Metabolic and bariatric surgery provides significantly greater long-term protection against heart attack, stroke, and death than widely used GLP-1 drugs for older adults with obesity and diabetes, according to a new real-world analysis study presented today at the American Society of Metabolic and Bariatric Surgery Annual Meeting (#ASMBS2026).
After 5 years, adults aged 65 and older who underwent bariatric surgery were almost 16% less likely to develop a major major cardiovascular event (MACE) compared to patients treated with GLP-1 drugs (11.5% vs. 13.6%). The risk of severe kidney disease was reduced by more than 25% (9.1% vs. 12.4%) and the risk of diabetic retinopathy was reduced by 35% (5.8% vs. 9.0%).
Differences in weight loss between the two treatments may have been the key to the differences in health outcomes. During the first year, surgical patients lost 17.3% of their weight, while GLP-1 users lost only 4.2% of their weight. Of note, glycemic control (HbA1c) improved similarly in both groups, suggesting that the superior outcome with surgery goes beyond glycemic control alone.
The study, conducted by UVA Health researchers, analyzed data from more than 200,000 older adults using Epic’s nationwide Cosmos database between 2017 and 2025. Patients who underwent surgery (2,843) had sleeve gastrectomy or Roux-en-Y gastric bypass, while those in the GLP-1 group (104,437) received either semaglutide, dulaglutide, or tirzepatide. After careful matching of patients with similar age, health status, and other factors, the final study population exceeded 107,000.
GLP-1 agonists have transformed the treatment landscape for obesity and diabetes, but our findings show that metabolic and bariatric surgery offers even greater protection against serious complications such as heart attack, kidney failure, and vision loss. Furthermore, this study showed that patients should not be excluded from surgery simply because of their advanced age. In fact, seniors may have the most to gain. ”
Thomas H. Shin, MD, PhD, senior study author, assistant professor of surgery, UVA Health, Charlottesville, VA
According to the American Heart Association, nearly 90% of American adults have at least one cardiometabolic risk factor and one-third have metabolic syndrome. Metabolic syndrome is a combination of conditions that dramatically increases the risk of obesity, heart disease, stroke, and type 2 diabetes.
“This study strengthens the concept that metabolic and bariatric surgery is more than just weight loss; it is a powerful metabolic intervention that can meaningfully alter the trajectory of chronic disease in a way that no other intervention currently can,” said Richard M. Peterson, MD, president of ASMBS and professor of surgery at UT Health San Antonio in Texas. He was not involved in this study.
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American Society of Metabolic and Bariatric Surgery
