Bariatric Surgery in the Era of GLP1RA: A Narrative Review

The prevalence of obesity continues to rise, with notable increase in stage III obesity in North America. The accumulation of excess adipose tissue can impair health with cardiovascular disease being the leading cause for increased mortality in people with obesity. The chronicity of the condition makes sustainable weight loss and improved health difficult for many with lifestyle changes alone, often necessitating the need for pharmacotherapy and bariatric surgery. Bariatric surgery remains the most efficacious treatment for obesity, despite improved pharmacotherapies. However, its low acceptability and accessibility render it an underutilized treatment. Meanwhile, the use of obesity pharmacotherapy, especially glucagon-like peptide 1 receptor agonists (GLP1RA) has become widespread with significant weight loss and improved health outcomes in randomised control trials. The real-world effectiveness of GLP1RA is hindered by issues including cost and tolerability. This narrative review discusses strategies to improve the effectiveness of pharmacotherapy and bariatric surgery and posits that bariatric surgery will continue to play an important role in obesity treatment in the GLP1RA era.