At the Races

A Silly New Horse Race: Surgery Versus Drugs for Obesity

The annual meeting of the ASMBS wrapped up last week in San Diego after producing a steady flow of new insights and headlines. Robotic surgery, long-term outcomes, and diabetes prevention figured prominently in the news. But one of the less enlightening threads of news from the meeting was a horse-race narrative about metabolic surgery versus emerging new drugs for obesity.

All week long, our newsfeeds filled up with headlines on the theme of “surgery more effective than obesity drugs.”

Low Information Value

From this perch, those headlines fail to enlighten in two ways. First, they are not very newsworthy because this has long been true. Metabolic surgery has long been the most highly effective and durable single tool for obesity treatment. But second, this horse-race narrative misses the most important point about the role of surgery and drugs in obesity care.

For the best outcomes, clinicians must work with all the tools available to manage this chronic disease. More often than not, obesity care is not a one-and-done proposition. Duh – it’s a chronic, progressive disease.

A Literature Review

The paper that prompted this flow of headlines was simply a literature review presented as a poster. Though ASMBS issued a press release describing it as a systematic review, we can find no evidence that this is the right description for this study. The study abstract makes no mention of a systematic review and there’s no prespecified protocol for such an approach.

As best we can tell, this was simply a narrative review to make the point that metabolic surgery can yield the best, most durable results for weight loss.


The authors of this study were keen to tell us surgery is “among the most underutilized” treatment for obesity. This might have something to do with anecdotal reports of surgery utilization going down while new obesity medicines are gaining popularity. We can imagine this is making some surgeons nervous about their role in obesity care.

But such a narrow focus misses a much larger point. The future of obesity care is comprehensive. Surgical, medical, nutrition, behavioral, and mental health care all have important roles to play. Different tools have different value for different patients. Rather that implicitly promoting an either/or mentality, obesity care professionals should be working to correct the underutilization of comprehensive obesity care.

Health of patients must come first, and for the best health outcomes, complete care is the only defensible framework.

Click here for the meeting abstract, here for the ASMBS press release, and here for a sample story. For perspective on building a more complete model for obesity care, click here.

At the Races, painting by Edgar Degas / WikiArt

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June 17, 2024

2 Responses to “A Silly New Horse Race: Surgery Versus Drugs for Obesity”

  1. June 17, 2024 at 8:09 am, Nancy Browne said:

    This abstract describes a narrative review of papers that included RCT and systematic reviews. These authors did not actually perform a systematic review, as Mr Kyle points out. Refer to PRISMA for guidelines. While probably a good summary of papers, the analysis in this abstract is different and less rigorous from systematic review no matter how well done. That said, it is the authors prerogative to submit the type of review they choose… but it is a slippery slope to not correct the erroneous press release. Mostly, we will never get anywhere for our patients until we stop protecting our own particular treatment specialty. A missed opportunity for ASMBS and the authors.

  2. June 21, 2024 at 7:43 pm, Val O’Hara,DABOM said:

    Well said Ted!
    We need all tools and equitable access to meet our patients needs first and foremost!
    Seeing the growth of available treatments over the last 2 decades provides so much hope to truly improve the health of our patients