The Future of Metabolic and Bariatric Surgery in the Glucagon-Like Peptide-1 Era: Has the Scalpel Become Obsolete?

Obesity remains a growing global health crisis, affecting nearly one billion adults worldwide and substantially increasing the risk of cardiometabolic disease, malignancy, and premature mortality. Metabolic and bariatric surgery (MBS) has evolved into an effective and durable treatment for severe obesity, providing sustained weight loss and significant remission of obesity-related comorbidities (i.e., type 2 diabetes mellitus and cardiovascular disease). Despite dramatic improvements in safety, efficacy, and long-term outcomes over time, MBS remains markedly underutilized, reaching fewer than 1% of eligible patients. Persistent barriers include limited patient and provider awareness, misconceptions regarding surgical risk, and significant disparities in access to care. Concurrently, the rapid adoption of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has transformed the medical management of obesity, offering effective pharmacologic weight loss but raising questions regarding their impact on MBS utilization, durability, and cost-effectiveness. Emerging evidence demonstrates that while MBS produces greater and more durable weight loss than GLP-1 RAs alone, these therapies need not be competitive. Rather, GLP-1 RAs may serve as 'neoadjuvant' treatment to optimize surgical candidacy or as adjunctive treatment for inadequate weight loss or postoperative weight regain. This review synthesizes contemporary data on MBS procedures, outcomes, disparities in access, and evolving perceptions of obesity treatment in the GLP-1 RA era. We propose a chronic weight management model that integrates pharmacotherapy, surgery, and multidisciplinary care along a continuous treatment spectrum. Positioning MBS and GLP-1 RAs as complementary modalities within individualized care pathways may improve long-term outcomes, expand access, and better address the complex, chronic nature of obesity.