Comparative Effectiveness of Surgical and Medical Interventions for Morbid Obesity: A Systematic Review

Abstract

Background: Morbid obesity is an increasing global health issue linked to considerable morbidity and mortality. Both surgical and medical interventions are employed, yet their relative efficacy is still contested. Objective: To systematically evaluate and compare the effectiveness of surgical versus medical interventions for morbid obesity, focusing on weight reduction, improvement or resolution of comorbidities, and associated safety outcomes. Methods: Systematic review of randomized controlled trials and observational studies published between 2005 and 2025 was performed. We searched PubMed, Scopus, and the Cochrane Library databases. Eligible studies compared bariatric surgery with medical or lifestyle- based treatments. The primary outcomes were weight loss and metabolic improvement, while secondary outcomes included complications and quality of life. Results: A total of 42 studies with 48,912 participants met the inclusion criteria. Surgical interventions, notably gastric bypass and sleeve gastrectomy, demonstrated superior and sustained weight loss compared with medical therapies. Surgery was also associated with higher rates of remission from type 2 diabetes and improved control of hypertension and dyslipidemia. While surgical groups experienced higher perioperative complication rates, long-term mortality was significantly lower compared with medical management. Conclusion: Bariatric surgery is more effective than medical interventions in achieving significant and sustained weight loss and ameliorating obesity-related comorbidities, notwithstanding elevated short-term risks. Individualized patient selection and long-term follow-up are crucial for optimizing outcomes.