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Bariatric Surgery Still Vital After Weight Loss Drugs, Says IFSO.
Published in *The Lancet Diabetes & Endocrinology* on July 22, 2025, a landmark statement by the International Federation for the Surgery of Obesity (IFSO) redefines the evolving partnership between pharmacotherapy and metabolic bariatric surgery (MBS) in treating clinical obesity.
For patients experiencing weight loss through medications like GLP-1 receptor agonists, the statement emphasizes that surgery remains a vital therapeutic option in cases of lingering obesity and metabolic disease.
### 1. **Official Endorsement from Global Experts in Obesity Surgery**
The document carries authoritative weight, crafted by some of the most prominent voices in metabolic and bariatric surgery, including Ricardo V. Cohen, Gerhard Prager, Carel W. le Roux, Ildiko Lingvay, and Paulina Salminen. This isn’t just an opinion — it’s a global clinical consensus that modern therapeutic obesity management must integrate pharmacological and surgical approaches.
### 2. **A Combined Approach to Obesity Treatment**
Pharmacotherapy alone is not always enough. The IFSO statement recognizes that even with significant drug-induced weight loss from medications like semaglutide and tirzepatide, many patients continue to experience residual obesity and metabolic complications. These individuals may need surgery to reach sustained health outcomes.
### 3. **Surgery Still Matters After Medication Success**
Even successful pharmacotherapy responders can remain clinically obese. The statement clarifies that medication-induced weight loss doesn’t disqualify patients from undergoing surgery — particularly if excess weight or metabolic dysfunction persists. MBS can be the next step, not a fallback.
### 4. **Multidisciplinary Assessment Is Crucial**
Before moving toward surgery, patients should undergo a comprehensive evaluation by a multidisciplinary team. This includes input from endocrinologists, surgeons, nutritionists, and psychologists to assess disease severity, patient readiness, and long-term goals.
### 5. **Better Outcomes Through Combination Therapy**
IFSO highlights that integrating pharmacotherapy and surgery often leads to the best outcomes. Combining these strategies can improve long-term weight maintenance, metabolic health, and the reversal or management of obesity-related organ dysfunction like fatty liver disease or type 2 diabetes.
### 6. **Surgical Risks Must Be Judiciously Balanced**
Despite improved health through drugs, many patients still face residual disease. IFSO advises careful risk–benefit analysis for surgery—even in pharmacotherapy responders—because underlying metabolic dysfunction may not be completely resolved through weight loss alone.
### 7. **Obesity Treatment Should Be Accessible to All**
The statement makes a strong point about healthcare equity: every patient should have access to appropriate obesity treatments, regardless of their response to weight-loss medications. Bariatric surgery should not be reserved only for those who don’t respond to drugs—it should be available based on clinical need.
### 8. **Personalized, Flexible Treatment Pathways**
IFSO emphasizes that obesity treatment should not be one-size-fits-all. Treatment must be patient-centred and adaptive. Surgery and pharmacotherapy should be seen as complementary tools within a continuous management plan—not competing options.
### 9. **Even with Powerful New Drugs, Surgery Remains Relevant**
While medications like semaglutide and tirzepatide have changed the obesity treatment landscape, they are not cure-alls. Persistent obesity symptoms or risks may still require surgical intervention. Surgery remains a cornerstone of care for selected patients.
### 10. **Call for Guidelines and Long-Term Evidence**
The statement ends with an urgent call for prospective research and clear clinical guidelines to better time and tailor the use of pharmacotherapy and MBS. This is essential to maximize outcomes and define the most effective sequencing of treatments in managing chronic obesity.
### **Conclusion: A New Era of Integrated Obesity Care**
The IFSO’s 2025 statement marks a paradigm shift in clinical obesity management. It acknowledges the power of modern pharmacotherapy while reaffirming the indispensable role of metabolic bariatric surgery. Patients and providers should work together to find the right sequence and combination of treatments — tailored to individual disease burden and long-term goals. Surgery is not becoming less relevant; it’s becoming more strategic.
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