Surgical and interventional approaches for the treatment of obesity

BACKGROUND: Lifestyle modification through diet and exercise remains the first-line therapy for obesity; however, long-term success is limited for many individuals. Metabolic and bariatric surgery (MBS) has emerged as the most effective intervention for durable weight loss and obesity-related comorbidity reduction. OBJECTIVE: To assess the efficacy, safety, and clinical significance of the effect of MBS in the management of obesity. METHODS: Data from recent clinical trials and advances in surgical and endoscopic techniques were reviewed, with an emphasis on durability of weight loss, resolution of comorbidities, cardiovascular outcomes, and procedural risk profiles. RESULTS: MBS consistently achieves superior and sustained weight loss compared with nonsurgical strategies. Substantial improvements, and in many cases resolution, of obesity-associated comorbidities-including type 2 diabetes, hypertension, and dyslipidemia-have been observed. Additionally, MBS significantly reduces major adverse cardiovascular events, particularly myocardial infarction and stroke. Advances in minimally invasive MBS and endoscopic techniques have improved safety and reduced perioperative risk. Nonetheless, both short- and long-term complications may occur. Indications for MBS differ between adult and pediatric populations, requiring individualized evaluation and selection. CONCLUSION: MBS is an effective long-term treatment for obesity, offering durable weight reduction and meaningful improvements in metabolic and cardiovascular health. Although not without potential adverse events, evolving surgical and endoscopic approaches have enhanced safety and broadened applicability. These findings underscore the importance of incorporating MBS into shared decision-making and highlight its critical role within a comprehensive, evidence-based strategy for obesity management.