Finding the Universe is Brighter Than We Thought, time lapse photograph from the NASA Goddard Space Flight Center

Surgery Plus Medicine for Obesity Makes Things Better

Just skimming headlines about new medicines for obesity and surgery, comparisons seem to be a dominant theme. Some of these headlines tell us surgery is more cost-effective or delivers more durable results. Some of that is certainly true. But the deeper truth surfaces this week in JAMA and JAMA Network Open. Clinical experience and, increasingly, clinical data tell us surgery plus medicine can yield better results than either option alone.

An RCT of Liraglutide Following Surgery

Wendy Brown and colleagues published a randomized clinical trial of liraglutide for persons who had a less than optimal response to metabolic surgery for obesity. A total of 48 subjects randomly received either a daily placebo or 3 mg liraglutide injection. In the liraglutide group, people lost an additional 4.4.% of their weight after 12 months. In the placebo group, they gained 1.4% of their weight. Brown explains why this is important:

“We have shown that for people who regain weight or don’t have an optimal weight loss effect from bariatric surgery, adding in a weight loss drug will help them to lose weight, often at a lower dose than is needed in people who have not had surgery.”

This, she says, can help to avoid the ordeal of a repeat surgery, which is a common option, for example, when the response to a gastric sleeve is less than desired.

Medicine Plus Surgery

Writing in the JAMA series on current topics in obesity, John Morton reviews the evidence on a complimentary role for obesity medicines either before or after metabolic surgery. Before surgery, he says, pharmacologic therapy has potential to enhance safety and efficacy of metabolic and bariatric surgery. Used after surgery, a systematic review suggests that an additional 10-15% weight loss is possible for patients with less than the desired reduction in excess body weight.

So it seems important not to be drawn to thinking about medicine versus surgery as a binary choice. In fact, they are complimentary and both may be useful for some patients in the pursuit of their best health.

Click here for the study by Brown et al and here for the insights by Morton. For further perspective, click here and here.

Finding the Universe is Brighter Than We Thought, time lapse photograph from the NASA Goddard Space Flight Center by T. Arai at University of Tokyo / Wikimedia Commons

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November 11, 2025