Cardiovascular and diabetes outcomes after metabolic bariatric surgery versus obesity management medications: nationwide overlap-weighted cohort study of 379 858 patients
In brief
Bariatric surgery linked to 45% lower kidney disease risk over five years
In a weighted nationwide cohort of adults with obesity and type 2 diabetes, kidney disease developed in 4.5% after bariatric surgery versus 8.3% after starting obesity medications over five years; eye disease, major cardiovascular events, and death were also less common. Surgery was linked to greater weight loss and blood sugar normalization at one year, but the observational design cannot prove it caused these advantages.
- Journal
- The British journal of surgery (Q1)
- Published
- 31 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Andrew P Gillikin, Emily P Rabinovich, Abdelrahman A Nimeri, Ali Tavakkoli, Thomas H Shin
- PMID
- 42975202
- DOI
- 10.1093/bjs/znag139
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 4 November 2026): Direct comparison of bariatric surgery and obesity medications, including clinical
Abstract
BACKGROUND: Metabolic bariatric surgery (MBS) and incretin-based therapy (IBT) are effective treatments for obesity and type 2 diabetes (T2D). However, their comparative effectiveness in current practice remains incompletely defined. METHODS: Adults aged ≥18 years with obesity and T2D who underwent MBS or initiated obesity management medications (OMMs) were identified. The median follow-up was 4.9 (interquartile range (i.q.r.) 3.6-6.7) years for MBS and 4.3 (i.q.r. 3.4-5.8) years for IBT. Overlap weighting balanced baseline covariates between groups. Five-year outcomes included nephropathy, retinopathy, major adverse cardiovascular events (MACE), and all-cause mortality. One-year outcomes included percentage total weight loss (%TWL) and rates of haemoglobin A1c (HbA1c) <6.5%. RESULTS: In total, 379 858 adults met the inclusion criteria (32 401 underwent MBS and 347 457 initiated OMMs). After overlap weighting, baseline covariates were well balanced. Compared with OMMs, MBS was associated with lower 5-year cumulative incidences of nephropathy (4.5% versus 8.3%; -3.8% points; HR 0.55 (95% c.i. 0.52 to 0.60)), retinopathy (3.6% versus 7.4%; -3.8% points; HR 0.60 (95% c.i. 0.55 to 0.65)), MACE (6.1% versus 8.1%; -2.0% points; HR 0.78 (95% c.i. 0.73 to 0.84)), and all-cause mortality (2.1% versus 3.7%; -1.6% points; HR 0.61 (95% c.i. 0.55 to 0.69)). At 1 year, the mean %TWL was greater after MBS (25.4% (95% c.i. 25.3% to 25.5%)) than after OMMs (6.4% (95% c.i. 6.3% to 6.5%)). Among patients with baseline HbA1c ≥6.5%, the proportion achieving HbA1c <6.5% at 1 year was higher after MBS (76.7% (95% c.i. 75.3% to 78.0%)) than after OMMs (47.2% (95% c.i. 46.2% to 48.1%); P < 0.001). Findings were consistent across agent-stratified, competing-risk, landmark, and no-censoring sensitivity analyses. CONCLUSION: 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, supporting the role of MBS as a durable therapy in multimodal obesity management.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.