drugs, we explore whether a more stepwise, pharmacotherapy-first approach may now be justified, particularly in patients with BMI 30–40 kg/m<sup>2</sup>. We also discuss future directions in obesity management, including personalized treatment strategies, perioperative drug use, and the integration of pharmacologic agents into long-term care pathways. As the field advances, a paradigm shift toward individualized, minimally invasive interventions appears inevitable—necessitating a timely re-evaluation of current bariatric surgery guidelines to reflect the expanding potential of medical therapy.https://www.mdpi.com/1648-9144/61/7/1292anti-obesity agentsbariatric surgeryobesityweight loss medicationsglucagon-like peptide 1 |
| spellingShingle | Safi G. Alqatari Abrar J. Alwaheed Manal A. Hasan Reem J. Al Argan Marj M. Alabdullah Mohammed D. Al Shubbar Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines Medicina anti-obesity agents bariatric surgery obesity weight loss medications glucagon-like peptide 1 |
| title | Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines |
| title_full | Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines |
| title_fullStr | Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines |
| title_full_unstemmed | Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines |
| title_short | Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines |
| title_sort | pharmacologic disruption how emerging weight loss therapies are challenging bariatric surgery guidelines |
| topic | anti-obesity agents bariatric surgery obesity weight loss medications glucagon-like peptide 1 |
| url | https://www.mdpi.com/1648-9144/61/7/1292 |
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