COMPARISON OF SURGICAL AND PHARMACOLOGICAL RISK IN THE TREATMENT OF OBESITY: BARIATRIC SURGERY VERSUS INJECTABLE ANTIDIABETIC DRUGS

Abstract

Obesity is a chronic disease associated with a significant increase in cardiovascular, metabolic, and inflammatory morbidity and mortality. Among the most effective therapeutic strategies for moderate to severe cases are bariatric surgery and the use of injectable antidiabetic drugs with weight-loss effects, especially GLP-1 agonists such as semaglutide and dual agonists such as tirrizepatide. Bariatric surgery, particularly techniques such as Roux-en-Y gastric bypass and sleeve gastrectomy, promotes an average weight loss of 25–35% of total body weight, in addition to significant improvement in glycemic control, with relevant rates of type 2 diabetes remission. There is also consistent evidence of a reduction in cardiovascular events and long-term mortality. However, it is an invasive procedure, with an estimated perioperative risk between 0.1% and 0.5% in specialized centers. Complications include bleeding, thromboembolism, fistulas, infections, and, later on, chronic nutritional deficiencies, dumping syndrome, and the need for lifelong supplementation. The risk is not only immediate: there is a permanent anatomical and metabolic impact. Injectable antidiabetic drugs, on the other hand, act by modulating incretin pathways that increase satiety and delay gastric emptying. Weight loss varies from 10% to 25%, depending on the molecule and dose. The risk profile is predominantly gastrointestinal, with nausea, vomiting, and diarrhea as the most common adverse events. Rare complications include pancreatitis and cholelithiasis associated with rapid weight loss. Unlike surgery, the immediate risk is lower; however, effectiveness depends on continuous use, and interruption often results in partial or total weight regain. Comparatively, surgery presents a greater magnitude and durability of metabolic response, especially in severe obesity, but with surgical risk and irreversible consequences. Pharmacological therapy offers less invasiveness and greater reversibility, but requires prolonged adherence and may not achieve the same sustained metabolic outcomes. The therapeutic choice should consider the severity of obesity, the presence of comorbidities, the individual risk profile, the capacity for clinical follow-up, and long-term cost-effectiveness.