Psychiatric symptoms, psychological well-being and quality of life after metabolic and bariatric surgery versus incretin-based therapy in obesity: The role of weight loss
In brief
Surgery produced 33 kg weight loss, but no adjusted mental-health edge over drugs
In this 207-person, nonrandomized study, both surgery and incretin-based drugs improved all 16 measures of psychiatric symptoms, well-being and quality of life at six months. Surgery's larger average weight loss, 33 kg versus 17 kg, explained its apparent advantage on some measures; emotion regulation was a possible exception, and longer-term results remain unknown.
- Journal
- General hospital psychiatry (Q1)
- Published
- 4 November 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Mehmet Alptekin Acar, Alparslan Saylar, Serkan Yazıcı, Dilek Gogas Yavuz
- PMID
- 42994195
- DOI
- 10.1016/j.genhosppsych.2026.10.008
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 8 November 2026): Prospective comparison of surgery and incretin therapy
Abstract
BACKGROUND: Metabolic and bariatric surgery (MBS) and incretin-based pharmacotherapy (GLP-1 receptor agonists) cause substantial weight loss, but whether the accompanying psychological improvement is associated with the degree of weight loss or with treatment-specific mechanisms is unclear. OBJECTIVE: To compare changes in psychiatric symptoms, psychological well-being and quality of life after MBS and incretin-based therapy, and to examine the role of weight loss. METHODS: In this prospective, non-randomized cohort study, 207 adults with obesity (MBS, n = 97; incretin-based pharmacotherapy, n = 110 [tirzepatide 87, semaglutide 19, liraglutide 4]) completed 16 psychiatric and quality-of-life scales before treatment and at 6 months. RESULTS: Weight loss was 33.2 ± 9.9 kg with MBS and 16.8 ± 11.5 kg with pharmacotherapy. Both groups improved significantly on all 16 scales (r = 0.28-0.84; all p ≤ 0.02). With pharmacotherapy, improvement correlated with weight loss on all scales (all p ≤ 0.04; |r| = 0.20-0.45); after MBS, no association was observed (all p > 0.5). Crude between-group differences favoring MBS (5/16 scales) disappeared after adjustment for weight loss. Only emotion regulation difficulties showed a significant group × time interaction (coefficient 3.3, 95% CI 0.7-5.9). CONCLUSIONS: Both groups showed improved psychological well-being and quality of life. Improvement tracked weight loss with pharmacotherapy but not after MBS, possibly reflecting less variable weight loss after surgery. The crude advantage of MBS was no longer evident after adjusting for weight loss, suggesting an association with greater weight loss rather than a modality-specific effect, with emotion regulation as a possible exception.
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.