A big analysis of 30 trials shows that weight‑loss surgery still beats drugs at shrinking belly fat and improving blood sugar, but the new dual drug tirzepatide comes close. In studies that looked only at tirzepatide, it wasn’t significantly worse than surgery, meaning it could be a powerful non‑surgical tool for people wanting big weight drops and better metabolism.

This study compared the efficacy of metabolic/bariatric surgery (MBS) and GLP-1 receptor agonists (GLP-1 RAs), including dual GLP-1/GIP analogues, for weight and metabolic outcomes in adults with obesity. A network meta-analysis of randomized controlled trials compared MBS or GLP-1 RAs versus lifestyle intervention in adults with overweight or obesity. Primary outcomes were percent total weight loss (TWL) and BMI; secondary outcomes included body weight, waist circumference, HbA1c, and systolic blood pressure. Random-effects models used lifestyle intervention as the common comparator; all MBS versus GLP-1 RA comparisons were indirect. Thirty randomized controlled trials (n = 20,015) were included. At < 104 weeks, MBS achieved greater reductions than GLP-1 RAs in %TWL (ETD -10.3%; p = 0.001), BMI (-4.5 kg/m²; p < 0.001), body weight (-11.7 kg; p < 0.001), waist circumference (-12.6 cm; p < 0.001), and HbA1c (-0.5%; p = 0.033). At ≥ 104 weeks, differences remained for %TWL (-9.1%; p = 0.022) and body weight (-14.6 kg; p = 0.049). In tirzepatide-only analyses, differences versus MBS were not significant. Among participants with type 2 diabetes, MBS produced greater reductions in BMI, weight, waist, and %TWL, with similar HbA1c improvement. Both MBS and GLP-1 RAs provide substantial metabolic benefits. MBS remains superior, but tirzepatide is a promising nonsurgical option supporting personalized obesity care.