Metabolic and bariatric surgery offers significantly greater long-term protection against heart attack, stroke and death than widely-used GLP-1 drugs in older adults with obesity and diabetes, according to new real-world analysis study presented today at the annual meeting of the American Society for Metabolic and Bariatric Surgery (#ASMBS2026).
After five years, adults age 65 and older who had bariatric surgery were nearly 16% less likely to develop major adverse cardiovascular events (MACE) compared to those treated with GLP-1 drugs (11.5% vs. 13.6%). The risk of severe kidney disease dropped by more than 25% (9.1% vs. 12.4%) and diabetic retinopathy plummeted by 35% (5.8% vs. 9.0%).
The difference in weight loss between the two treatments was likely the key to the difference in health outcomes. In the first year, surgical patients lost 17.3% of their body weight compared to just 4.2% among GLP-1 users. Notably, blood sugar control (HbA1c) improved similarly in both groups, suggesting superior outcomes with surgery extend beyond glycemic control alone.
The study, conducted by researchers at UVA Health, analyzed data from more than 200,000 older adults using Epic's nationwide Cosmos database between 2017 and 2025. Patients undergoing surgery (2,843) had either sleeve gastrectomy or Roux-en-Y gastric bypass while the GLP-1 group (104,437) had either semaglutide, dulaglutide or tirzepatide. After carefully matching patients with similar age, health status and other factors, the final study population exceeded 107,000 patients.
While GLP-1 agonists have transformed the treatment landscape for obesity and diabetes, our findings show metabolic and bariatric surgery delivers even greater protection against serious complications including heart attacks, kidney failure and vision loss. What's more, this study showed advanced age alone should not exclude patients from surgery. In fact, older adults may have the most to gain."
Thomas H. Shin, MD, PhD, lead study author, Assistant Professor, Surgery, UVA Health in Charlottesville, Virginia
According to the American Heart Association, nearly 90% of U.S. adults have at least one cardiometabolic risk factor and one-third have metabolic syndrome, a cluster of conditions that occur together and dramatically increase the risk for obesity, heart disease, stroke, and type 2 diabetes.
"This study reinforces the notion that metabolic and bariatric surgery is not just about weight loss. It's a powerful metabolic intervention that can meaningfully change the trajectory of chronic disease in ways no other intervention currently can," said Richard M. Peterson, MD, FASMBS, MPH, President, ASMBS and Professor of Surgery at UT Health San Antonio in Texas, who was not involved in the study.
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