Bariatric surgery in the era of modern obesity pharmacotherapy

Abstract Introduction Obesity is a chronic multi-system disease affecting almost 1 billion people. Bariatric surgery has been the most efficacious treatment for obesity, but new/emerging pharmacotherapies can achieve comparable weight loss in sub-groups of patients as well as improving health outcomes. Objectives To provide an overview of the efficacy and effectiveness of bariatric surgery and obesity pharmacotherapy. Design This is a narrative review. Methods We reviewed the efficacy of bariatric surgery and pharmacotherapy on weight loss and health outcomes in randomized control trials and observational data. We also review the acceptability, tolerability and accessibility to these treatments and its impact on real-world treatment effectiveness. Results Bariatric surgery remains the most efficacious treatment for obesity and can improve/remit many obesity associated conditions. Low patient acceptability and barriers to access impact its effectiveness. Pharmacotherapy is likely more acceptable, but access/cost and side effects reduce its effectiveness. Nutritional support and flexible dosing strategies can attenuate adverse effects. Conclusions Bariatric surgery and pharmacotherapy present unique challenges in efficacy, accessibility and acceptability in weight loss. In the future, both options should be explored and potentially combined to deliver the most efficacious weight loss strategy.