ENDO2025: A Fresh View of Medical and Surgical Obesity Care
At ENDO2025 Saturday, we got a fresh view of the future that lies ahead for medical and surgical obesity care. In a sharp contrast to either/or constructs that pit medical and surgical care as rivals, endocrinology fellow Angela Rao presented data pointing to complementary roles for medical and surgical obesity care.
Analyzing data from 846 patients receiving metabolic and bariatric surgery, Rao and colleagues found that combining GLP-1 therapies with surgery – both before and after surgery – might result in optimal outcomes for patients.
Looking Beyond Treating Regain
Rao emphasized the importance of looking beyond a limited role for medicines in treating weight regain after surgery:
“Patients on GLP-1 receptor agonists both preoperative and postoperatively relative to bariatric surgery experienced the greatest weight loss in a real-world environment. Existing studies have focused on GLP-1’s primarily for weight regain, but our findings highlight the potential as adjunctive therapy for weight loss during the critical perioperative period.
“With surgery, you get altered gut anatomy and hormonal feedback leading to more L-cell stimulation and GLP-1 release, and synthetic analogues work in multiple pathways as well, including the pancreas, brain, and gut. Together, this may compliment the metabolic effect of surgery.”
Obsolete Zero-Sum Thinking
The disruptive effects of advanced obesity medicines has prompted a lot of zero-sum thinking. Will these remarkable medicines make metabolic surgery obsolete? Though we hear that question often, it doesn’t really point us to the future of obesity care. Nor do press releases touting surgery as “superior” to GLP-1s for obesity.
The real future of obesity will come with the emergence of integrated medical and surgical obesity care – something we noticed emerging seven years ago. Today the trend is supercharged because professionals who are serious about patient-centered care see its potential.
There was a time when surgical approaches to treating breast cancer were overwhelmingly dominant. But today, no one thinks in terms of pitting surgical and medical oncology against each other. The focus is on precision care, tailored to individual patient needs and informed by robust evidence.
In obesity care, we are at the beginning of that journey. As Rao points out, much more research will be necessary to guide an integrated care model. But the promise for this approach is great.
Click here for the abstract of Rao’s presentation and here for further reporting. For additional views of the potential for comprehensive obesity treatment, click here and here.
Sail – In Two Movements, painting by Charles Demuth / WikiArt
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July 15, 2025
July 15, 2025 at 9:35 am, GLP-1s as a first-line treatment prior to surgery... said:
I’d like to promote some conversation on something dietitians have been experiencing for a while. RDNs have seen first-hand how effective both surgery and GLP-1s can be. What, then, is their role when a patient comes in for pre-surgical nutrition counseling but GLP-1s haven’t been mentioned or tried? Some dietitians appear to be afraid of overstepping or offending surgeons. While RDNs have NO role in prescribing meds, shouldn’t these effective meds, at minimum, be CONSIDERED as a first-line treatment (unless contraindicated) prior to bariatric surgery by all providers, including surgeons? (Please limit comments to medical considerations only rather than including financial ones in this conversation. Financial limitations, while very real for SOME patients, appear to be a scapegoat on this subject.)