A new Mayo Clinic study compared bariatric surgery with GLP-1 weight-loss medications in adults with obesity.
Both treatments improved cardiovascular health, but surgery was linked to larger reductions in long-term heart disease risk.
Researchers say the findings support a more personalized approach to obesity treatment rather than viewing medications and surgery as competing options.
For years, bariatric surgery was often seen as a last-resort option for people struggling with obesity. But as newer GLP-1 medications such as semaglutide and tirzepatide have surged in popularity, doctors and researchers have been taking a closer look at how these treatments compare — especially when it comes to long-term health, not just the number on the scale.
Now, a new study from Mayo Clinic suggests that while both approaches can improve cardiovascular health, bariatric surgery may provide a greater reduction in long-term heart disease risk. The research, published in the journal Annals of Surgery, focused on adults with obesity and examined how different treatment approaches affected estimated cardiovascular risk over time.
"This study reinforces that obesity treatment should be viewed as a strategy to reduce cardiovascular risk, not just body weight," researcher Omar Ghanem, M.D. said in a news release.
"It supports a more individualized, patient-centered approach where treatment decisions are based on long-term health impact."
The study
The researchers analyzed outcomes from 812 adults with obesity who were treated between 2020 and 2023 within a large U.S. health system.
Of those participants, 579 underwent metabolic or bariatric surgery, while 233 received GLP-1 receptor agonist medications.
Rather than simply measuring pounds lost, investigators looked at changes in estimated cardiovascular disease risk, including both 10-year and lifetime risk calculations. They also tracked changes in body weight after treatment. The study was observational, meaning researchers reviewed real-world patient outcomes instead of assigning participants to treatments in a randomized trial.
What the study found
According to the findings, both treatments improved cardiovascular risk profiles, but the changes were more substantial among people who underwent surgery.
Lifetime cardiovascular risk declined by 8.6% in the surgery group, compared with 1.7% among patients treated with GLP-1 medications.
Researchers also found that surgery produced greater overall weight loss. On average, patients who had bariatric surgery lost nearly 28% of their body weight, while those taking medications lost about 11%.
The study also found that larger amounts of weight loss were closely tied to greater reductions in cardiovascular risk, particularly among patients who lost more than 20% of their body weight after surgery.
Researchers emphasized that the findings should not be interpreted as an argument against medications. Instead, they say both treatments have an important role in obesity care.
"Rather than thinking of these treatments as competing options, we should view them as complementary tools," says Dr. Ghanem. "Both surgery and medications play important roles in reducing long-term cardiovascular risk, and the right approach depends on the individual patient."
The authors noted that additional long-term studies are still needed to evaluate outcomes such as heart attacks, strokes, survival rates, and how durable medication-related weight loss remains over time.