WILL BARIATRIC SURGERY CEASE TO EXIST IN THE FUTURE?

Abstract

Introduction: Obesity is a serious public health problem, affecting 34% of Brazilian adults, with a projected prevalence of 75% overweight/obesity by 2044. The Brazilian Unified Health System (SUS) offers bariatric surgery as a treatment option for selected cases. GLP-1 (liraglutide and semaglutide) and GIP (tirzepatide) analogues are also effective, but they are not available through SUS and have a high cost.

Objective: To compare excess weight loss (%EWL) and total weight loss (%TWL) between bariatric surgery and GLP-1 and GIP analogues.

Methodology: Review of articles from SciELO and PubMed (2014–2024), in English and Portuguese, using the descriptors: bariatric surgery, gastric bypass, sleeve, duodenal switch, gastric banding, GIP, GLP-1, excess weight loss, total weight loss. Data from DataSUS (2008–2024) complemented the analysis.

Results: The number of bariatric surgeries in Brazil increased by 22.9% compared to 2019, with Roux-en-Y bypass, sleeve gastrectomy, gastric banding, and duodenal switch being the most common procedures. The mean outcomes found were: Roux-en-Y: TWL 28.6%, EWL 68.3% (5 years); gastric banding: TWL 15.9% (3 years), EWL 45.9% (=10 years); sleeve: TWL 25%, EWL 61.1% (5 years); duodenal switch: TWL 39.4%, EWL 98.8% (1 year). Clinical trials showed: semaglutide mean weight loss of 10.2% (4 years) up to 14.9% (68 weeks); tirzepatide up to 18% (72 weeks); liraglutide ranging from 2.2% to 18.5% (6–12 months).

Conclusion: Although pharmacological therapies demonstrate efficacy, their high cost and unavailability within SUS limit their use. Bariatric surgery remains associated with greater weight loss and longer durability of results, maintaining its central role in obesity management in Brazil.