Over the last five years, the landscape of weight management has shifted dramatically. It’s not as simple as medications versus surgery; the choices for obesity treatment are becoming more tailored. Development of highly effective incretin therapies has transformed obesity treatment, delivering weight loss outcomes previously associated almost exclusively with metabolic and bariatric surgery (MBS).1–3 Importantly, the benefits extend beyond weight loss, with improvements seen in a range of obesity-related comorbidities. Recent US data suggest that incretin therapy use increased by 140.4% between 2022 and 2024, while metabolic surgery declined by 34.1%. Equivalent UK data is currently limited, but as access to incretin therapies continues to increase, a natural question arises: is there still a role for metabolic surgery?

  1. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. https://www.nejm.org/doi/full/10.1056/NEJMoa2206038
  2. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
  3. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes (STAMPEDE trial). N Engl J Med. 2017;376(7):641-651. https://www.nejm.org/doi/full/10.1056/nejmoa1600869
  4. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in patients with obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
  5. Calzaretta RJ, Fink S, Kothari K, et al. Trends in metabolic bariatric surgery utilisation in the era of GLP-1s 2022-2024. JAMA Surg. Published online May 2026. https://jamanetwork.com/journals/jamasurgery/article-abstract/2848849
  6. National Institute for Health and Care Excellence (NICE). Obesity management (NG246). Published 2025. https://www.nice.org.uk/guidance/ng246
  7. Medicines and Healthcare products Regulatory Agency (MHRA). Semaglutide (Wegovy): summary of product characteristics. https://www.medicines.org.uk/emc/product/15481/smpc
  8. Bray A, Schnitzer H, Mahase E et al. Variation in the commissioning of semaglutide for the treatment of obesity and overweight across England: results of three freedom of information-based mapping exercises across the 42 integrated care boards of England. Clin Obes. 2025;16(1). doi:10.1111/cob.70044
  9. Eisenberg D, Shikora SA, Aarts E, et al. 2022 ASMBS and IFSO indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18(12):1345-1356. doi:10.1016/j.soard.2022.08.013
  10. Sjöström L. Effects of bariatric surgery on mortality in the Swedish Obese Subjects study. J Intern Med. 2012;273(3):219-234. https://onlinelibrary.wiley.com/doi/10.1111/joim.12012
  11. Leslie DB, Steffen BT, Wise E, et al. One-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in obesity in type 2 diabetes: a retrospective cohort study. Lancet Diabetes Endocrinol. Published online June 2026. https://www.sciencedirect.com/science/article/abs/pii/S2213858726000306
  12. Wharton S, Batterham RL, Bhatta M, et al. Two-year effect of semaglutide 2.4mg on control of eating in adults with overweight/obesity: STEP 5. Obesity. 2023;31(3):703-715. https://pubmed.ncbi.nlm.nih.gov/36655300/
  13. Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending obesity stigma. Nat Med. 2020;26(4):485-497. https://www.nature.com/articles/s41591-020-0803-x
  14. Jastreboff AM, Kaplan LM, Frias JP, et al. Triple-hormone-receptor agonist Retatrutide for obesity. N Engl J Med. 2023. https://www.nejm.org/doi/full/10.1056/NEJMoa2301972
  15. Stanley C, Mallik R, Hamid N, et al. Semaglutide versus placebo in individuals with poor weight loss after bariatric surgery: a double-blind, randomised, placebo-controlled trial. Nat Med. 2026. https://www.nature.com/articles/s41591-026-04416-4
  16. Iannelli A, Carandina S, Angrisani L. Metabolic surgery in the GLP-1 era. Published online June 2026. https://onlinelibrary.wiley.com/doi/10.1002/oby.70237
  17. Tan TMM. GLP-1 receptor agonists vs bariatric surgery outcomes: the debate goes on. Lancet Diabetes Endocrinol. June 2026. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(26)00124-5/abstract

About the Author: Jen Credicott, RD

Jen is a Specialist Dietitian working across Gloucestershire Hospitals NHS Foundation Trust, private practice and her own freelance business. Her interests include obesity care, bariatric surgery and sustainable behaviour change.

Leave A Comment

Over the last five years, the landscape of weight management has shifted dramatically. It’s not as simple as medications versus surgery; the choices for obesity treatment are becoming more tailored. Development of highly effective incretin therapies has transformed obesity treatment, delivering weight loss outcomes previously associated almost exclusively with metabolic and bariatric surgery (MBS).1–3 Importantly, the benefits extend beyond weight loss, with improvements seen in a range of obesity-related comorbidities. Recent US data suggest that incretin therapy use increased by 140.4% between 2022 and 2024, while metabolic surgery declined by 34.1%. Equivalent UK data is currently limited, but as access to incretin therapies continues to increase, a natural question arises: is there still a role for metabolic surgery?

  1. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. https://www.nejm.org/doi/full/10.1056/NEJMoa2206038
  2. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
  3. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes (STAMPEDE trial). N Engl J Med. 2017;376(7):641-651. https://www.nejm.org/doi/full/10.1056/nejmoa1600869
  4. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in patients with obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
  5. Calzaretta RJ, Fink S, Kothari K, et al. Trends in metabolic bariatric surgery utilisation in the era of GLP-1s 2022-2024. JAMA Surg. Published online May 2026. https://jamanetwork.com/journals/jamasurgery/article-abstract/2848849
  6. National Institute for Health and Care Excellence (NICE). Obesity management (NG246). Published 2025. https://www.nice.org.uk/guidance/ng246
  7. Medicines and Healthcare products Regulatory Agency (MHRA). Semaglutide (Wegovy): summary of product characteristics. https://www.medicines.org.uk/emc/product/15481/smpc
  8. Bray A, Schnitzer H, Mahase E et al. Variation in the commissioning of semaglutide for the treatment of obesity and overweight across England: results of three freedom of information-based mapping exercises across the 42 integrated care boards of England. Clin Obes. 2025;16(1). doi:10.1111/cob.70044
  9. Eisenberg D, Shikora SA, Aarts E, et al. 2022 ASMBS and IFSO indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18(12):1345-1356. doi:10.1016/j.soard.2022.08.013
  10. Sjöström L. Effects of bariatric surgery on mortality in the Swedish Obese Subjects study. J Intern Med. 2012;273(3):219-234. https://onlinelibrary.wiley.com/doi/10.1111/joim.12012
  11. Leslie DB, Steffen BT, Wise E, et al. One-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in obesity in type 2 diabetes: a retrospective cohort study. Lancet Diabetes Endocrinol. Published online June 2026. https://www.sciencedirect.com/science/article/abs/pii/S2213858726000306
  12. Wharton S, Batterham RL, Bhatta M, et al. Two-year effect of semaglutide 2.4mg on control of eating in adults with overweight/obesity: STEP 5. Obesity. 2023;31(3):703-715. https://pubmed.ncbi.nlm.nih.gov/36655300/
  13. Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending obesity stigma. Nat Med. 2020;26(4):485-497. https://www.nature.com/articles/s41591-020-0803-x
  14. Jastreboff AM, Kaplan LM, Frias JP, et al. Triple-hormone-receptor agonist Retatrutide for obesity. N Engl J Med. 2023. https://www.nejm.org/doi/full/10.1056/NEJMoa2301972
  15. Stanley C, Mallik R, Hamid N, et al. Semaglutide versus placebo in individuals with poor weight loss after bariatric surgery: a double-blind, randomised, placebo-controlled trial. Nat Med. 2026. https://www.nature.com/articles/s41591-026-04416-4
  16. Iannelli A, Carandina S, Angrisani L. Metabolic surgery in the GLP-1 era. Published online June 2026. https://onlinelibrary.wiley.com/doi/10.1002/oby.70237
  17. Tan TMM. GLP-1 receptor agonists vs bariatric surgery outcomes: the debate goes on. Lancet Diabetes Endocrinol. June 2026. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(26)00124-5/abstract

About the Author: Jen Credicott, RD

Jen is a Specialist Dietitian working across Gloucestershire Hospitals NHS Foundation Trust, private practice and her own freelance business. Her interests include obesity care, bariatric surgery and sustainable behaviour change.

Leave A Comment

You may also like