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December 18, 2024
FrancescaCelletti,MD, PhD1; FrancescoBranca,MD, PhD1; JeremyFarrar,MD, PhD2
Author Affiliations Article Information
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1Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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2World Health Organization, Geneva, Switzerland
JAMA. 2025;333(7):561-562. doi:10.1001/jama.2024.25872
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A new, yet familiar, debate in translational science has erupted. After many years of remarkable advances in basic science, novel therapeutic interventions have emerged, offering the promise of an effective treatment for obesity. Should the world embrace this novel pharmacological solution as the answer to the obesity pandemic? Or should the world be concerned that the medicalization of obesity will dull incentives for healthier lifestyles and allow market forces to perpetuate a profitable cycle of cause and cure?
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December 19, 2024
Alternative obesity therapy
Joseph Greene, MD, MBA, FACS, FASMBS | Reston Hospital Center
As an obesity, treatment, specialist, I agree with Cellenti et al that GLP1-RAs present a revolution in the treatment of obesity, a pandemic which has spread across the globe. I fear that the immediate treatment paradigm presented has neglected an important therapy. Metabolic and Bariatric Surgery has been proven to be the most durable, safe, and effective treatment for obesity in the modern era. Obesity prevention via a healthy lifestyle, including nutrition education and exercise training, as well as mind-body wellness cannot be understated at a population health level. However, multiple studies, including the STAMPEDE trial demonstrated the effectiveness of Roux-en-Y, gastric bypass and sleeve gastrectomy for obesity treatment when compared to lifestyle intervention alone. Additionally, studies of GLP1-RAs, such as SURMOUNT-4 and STEP-4, have shown the temporary effectiveness of these medications only for the duration of administration, but subsequent weight regain once they are stopped. I highlight this data in a non-stigmatizing manner, but only to highlight that lifelong dependence of these medications will be required by patients and health systems, rather than a one time, permanent, solution. A recent study by the group at the University of South Florida in Tampa analyzed the break-even point between the cost of bariatric surgery and GLP1-RAs to be between roughly 12 and 18 months, depending on the medication and procedure choice. It is in this light, that I suggest Metabolic and Bariatric Surgery, be discussed, considered, and implemented in the current treatment paradigm for obesity, until which a long-term prevention and population management strategy can be effectively implemented
CONFLICT OF INTEREST: Intuitive: Proctor, Stryker: Consultant
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Celletti F, Branca F, Farrar J. Obesity and Glucagon-Like Peptide-1 Receptor Agonists. JAMA. 2025;333(7):561–562. doi:10.1001/jama.2024.25872
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