Weight-Loss Outcomes After Sleeve Gastrectomy Versus Tirzepatide in a Minority Cohort With Severe Obesity: Results From a Propensity Score Matched Cohort.
In a minority cohort with severe obesity, sleeve gastrectomy resulted in significantly greater weight loss than tirzepatide after 12 months, with 30% TWL compared to 12%. However, individualized treatment decisions should consider patient preferences and metabolic goals.
Where it sits
this study against the rest of the semaglutide corpusSummary and findings
This study evaluated 12-month weight loss outcomes comparing tirzepatide and sleeve gastrectomy (SG) in a diverse urban patient population. The SG group achieved a 30% total weight loss (TWL) and a 12 kg/m² BMI reduction, while the tirzepatide group had a 12% TWL and a 7 kg/m² BMI reduction. Statistically significant differences in weight loss were observed between the two cohorts (p < 0.001).
Abstract
While GLP-1 and GIP receptor agonists like semaglutide and tirzepatide have revolutionized pharmacologic obesity treatment, metabolic and bariatric surgery (MBS) continues to demonstrate superior weight loss and cost-effectiveness. Current evidence shows tirzepatide outperforms semaglutide with over 20% weight reduction, yet most clinical trials lack ethnic diversity, limiting the generalizability of these outcomes. This is a retrospective, single-centre study that evaluates 12-month weight loss results comparing tirzepatide and SG within a diverse, urban patient population. 12-month weight loss outcomes were compared between patients receiving tirzepatide and those undergoing sleeve gastrectomy (SG). Primary endpoints included changes in BMI, excess weight loss and total weight loss (TWL) percentage at 3, 6 and 12 months, following ASMBS reporting standards to evaluate treatment efficacy and comparative outcomes. Linear mixed models revealed statistically significant differences in weight loss between SG and tirzepatide cohorts across all time points (p < 0.001). By 12 months, the SG group was associated with greater weight loss than tirzepatide in this selected matched cohort with a 30% TWL and a 12 kg/m<sup>2</sup> BMI reduction, compared to 12% TWL and 7 kg/m<sup>2</sup> for tirzepatide. SG was associated with greater weight loss than tirzepatide in this selected matched cohort, especially for eligible patients in ethnic minority groups. However, tirzepatide serves as a vital non-invasive alternative, requiring individualized treatment decisions based on patient preference, cost and specific metabolic goals.
Background
This paper addresses the comparative effectiveness of tirzepatide, a GLP-1 and GIP receptor agonist, versus sleeve gastrectomy (SG) for weight loss in a minority cohort with severe obesity. Prior studies indicate that metabolic and bariatric surgery generally leads to greater weight loss compared to pharmacologic treatments. This study is significant as it evaluates these interventions in a diverse population, which is often underrepresented in clinical trials.
Methods
This retrospective, single-centre study evaluated 12-month weight loss outcomes in a matched cohort of patients receiving tirzepatide versus those undergoing sleeve gastrectomy. Primary endpoints included changes in BMI, excess weight loss, and total weight loss percentage at 3, 6, and 12 months. Linear mixed models were used for statistical analysis.
Results
At 12 months, the SG group demonstrated a total weight loss of 30% and a BMI reduction of 12 kg/m², while the tirzepatide group had a total weight loss of 12% and a BMI reduction of 7 kg/m². Statistically significant differences were noted between the two groups (p < 0.001).
Interpretation
The results indicate that sleeve gastrectomy may lead to significantly greater weight loss compared to tirzepatide in this cohort, particularly in ethnic minority groups. While the statistical significance is clear, the clinical relevance of the 18% difference in TWL may vary among practitioners. Limitations such as the retrospective design and single-centre nature of the study may affect the applicability of these findings to broader populations.
Key findings
- 30% TWL and 12 kg/m² BMI reduction for SG at 12 months, p < 0.001.
- 12% TWL and 7 kg/m² BMI reduction for tirzepatide at 12 months, p < 0.001.
- Statistically significant differences in weight loss between SG and tirzepatide cohorts across all time points.
Limitations
- Retrospective study design.
- Single-centre study may limit generalizability.
- Short follow-up duration of 12 months.