What is the future of bariatric surgery in the era of GLP-1 receptor agonists? That was the question specialists addressed at the International Congress on Obesity (ICO) 2026, held in Mexico City, Mexico, and organized by the World Obesity Federation, where they highlighted the importance of a patient-centered model of obesity care that integrates medications and surgery according to individual needs.

The experts emphasized that both pharmacotherapy and bariatric surgery have limitations, but that the two approaches can complement each other to achieve better outcomes. They stressed that these strategies should not be viewed as opposites but rather as part of the same clinical response, and highlighted the need to define when, how, and for whom each intervention should be used.

In 2024, official guidelines for combining pharmacologic and surgical therapy were published for the first time. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued a consensus statement on the use of medications to treat obesity in the context of bariatric surgery, promoting a multimodal care model.

Toward a Unified Model

Miguel Herrera Hernández, MD, PhD, bariatric surgeon and medical director of the Clinic for Nutrition and Obesity at ABC Medical Center in Mexico City, said that for decades, obesity care was fragmented among different professional “tribes”: surgeons, endocrinologists, nutritionists, and public health specialists. “Today we recognize that no single discipline alone has the complete answer. We are moving toward a medical model that integrates all evidence-based tools,” he said.

Herrera highlighted as a key milestone the point at which IFSO and the World Obesity Federation stopped using BMI as the sole criterion for diagnosing obesity and agreed that it should be considered a chronic, recurrent disease whose management requires lifelong care and a multidisciplinary approach. From this perspective, the patient is at the center, and interventions such as nutrition, physical activity, behavioral therapy, pharmacotherapy, and surgery are organized around that patient. He added that this model must be supported by public policies and health systems that improve access and reduce the stigma associated with the disease.

Bariatric Surgery vs GLP-1 Drugs

Although GLP-1 receptor agonists and bariatric surgery have both shown favorable results, each approach presents challenges. José Gotes Palazuelos, endocrinologist and associate professor at the Salvador Zubirán National Institute of Medical Sciences and Nutrition in Mexico City, emphasized that medications allow intervention at earlier stages: With reductions of 10%-20% in body weight, many patients experience a decrease in metabolic or cardiovascular complications, making drug therapy the best option in such cases.

Among the advantages of GLP-1 receptor agonists are their reversibility, outpatient use, and reduction of comorbidities beyond weight, including major cardiovascular events, obstructive sleep apnea, osteoarthritis, heart failure, and metabolic liver disease. However, efficacy depends on treatment adherence, and factors such as cost and gastrointestinal adverse effects may limit long-term use.

Carlos Zerrweck, MD, a bariatric surgeon and president of the Mexican College of Bariatric & Metabolic Surgery, noted that surgery offers greater magnitude and durability of weight loss, a more predictable course, and better outcomes in cases of extreme obesity and type 2 diabetes. Although the initial cost is higher, he said, surgery may prove more cost-effective in the long term. He also noted that 20%-50% of patients may experience insufficient weight loss or weight regain after surgery, making combination with drug therapy relevant in some cases.

Drug therapy can support certain patients before or after surgery, for example, when weight-loss plateaus or significant weight regain occurs. Khaled Gawdat, MD, president of IFSO, recommended considering medications before resorting to revision surgery — which is more complex and carries greater risk — although he cautioned that the evidence is not yet conclusive enough to support their routine preoperative use. It remains unclear which patients benefit most, the optimal duration of treatment, and the degree of preoperative weight reduction that improves outcomes.

Will Bariatric Surgery Be Replaced by Medications?

The specialists ruled out the possibility that surgery will disappear; instead, they advocated integrating it with drug therapy. Gawdat compared the situation with other medical specialties: The introduction of stents did not eliminate coronary surgery, nor did chemotherapy and immunotherapy make cancer surgery obsolete. Surgery will continue to be indicated for patients with extreme obesity, particularly those for whom drug therapy is insufficient or who are intolerant of medications.

“We simply need to determine what each patient needs,” Zerrweck said. Gotes Palazuelos added that medications can prevent or postpone surgery for many people, but they are also useful for those who have already undergone surgery. The question now is which patients to select and what the optimal time is to initiate drug therapy after surgery.

Combination Therapy as the Future

Several specialists agreed that combination therapy represents the future: starting with the least invasive option, progressing to surgery if results are insufficient, adding medications when weight-loss plateaus or weight is regained, and reserving revision surgery as a last resort. The major challenge, they said, will be to develop clinical algorithms to guide the choice and timing of each intervention, as well as to ensure collaboration among surgeons, internists, endocrinologists, nutritionists, and other specialists.

Gotes Palazuelos disclosed serving as a speaker for various pharmaceutical companies. Zerrweck disclosed serving as a consultant at ABC Medical Center. Herrera Hernández and Gawdat reported having no relevant financial relationships. 

This story was translated from Medscape’s Spanish edition.