Weight-Loss Surgery May Protect Your Heart More Than Drugs Like Ozempic, Mounjaro: Study

As weight-loss injections such as Ozempic and Mounjaro gain popularity worldwide, a new study suggests that metabolic and bariatric surgery may offer stronger long-term cardiovascular protection in people with obesity and type 2 diabetes. The research, published in the journal Obesity Surgery, found that while GLP-1 receptor agonist drugs significantly improve weight and metabolic markers, surgical interventions were associated with more sustained reductions in major adverse cardiovascular events (MACEs), including heart attack and stroke.

Obesity is a major driver of cardiovascular disease globally. According to the World Health Organization (WHO), excess body weight increases the risk of hypertension, coronary artery disease, stroke and heart failure. In India, where type 2 diabetes and central obesity are rising at younger ages, the need for durable treatment strategies is particularly pressing.

Experts stress that both medical and surgical therapies have a role. However, the study reignites discussion around which intervention offers deeper and longer-lasting heart protection, especially in patients with moderate to severe obesity.

What The Study Found

The meta-analysis in Obesity Surgery compared long-term cardiovascular outcomes among patients treated with metabolic and bariatric surgery versus those using GLP-1 receptor agonist medications such as semaglutide and tirzepatide.

Key findings included:

• Greater reduction in major adverse cardiovascular events (MACEs) among surgery patients
• Lower all-cause mortality in the surgical group
• More sustained weight loss over time

GLP-1 drugs have demonstrated cardiovascular benefits in multiple trials. The American College of Cardiology recognises GLP-1 receptor agonists as beneficial in reducing cardiovascular risk in patients with obesity and diabetes. However, long-term durability remains an important consideration.

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Why Surgery May Offer More Durable Protection

Dr Ashish Gautam, Principal Director, Robotic and Laparoscopic Surgery at Max Super Speciality Hospital, Patparganj, says the growing interest in weight-loss injections must be viewed in proper medical context. "The recent attention around weight-loss injections has created understandable interest among patients, but the long-term picture needs careful medical context. GLP-1-based medicines can certainly help with weight reduction and metabolic control while they are being used," he explains.

Dr Gautam notes that many patients experience improved blood sugar levels and some reduction in cardiovascular risk during active therapy. However, the concern emerges when medication is discontinued. "In clinical practice, weight regain is common unless a very strict diet and disciplined lifestyle are maintained," he says. "For many individuals, sustaining that level of restriction over years becomes difficult."

By contrast, he explains that metabolic surgery offers what he describes as a "more durable metabolic reset." "Evidence accumulated over the past two decades shows that procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass deliver sustained weight loss along with meaningful reductions in cardiovascular risk," he explains. "Long-term follow-up studies extending up to 20 years have shown that many patients maintain improved glycaemic control, stable weight, and lower rates of obesity-related complications."

The Mechanism Makes The Difference

According to Dr Gautam, the difference lies in how the treatments work. "Bariatric surgery does not rely only on appetite suppression. It produces structural and hormonal changes together. There is restriction of stomach capacity, shifts in gut hormones that regulate hunger and satiety, and improved insulin sensitivity. Because of these combined effects, the body's metabolic set point changes in a more lasting way."

GLP-1 drugs primarily mimic gut hormones that regulate appetite and insulin secretion. While highly effective during use, they depend on continued administration. Surgery, on the other hand, alters gastrointestinal anatomy, influencing hormones such as GLP-1, ghrelin and peptide YY in a sustained manner. The WHO notes that sustained weight reduction is strongly linked to improved cardiovascular outcomes, especially in high-risk individuals.

The Indian Context: Why It Matters

India faces a dual burden of obesity and early-onset type 2 diabetes. Dr Gautam highlights that the distinction between medications and surgery is particularly relevant locally. "This distinction is particularly relevant in the Indian context, where type 2 diabetes and central obesity appear earlier and progress faster in many patients. For individuals with a body mass index above recommended thresholds along with conditions such as diabetes, hypertension, sleep apnea, or fatty liver disease, metabolic surgery remains a medically established option with strong long-term data."

Asian populations often develop metabolic complications at lower BMI thresholds compared to Western populations, making early intervention critical.

Also Read: People Continue Taking Ozempic For Weight Loss Despite Side Effects, Reveals Study

Individualised Treatment Remains Key

Experts caution against viewing the debate as surgery versus drugs. "Treatment must always be individualized. Medications have a role, especially for those who are not surgical candidates or who prefer non-operative care," says Dr Gautam. "However, for patients with moderate to severe obesity and related illnesses, bariatric surgery continues to show deeper and more sustained cardiovascular protection in long-term studies."

He adds: "The focus should remain on matching the right therapy to the right patient, based on medical risk, durability of benefit, and the ability to maintain results over time."

The latest study suggests that while GLP-1 weight-loss injections like Ozempic and Mounjaro offer significant metabolic and cardiovascular benefits, bariatric surgery may provide stronger and more durable heart protection in selected patients. For individuals with obesity, particularly those with diabetes, hypertension or other metabolic conditions, long-term cardiovascular health should remain the central goal. As evidence continues to evolve, experts emphasise personalised care, careful medical supervision and informed decision-making.

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