Comparative effectiveness of sleeve gastrectomy and semaglutide for weight loss and metabolic outcomes: a prospective non-randomized study.

Abstract

Bariatric surgery and pharmacotherapy represent two major strategies for the treatment of obesity. Sleeve gastrectomy (SG) is the most widely performed surgical procedure and is supported by long-term evidence, while semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has recently emerged as an effective medical therapy. However, prospective real-world studies directly comparing these interventions are limited. We conducted a prospective, non-randomized trial at a single tertiary center (ChiCTR2300070632). Adults with obesity were allocated to SG (n = 36) or once-weekly semaglutide (n = 35) based on shared decision-making. Semaglutide was administered for a planned duration of 24 weeks, after which continuation or discontinuation was determined by patient preference. Primary outcomes were percentage total weight loss (%TWL) and changes in body mass index (BMI) at 1, 3, 6, and 12 months. Secondary outcomes included changes in metabolic parameters. SG achieved significantly greater weight loss at all time points. At 12 months, mean %TWL was 28.6% for SG versus 11.3% for semaglutide (p < 0.001). Mean BMI decreased from 32.7 ± 2.8 to 23.8 ± 2.6 kg/m² in the SG group and from 32.0 ± 2.6 to 28.4 ± 4.0 kg/m² in the semaglutide group (p < 0.001). Both groups demonstrated metabolic improvements, but SG was associated with greater reductions in triglycerides and greater increases in high-density lipoprotein cholesterol (HDL-C). Among patients who discontinued semaglutide after 6 months (n = 25), mean weight increased from 74.6 ± 11.3 to 83.2 ± 12.3 kg by 12 months, with 32% regaining to baseline weight or higher. SG achieved greater weight loss and improvements in triglycerides and HDL-C compared with semaglutide. Semaglutide was effective during treatment, but many patients experienced weight regain after discontinuation. Trial Registry No. ChiCTR2300070632 (2023 April 19).