A recent multicenter study of more than 8,600 patients with metabolic dysfunction-associated steatotic liver disease (MASLD) found that bariatric surgery is associated with lower five-year mortality. It also showed a reduced risk of major adverse cardiovascular events (MACEs) compared to treatment with GLP-1 receptor agonists, SGLT2 inhibitors, or a combination of both medications and surgery. Patients who underwent bariatric surgery alone had better long-term survival and cardiovascular outcomes, with adjusted hazard ratios indicating higher risks for those treated pharmacologically. Researchers presented the findings at The Liver Meeting 2024, underscoring the need for personalized treatment decisions based on individual health profiles and goals.

While weight loss medications offer notable metabolic benefits, the study suggests bariatric surgery may provide more robust and sustained improvements in weight and cardiovascular health for certain patients with MASLD. However, both researchers and external experts cautioned that surgery isn’t suitable for all patients, and outcomes can vary based on factors like comorbidities, BMI, glucose control, and patient preferences. The findings highlight the importance of a multidisciplinary approach in MASLD treatment and call for further randomized trials to better understand which patients benefit most from surgical versus pharmacologic interventions.

Reference: Crist C. Bariatric Surgery Better Than Obesity Drugs for Some Patients With MASLD. GI and Hepatology News. Published December 12, 2024. Accessed June 9, 2025. https://www.mdedge.com/gihepnews/article/271916/liver-disease/bariatric-surgery-better-obesity-drugs-some-patients-masld