Alex Brecher

Doctors already have good evidence that weight loss surgery lowers the risk of heart trouble, and good evidence that GLP-1 medicines do too. What has never been settled is which one does more. A new analysis published on September 5, 2026 in the journal Endocrinology, Diabetes and Metabolism pooled 43 studies covering 932,380 patients to try to answer that. The main result: bariatric surgery was linked to a 34 percent lower risk of a major heart event (hazard ratio 0.66, 95 percent confidence interval 0.60 to 0.74). GLP-1 receptor agonists were linked to a 15 percent lower risk of the same thing (hazard ratio 0.85, 0.77 to 0.94). Each estimate compares a treatment with its own control groups. These are not results from a randomized surgery-versus-medicine trial. A hazard ratio below 1.0 means lower risk. The confidence interval is the range the true number is likely to sit in. When that range does not cross 1.0, researchers call the result statistically significant, which means it is unlikely to be a fluke of chance. It does not mean the effect is large or that the treatment caused it. "Major heart event" here is a standard research bundle called MACE. In this analysis it counted death from any cause, plus the first heart attack, stroke, hospital admission for heart failure, or procedure to reopen a blocked artery. Surgery showed lower risk on all three heart outcomes, the drugs on only one The researchers also looked at heart failure and heart attack on their own. For heart failure, surgery was linked to a 55 percent lower risk (hazard ratio 0.45, 0.38 to 0.53). GLP-1 medicines came in at 0.87, but the range ran from 0.73 to 1.05. Because that range crosses 1.0, the result was not statistically significant. For heart attack, surgery was linked to a 47 percent lower risk (hazard ratio 0.53, 0.45 to 0.63). GLP-1 medicines came in at 0.91, range 0.77 to 1.08, again not statistically significant. That last part depends on which statistical model is used, and the paper is honest about it. Under a second, less conservative model, the GLP-1 numbers for heart failure (0.89, 0.83 to 0.96) and heart attack (0.90, 0.84 to 0.97) did reach significance. So the fair reading is not that GLP-1 drugs do nothing for those two outcomes. It is that the evidence for them is weaker and less stable than the evidence for surgery. The surgery evidence and the drug evidence do not come from the same kind of study This is the most important thing to understand about the comparison, and the authors flag it themselves. Every one of the 28 studies comparing surgery to no surgery was an observational cohort. That means researchers watched what happened to people who had surgery and people who did not, rather than assigning anyone. People who reach the operating room have usually been screened for fitness, cleared by several specialists, and have shown they can follow a program. People who do not have surgery may be sicker, poorer, or less able to access care in the first place. Some of the difference in heart outcomes may therefore reflect who gets surgery rather than what surgery does. Researchers call this residual confounding, and statistical adjustment reduces it but does not remove it. The drug side is the reverse. Most of that evidence came from randomized controlled trials, where a coin flip decides who gets the medicine. Random assignment reduces treatment-selection bias. It does not make the drug trials directly comparable with the separate observational surgery studies. Comparing a number from an observational study against a number from a randomized trial is not a level comparison. Only four studies compared the two treatments directly Of the 43 studies, four compared surgery patients to GLP-1 patients head to head, covering 18,880 people. All four were observational. The rest of the comparison is indirect. Indirect means the math works out surgery versus drugs by lining up each one against the untreated group, the way you might compare two runners who never raced each other by looking at their times against a third runner. The technique is called a network meta-analysis. It is a reasonable way to use the evidence that exists, and the authors ran a check called node splitting that found the direct and indirect estimates agreed with each other. It is still not the same as a trial that randomly assigned people to surgery or a drug. This review included no randomized trial directly comparing surgery with a GLP-1 medicine. The search stopped in September 2024, before the newest medicines had heart data The authors searched the literature through September 30, 2024. Anything published after that is not in here. The authors also note that the randomized trials in the drug arm used mostly first-generation GLP-1 medicines. That matters because the newer drugs produce considerably more weight loss than the older ones, and weight loss is thought to be part of how these medicines protect the heart. Whether the newer agents close the gap with surgery is an open question this analysis cannot answer. Results varied widely from study to study The paper reports a heterogeneity statistic between 66 percent and 93 percent depending on the outcome. Heterogeneity measures how much the individual studies disagreed with each other. Numbers in that range are high, and they mean the pooled averages sit on top of a lot of scatter. The authors say so directly and call for cautious interpretation. They also could not run the follow-up analyses that would explain the scatter. There were no breakdowns by type of operation, by which GLP-1 drug, by diabetes status, or by starting BMI, because the source studies did not report the data consistently enough. The review was also not registered with PROSPERO in advance, a step that helps show researchers did not change their plan after seeing results. What a patient can reasonably take from this Both treatments were associated with fewer major heart events than no treatment. That is the finding with the most support behind it. Beyond that, this analysis is a reason to ask your own clinician a better question, not a reason to change treatment. It cannot tell you what will happen to you, and it does not account for surgical risk, your other conditions, cost, or what you are able to stick with. The authors themselves end on individualized choice rather than a winner.

A study published on September 5, 2026 in the journal Obesity Surgery followed 111 women who had a sleeve gastrectomy and who also had the hormone condition long known as polycystic ovary syndrome, or PCOS. Twelve months after surgery their median body mass index had fallen from 38.5 to 26.7. Their median HbA1c, a blood test that reflects average blood sugar over about three months, had fallen from 5.8% to 5.2%. Those are strong numbers. The more useful part of the paper is what the researchers looked for and did not find. Two weight loss patterns, 30.1% and 19.7% of body weight at one year Rather than reporting a single average, the researchers used a method called group based trajectory modeling. It takes repeated measurements over time and sorts people into groups whose curves look alike, instead of assuming everyone follows one path. Two groups came out of the data. The faster group, 64 women or 57.7% of the total, had lost 11.9% of their starting weight at one month, 20.7% at three months and 30.1% at twelve months. The slower group, 47 women or 42.3%, had lost 6.6% at one month, 13.8% at three months and 19.7% at twelve months. Both curves describe real weight loss. A 19.7% loss at one year is not a poor result. But the gap between the two groups is about ten percentage points of starting body weight, and it was already visible one month after the operation. No preoperative measurement separated the two groups The researchers then looked back at everything recorded before surgery to see what distinguished the two groups. They report that the baseline characteristics of the two trajectory groups "were comparable across all measured demographic, anthropometric, hormonal, and metabolic parameters." Age, starting weight and body mass index, hormone levels and metabolic blood tests all looked the same beforehand in the women who went on to lose faster and the women who lost more slowly. For a patient sitting in a preoperative appointment, that is the practical point. In this group, nothing on the chart on the day of the decision indicated which curve a given woman would follow. Faster losers had lower insulin, C-peptide and LDL at follow-up visits The faster group had lower fasting insulin at 1, 6 and 12 months, lower fasting C-peptide at 6 and 12 months, and lower LDL cholesterol at 3 and 12 months. At twelve months, LDL cholesterol averaged 2.41 mmol/L in the faster group against 3.02 mmol/L in the slower group. Insulin and C-peptide are both markers of how hard the pancreas is working to keep blood sugar in range. These differences were measured at the same visits as the weight difference, not before it, so they describe what went along with faster weight loss rather than something that caused it. The condition was renamed in May 2026 The paper calls the condition polyendocrine metabolic ovarian syndrome, or PMOS. That is the new name for PCOS, agreed in May 2026 through a global consensus process backed by more than 50 patient and professional organizations, including the Endocrine Society. The reason given for the change is that the old name was misleading. The consensus group states that research shows there is no increase in abnormal cysts on the ovary in this condition, and that the focus on cysts and ovaries contributed to missed diagnoses and inadequate treatment. The Endocrine Society says the condition affects more than 170 million women worldwide, roughly one in eight. The transition is planned over about three years, with full adoption in a 2028 guideline update, so patients will see both names in medical records and research papers for a while yet.

Surgeons in Michigan have published a multi-hospital safety review of SADI-S, one of the newest weight-loss operations, and the numbers point at something patients can act on. Across 330 operations there were no deaths and a 2.7 percent rate of serious complications. But serious complications were far more common while a surgeon was still learning the procedure. The study appeared in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery. It was posted online on August 10, 2026 and indexed by the National Library of Medicine on September 4, 2026. A newer operation that makes one intestinal connection instead of two SADI-S stands for single anastomosis duodeno-ileal bypass with sleeve gastrectomy. An anastomosis is a surgical join between two sections of intestine. The name says the operation makes only one of them. The surgery begins the same way as a sleeve gastrectomy, with most of the stomach removed to leave a narrow tube. The surgeon then divides the small intestine just past the stomach and connects a lower loop of intestine directly to it. Food travels a shorter route through the gut, and the body absorbs fewer calories and fewer nutrients. ASMBS describes SADI-S as the most recent operation it has endorsed, and lists among its drawbacks that it is a newer operation with only short-term outcome data. That is the gap this study set out to narrow. 330 operations across nine hospitals, no deaths, 2.7 percent serious complications The researchers used the Michigan Bariatric Surgery Collaborative, a registry that has collected data from bariatric programs across the state since 2005. A registry records every operation a participating hospital performs, rather than only the cases a surgeon chooses to write up. That makes disappointing results harder to leave out. The collaborative spans 41 hospitals. Between 2016 and 2025, 13 surgeons at nine of those hospitals performed 330 primary SADI-S operations. Serious complications occurred in 2.7 percent of them. The researchers counted a complication as serious if it involved a major heart or lung event, a leak at the intestinal join, kidney failure, a surgical site infection, a blood clot in a vein, or a return to the operating room. No patient died. Complication rates stayed at or below 2.7 percent even in 2022, when the number of cases jumped. Serious complications ran 5.2 percent in a surgeon's first 20 cases and 0.9 percent after The learning curve was the sharpest finding. Among the surgeons in this group, serious complications occurred in 5.2 percent of a surgeon's first 20 SADI-S operations, and in 0.9 percent of the operations that followed. The authors reported a P value of .018 for that difference. A P value that small means a gap this large would be unlikely to show up by chance alone if experience made no difference. It does not prove experience was the cause, and it does not tell you how large the true difference is. The researchers also checked whether any individual surgeon stood out as unusually risky, using two methods. A funnel plot compares each surgeon's complication rate against how many cases that surgeon performed, since surgeons with few cases naturally show more variation. A cumulative sum analysis, often shortened to CUSUM, tracks results case by case to flag a surgeon whose outcomes drift worse over time. Neither method flagged anyone among the six surgeons who had performed more than 15 cases. One state, 330 cases, and no weight or nutrition data This was an observational study, not a randomized trial, and its limits are real. 330 operations is a small number for measuring rare events. No deaths in 330 cases is reassuring, but it does not mean the risk is zero. Statisticians use a rule of thumb that when no events occur in a study, the true rate could still be as high as roughly three divided by the number of patients. Here that works out to about 1 in 110. The authors framed their conclusion around experienced mid-career bariatric surgeons. The study says little about what happens when a surgeon newer to bariatric surgery takes up SADI-S, or at a hospital performing a handful of these cases a year. The surgeon-level monitoring covered six of the 13 surgeons, because the other seven had not performed enough cases to analyze that way. The results cover short-term surgical complications only. They say nothing about how much weight patients lost, whether diabetes improved, or whether patients developed the vitamin and mineral deficiencies that operations rerouting the intestine are known to cause. Those outcomes take years to measure, and they are a large part of what decides whether an operation was the right choice. All the data came from one state. Michigan hospitals in this collaborative report into a shared quality program and meet regularly to compare results, which is not how every bariatric program in the country operates. The registry is funded by Blue Cross Blue Shield of Michigan and Blue Care Network through the insurer's Value Partnerships Program, and four of the authors reported honoraria or salary support from Blue Cross Blue Shield of Michigan for their roles leading the collaborative. No drug or device maker was reported as funding the work. Anyone weighing SADI-S against a sleeve gastrectomy, a gastric bypass, or a traditional duodenal switch should work through their own risks with their surgical team. How many of these specific operations the surgeon has performed is a fair question to ask.

A randomized trial published on September 5, 2026 in Obesity Surgery tested a 16-week supervised exercise program that started about 10 days after weight-loss surgery. The program did not produce more weight loss than usual care, either at 4 months or at 12 months. The trial is called EFIBAR. Eighty patients having bariatric surgery at Complejo Hospitalario Torrecárdenas in Almería, Spain were assigned at random to usual care after surgery, or to usual care plus the training program. Random assignment is what makes a comparison like this worth reading. It keeps the two groups similar at the start, so a difference in results is more likely to come from the program than from which patients were the type to exercise anyway. The program ran three sessions a week, 60 minutes each, with a trainer supervising each person individually. It combined resistance training, meaning weights, at 50 to 75 percent of the heaviest load a person could lift once, and aerobic training at 65 to 85 percent of heart rate reserve, which is a way of setting effort using a person's own resting and maximum heart rates. Patients were measured before surgery and again at 4 and 12 months. Both groups lost about 37 percent of their body weight by one yearThe result the trial was built to answer was percent total weight loss, meaning the share of starting body weight a person lost. At 4 months it was 24.9 percent with exercise and 23.4 percent without. At 12 months it was 37.0 percent with exercise and 37.2 percent without. The researchers reported no statistically significant difference, which means the gaps were small enough to be explained by ordinary chance rather than by the program. Body composition, inflammation markers measured in blood, and physical fitness testing also showed no significant difference between the groups at any time point. The fitness result is the surprising one, because protecting fitness and muscle is the usual reason exercise is prescribed in the months right after surgery. Blood pressure and blood sugar improved at four months, then the difference disappearedTwo secondary measurements did favor the exercise group early. At 4 months, systolic blood pressure, which is the upper number and reflects the pressure in the arteries when the heart beats, was 6.5 mmHg lower in the exercise group, with a 95 percent confidence interval running from 0.2 to 12.7 mmHg. Glycated hemoglobin, usually written HbA1c, which reflects average blood sugar over roughly the previous three months, was 0.3 percentage points lower, with an interval of 0.1 to 0.5. A confidence interval is the range of underlying values the data are compatible with. Both of these ranges stop just short of zero, so the findings clear the usual statistical bar but do not clear it by much. Neither difference was still present at 12 months. In the paper's key points, the authors describe early supervised exercise as a safe addition to care after surgery. The published abstract does not include a safety table, so that description cannot be checked against numbers here. Eighty patients at one hospital cannot rule out a smaller benefitThe trial enrolled 80 people at a single hospital. A study that size can detect a large effect on weight loss and would miss a small one. So the fair reading is not that exercise does nothing after bariatric surgery. It is that this program, at this intensity, starting this early, did not add measurable weight loss on top of what the surgery itself produced, and both groups lost a great deal of weight either way. The trial was registered before it began, under the identifier NCT03497546, with percent total weight loss named in advance as the main outcome. That matters, because it means the negative result was not produced by switching to a different outcome after the numbers came in. The registry lists a single site, 80 participants, a start date of May 2018 and completion in September 2022. The published abstract does not break the results down by operation type, and the full paper sits behind a paywall. This brief relies on the abstract, the journal's key points, and the trial registry entry.

Use of weight-loss surgery in US teenagers rose sharply over the past decade and is still rare. A study published September 4, 2026 in the Journal of Pediatric Surgery counted 5,430 adolescents aged 12 to 19 who had metabolic and bariatric surgery between 2016 and 2025. Over that period the rate rose 7.7-fold, from 31 to 239 operations per 100,000 eligible adolescents. Even at the peak, 0.24 percent of eligible teenagers had surgery. The researchers used Epic Cosmos, a de-identified research database built from the electronic health records of health systems that use Epic software. That means the study counts what clinicians actually recorded during care across a large share of US hospitals and clinics, rather than answers to a survey or the case series of a single hospital. Sleeve gastrectomy accounted for 89.1 percent of the operationsNearly nine in ten teens had a sleeve gastrectomy, an operation that removes most of the stomach and leaves a narrow tube behind. Conversion to gastric bypass, which is a second and more complex operation, was rare, under 0.4 percent. How often surgery was used tracked closely with how severe the obesity was. By 2025, adolescents with a body mass index of 50 or above had a sleeve gastrectomy roughly nine times as often as those in the lowest eligible BMI group, 605 versus 69 per 100,000. Average hospital stay fell over the decade from 2.0 days to 1.6 days. Serious complications within 30 days stayed at or below 0.6 percentIn the first 30 days after surgery, surgical complications and infections each affected 0.6 percent of patients or fewer. Cardiovascular events and blood clots each affected 0.3 percent or fewer. Reoperation, conversion to bypass, and death were each recorded in under 0.4 percent of patients. Those are rates of events recorded in the first month. They are not an account of long-term risk. A teenager who has this operation lives with an altered digestive system for decades, and a ten-year picture is not what this study set out to provide. Nausea and gallbladder removal were the common problems afterwardThe most frequent diagnoses after surgery were digestive and biliary. Nausea and vomiting were recorded in 12.5 percent of patients within one year. Cholecystectomy, meaning removal of the gallbladder, was recorded in 7.5 percent within three years. As general background, gallstones are a recognized risk after rapid weight loss from any cause. This study counted the operations that happened and did not test what caused them, so the gallbladder figure should be read as a description of what families can expect to encounter rather than a measured effect of the surgery itself. A records study can count operations but cannot say why so few teens have themThe authors conclude that access should be widened. That is their interpretation, and the data support only part of it. The study shows that use is low and that recorded early complications are low. It does not measure why families do not proceed, whether insurers denied coverage, how many eligible teenagers were even offered a referral, or what happened to the teenagers who did not have surgery. The 0.24 percent figure also depends entirely on how the researchers defined an eligible adolescent, and the published abstract does not spell that out. The full paper is behind a paywall, so that denominator could not be checked for this brief. Rates expressed per 100,000 eligible adolescents move a great deal depending on where that line is drawn. Finally, the record only covers what clinicians entered into Epic systems. Care delivered elsewhere, including an operation at a center that does not use Epic software, would not appear in these counts.

A study published on September 3, 2026 in Ophthalmology Retina looked at whether GLP-1 medicines raise the risk of a sudden, usually permanent form of vision loss. The headline result was not statistically significant. It was also based on only 29 cases, which leaves the question a long way from settled. The condition is non-arteritic anterior ischemic optic neuropathy, shortened to NAION. It happens when blood flow to the front of the optic nerve drops and part of the nerve is damaged. People typically wake up with painless loss of vision in one eye, often in the upper or lower half of the visual field. It is uncommon, it usually does not fully recover, and there is no established treatment. Concern about a possible link to GLP-1 medicines has been circulating for roughly two years. The authors of the new paper open by noting that published findings have been inconsistent, partly because earlier studies differed in why patients were taking the drug, what they were compared against, and how long they were followed. The study compared new users of GLP-1 medicines against new users of two other diabetes drug classes The team, led by Jonathan J. Lee at MedStar Georgetown University Hospital with colleagues at the University of Rhode Island College of Pharmacy and Mass Eye and Ear at Harvard Medical School, used administrative claims from United States private health plans covering 2012 through 2024. They restricted the analysis to adults with type 2 diabetes and used what is called a target trial emulation. That means the study was designed to imitate the structure of a randomized trial as closely as claims data allow. Two features matter here. Only people newly starting a medicine were included, which avoids the distortion that comes from studying people who have already tolerated a drug for years. And the comparison group was people starting a different active diabetes medicine, specifically an SGLT-2 inhibitor or a DPP-4 inhibitor, rather than people on no treatment at all. That comparison choice matters, because people who start any new diabetes medicine tend to differ from people who start none. The researchers then used propensity score methods to further balance the two groups on measured characteristics. The overall hazard ratio was 1.87, with a confidence interval running from 0.85 to 4.12 The analysis included 19,505 adults. Of those, 9,213, or 47.2 percent, started a GLP-1 medicine and 10,292, or 52.8 percent, started an SGLT-2 inhibitor or a DPP-4 inhibitor. Across the whole group there were 29 cases of NAION. Compared with the other two drug classes, GLP-1 use overall was not significantly associated with a higher risk of NAION. The adjusted hazard ratio was 1.87, with a 95 percent confidence interval of 0.85 to 4.12. A confidence interval that stretches from 0.85 to 4.12 is doing most of the work in that sentence. Because the interval includes 1.0, the data are compatible with no increase in risk. They are also compatible with a fourfold increase. With 29 events spread across nearly 20,000 people, the study simply cannot distinguish between those possibilities. Reporting this as evidence that GLP-1 medicines are safe for the optic nerve would be as wrong as reporting it as evidence that they are dangerous. The subgroup signal centered on liraglutide, an older medicine, and the numbers behind it are not public The authors report that risk among people taking liraglutide was higher than in the comparison group within 12 or 18 months of follow-up, and that the elevated risk relative to the comparison drugs showed up in men and in older adults. Those are subgroup findings, and subgroup findings drawn from 29 total events are fragile by construction. Splitting a small number of cases into smaller groups produces estimates that move a lot on very little data, and it raises the chance that something looks meaningful purely by accident. The published abstract does not give hazard ratios or confidence intervals for any of those subgroups, and the full paper is behind a subscription, so BariatricPal could not check those numbers against the source. The authors themselves conclude that further research is needed to confirm the findings. Liraglutide, sold as Victoza for diabetes and Saxenda for weight management, is an older daily injection that has largely been displaced by weekly options. A signal concentrated in liraglutide users does not automatically carry over to semaglutide or to the newer medicines, and this study was not designed to answer that. Claims data record billing codes, not eye examinations Everything here rests on insurance claims. NAION was identified from diagnosis codes entered for billing, not from ophthalmologists reviewing charts, so both missed cases and miscoded ones are possible. The study covered people with type 2 diabetes on private insurance, which leaves out people taking these medicines for weight management alone, people on Medicare or Medicaid, and people paying cash. Anyone who has a sudden change in vision in one eye should be evaluated promptly, whatever medicines they take. That is standard advice and it does not change because of this paper. What the paper does change is the state of the evidence, marginally: one more carefully designed study, with a result too imprecise to resolve the question either way.

Adults taking a GLP-1 medicine who were then prescribed oxycodone for pain had more severe gut complications over the next month than similar patients given hydrocodone or tramadol. The finding comes from an analysis of 411,188 US insurance records published on September 2 in Diabetes Care. GLP-1 medicines, the class that includes semaglutide and tirzepatide, work partly by slowing how fast the stomach empties. Opioid painkillers slow the gut as well. The study asked a narrow and practical question: when a patient is already on a GLP-1 and needs a painkiller, does the choice of opioid matter? Within 30 days of the first opioid prescription, the researchers counted a combined measure of three problems. Severe constipation. Bowel obstruction, which is a blockage of the intestine and a surgical emergency. And gastroparesis, which means the stomach empties far more slowly than it should, causing nausea, vomiting and a full feeling after small meals. Roughly one extra case for every 550 to 600 people given oxycodone The rate of that combined measure was 0.51 percent for oxycodone, 0.35 percent for hydrocodone and 0.33 percent for tramadol. Set against hydrocodone, oxycodone carried a risk ratio of 1.48 (95 percent confidence interval 1.30 to 1.69) and an absolute risk difference of 0.17 per 100 patients (0.11 to 0.22). Set against tramadol, the risk ratio was 1.55 (1.33 to 1.79) and the risk difference 0.18 per 100 (0.12 to 0.24). A risk ratio near 1.5 sounds alarming on its own. The absolute numbers are small. A risk difference of 0.17 per 100 works out to about one extra case for every 550 to 600 people who receive oxycodone rather than one of the other two drugs. A confidence interval is the range the true value most likely sits in. None of the ranges above crosses 1.0 for the ratios, so chance alone is an unlikely explanation. The gap came from severe constipation and bowel obstruction. The researchers did not find a difference in gastroparesis between the three opioids. Hydrocodone and tramadol were indistinguishable from each other Comparing hydrocodone with tramadol gave a risk ratio of 1.05 (0.91 to 1.21) and a risk difference of 0.02 per 100 (-0.03 to 0.06). Both ranges include no difference at all, so this study gives no reason to prefer one of those two over the other on gut safety. Everyone studied had type 2 diabetes and averaged 62.8 years of age The cohort came from US insurance claims filed between 2016 and 2025. All 411,188 patients had type 2 diabetes and were already taking a GLP-1. Mean age was 62.8 years and 53.8 percent were women. Of the group, 24.4 percent started oxycodone, 48.5 percent hydrocodone and 27.1 percent tramadol. That shapes who the result speaks to. People taking a GLP-1 for obesity without diabetes, and younger patients generally, were not the population under study. The finding may well extend to them. This study does not show that it does. Claims records cannot show why a clinician picked one opioid This was a new-user cohort study, meaning it followed people from the moment they first filled one of these opioids rather than mixing in long-term users. The researchers applied propensity score matching weights, a statistical method that balances measured differences between groups, such as age, other conditions and previous medicines, so the comparison sits closer to like with like. That method can only balance what was written down. Oxycodone is generally held back for more severe pain, and the reason a clinician reached for it does not appear in a claims database. Patients who receive oxycodone may differ from those who receive tramadol in ways the data cannot capture, and part of the gap could reflect those patients rather than the drug. The authors flag their own caution, writing that variation across secondary analyses warrants cautious interpretation. Follow-up ran for 30 days, so the study says nothing about longer opioid use. This is a prescribing decision, not a patient decision. Anyone on a GLP-1 who is offered a painkiller can raise the question with the prescriber. Nobody should stop or change a prescribed dose on their own.

Weight loss after bariatric surgery gets reported in more than one way, and the formula a program picks changes the number a patient hears. Researchers at Brigham and Women's Hospital and Harvard Medical School tested the three formulas in common use against a national registry of 182,826 operations, and reported on September 2 that two of the three overstate how much weight was actually lost. The analysis used 2023 data from MBSAQIP, the accreditation registry that US bariatric programs report their cases into. It covered sleeve gastrectomy and gastric bypass. Of the 182,826 patients, 136,406 had a body mass index recorded both before surgery and at six months. A smaller group, 27,517 patients, also had a hemoglobin A1c at both points. A1c is a blood test that reflects average blood sugar over roughly the previous three months. The remaining patients were lost to follow-up. Three formulas give three different answers for the same patient Percent total weight loss, written %TWL, is the plain version. It is the share of starting body weight that is gone. Someone who started at 300 pounds and now weighs 240 has lost 20% of total weight. The other two work from excess weight, meaning the amount above a reference weight rather than the whole body weight. Percent excess BMI loss (%EBMIL) and percent excess body weight loss (%EBWL) divide by a smaller starting figure, so they produce larger and more flattering percentages for the identical pounds lost. The researchers first checked whether each formula moved with a patient's starting BMI. Only %TWL was essentially independent of it, with a correlation of -0.016, close to zero. %EBMIL and %EBWL were strongly tied to the starting point, at -0.458 and -0.337. In plain terms, the same physical weight loss produces a much higher excess-weight percentage in a patient who started at a lower BMI, and a lower one in a patient who started very heavy. Two people can lose the same fraction of their body and be handed very different scores. In 1.46% of patients, %EBMIL came out above 100%. The authors call that value uninterpretable, because it implies losing more than all of the excess weight there was to lose. No weight number predicted whether blood sugar improved The second question was whether any weight formula tells you anything useful about diabetes. The team looked at patients whose blood sugar was uncontrolled before surgery and asked which of them reached an A1c below 7.0% at six months. All three metrics discriminated poorly, scoring between 0.60 and 0.63 on area under the curve. Area under the curve runs from 0.5 to 1.0, where 0.5 is a coin flip and 1.0 is perfect separation. Using nothing but how severe a patient's metabolic disease was at the start scored 0.768, better than any of the weight numbers. Weight response and blood sugar response pointed in different directions in 47.4% of patients. Kappa, a statistic that measures agreement beyond what chance alone would produce, was 0.119, near the bottom of its range. Balanced accuracy was 59.2%. The authors conclude that metabolic outcomes should be measured directly rather than inferred from a weight number, and prioritized in patients who have type 2 diabetes. Six months is early, and follow-up was patchy This is a registry study, not a trial. It describes what was recorded in routine US practice in one year, and it cannot establish cause. Six months is early for either weight or diabetes outcomes, and the paper says nothing about how these metrics behave at two years or ten. Follow-up was incomplete by a wide margin. Only 136,406 of 182,826 patients had a paired BMI, and only 27,517 had a paired A1c, so the diabetes analysis rests on roughly 15% of the starting group. Patients who return for follow-up bloodwork may differ from those who do not. The finding is also about measurement, not about whether surgery works. Nothing here says surgery produced less weight loss or worse diabetes control than previously reported. It says that one common way of expressing the result inflates it, and that a weight number is a weak stand-in for a blood test.

An analysis of ten years of United States registry data has found that duodenal switch operations done with a surgical robot were followed by more 30-day hospital readmissions than the same operation done laparoscopically. The paper was published online in Obesity Surgery on September 1, 2026, by a team at the University of Minnesota with a co-author at Dartmouth College. The duodenal switch is one of the less common bariatric operations. It combines a sleeve gastrectomy with a long rerouting of the small intestine, and it typically produces the largest weight loss of any standard procedure. It also carries the highest ongoing nutritional demands, because a long stretch of intestine is bypassed and fewer nutrients get absorbed. The data came from MBSAQIP, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, a national registry run jointly by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. Accredited centers submit standardized 30-day outcome data on their cases. Readmission was 6.2% after robotic surgery and 5.0% after laparoscopic The study included 17,615 minimally invasive duodenal switch cases performed between 2015 and 2024. Of those, 5,496, or 31.2%, were robotic-assisted. Open, endoscopic, hand-assisted and single-incision cases were excluded, as were revisions and conversions from an earlier operation. Within 30 days of surgery, 6.2% of robotic patients were readmitted to hospital, against 5.0% of laparoscopic patients. That difference was significant at p below 0.01. The absolute gap is 1.2 percentage points. Put another way, about 1 extra readmission for every 83 robotic operations. After adjusting for other factors, robotic assistance was associated with an odds ratio of 1.78 for readmission, with a 95% confidence interval of 1.25 to 2.55. An odds ratio is not the same as a risk. It compares the odds of an event in two groups, and when the event is uncommon it tends to look more dramatic than the underlying difference in plain percentages. Both figures are describing the same 6.2% against 5.0%. Longer operations were also independently associated with readmission, at an odds ratio of 1.27 for each standard deviation of extra operating time, with a confidence interval of 1.18 to 1.38. Operating faster did not close the gap The researchers built a pre-specified interaction term to test whether operating time explained the robotic disadvantage. It did not, and the direction was the opposite of what a simple time explanation would predict. Adding the interaction significantly improved the statistical model, with a likelihood ratio p of 0.007. The interaction odds ratio was 0.79, with a confidence interval of 0.67 to 0.94. In practical terms, each standard deviation reduction in operating time made the robotic disadvantage relatively larger, not smaller. The authors draw the obvious conclusion: improved operative efficiency will not resolve the robotic readmission disadvantage. Whatever is driving the extra readmissions, it is not simply that robotic cases take longer. The disadvantage sat in the cases from 2015 through 2019 A subgroup analysis by time period found the effect concentrated in the earlier years of the decade, 2015 through 2019. That pattern is what a learning curve looks like. Robotic bariatric surgery was far less established in 2015 than it is now, and centers adopting it were early in their experience with it. The registry does not record how many robotic cases an individual surgeon had done, which the authors identify as a critical missing confounder. A surgeon on case number five and a surgeon on case number five hundred appear identically in this data. What a registry of this kind can and cannot settle This is an observational analysis, and the authors say plainly that it does not establish cause. Patients were not randomly assigned to robotic or laparoscopic surgery. Surgeons choose the approach, and that choice can be influenced by patient factors, including ones the registry does not capture well. MBSAQIP only covers accredited centers, so results from non-accredited centers are absent. The registry window closes at 30 days, which means nothing here speaks to weight loss, nutritional problems, revision rates or anything else that unfolds over months and years. Cost and resource use were not available. Readmission is also a blunt outcome. It counts a return to hospital without distinguishing a short stay for dehydration from something serious. For a patient weighing a duodenal switch, the practical takeaway is narrow. This is a reason to ask a surgeon how many robotic duodenal switches they personally have done and what their own readmission rate is. It is not a reason to rule out a robotic operation at an experienced center.

A study of nearly 1.8 million operations in the main United States bariatric surgery registry has put numbers to a group surgeons see regularly but that research has largely skipped: people whose body mass index is 60 or higher. Body mass index, or BMI, is weight divided by height squared. It is a blunt measure and says little about any one person's health, but it is the number most surgical programs use to sort risk. A BMI of 60 is roughly a person of average height carrying about 350 pounds. The analysis drew on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, known as MBSAQIP, which collects standardized data from accredited surgical centers. Researchers examined cases from 2015 through 2023 and compared six BMI bands, from under 40 up through 80 and above. Extreme obesity was 5.3% of the eligible surgical sample Across 1,795,127 cases covering 1,262,454 patients, 5.3% met the study's definition of extreme obesity, a BMI of 60 or above. Patients at BMI 70 or higher were a smaller but steady presence, about 1.1% of cases every year, which came to 13,677 cases over the nine years. That steadiness matters. It means the highest-BMI patients are not a rare event that a program encounters once. They are a small, consistent share of the operating schedule at accredited centers nationwide. These patients arrived sicker. Compared with patients below BMI 40, those at BMI 70 or above more often had high blood pressure, 56.7% against 46.9%, and sleep apnea, 59.6% against 34.6%. Chronic obstructive pulmonary disease, a long-term lung condition, was present in 2.6% against 1.1%. Functional dependence, meaning a person needed help with daily activities such as dressing or bathing, was recorded in 4.5% against 0.5%. Complications and deaths rose with BMI but stayed under 3% Serious complications within 30 days of surgery occurred in 2.6% of patients at BMI 70 or higher, compared with 0.7% of patients below BMI 40. Deaths within 30 days were 0.35% against 0.05%. Both differences were statistically significant, meaning they are unlikely to be chance. Read as a ratio, the risk looks steep. Read as a count, it looks different. At BMI 70 and above, roughly 97 of every 100 patients had no serious complication in the first month, and roughly 996 of every 1,000 were alive at 30 days. The authors make that point directly. Their stated conclusion is that although greater BMI is associated with a progressively higher burden of illness and more complications, absolute events are low and do not contraindicate multidisciplinary obesity treatment. They also write that strategies to reduce BMI before surgery in the heaviest patients warrant evaluation, which is a call for more research rather than a recommendation any patient should act on alone. A 30-day snapshot, not a long-term outcome study This is a cross-sectional analysis of registry data. It describes who had surgery and what happened in the first 30 days. It does not report weight loss, diabetes remission, quality of life, or survival beyond one month, and it cannot say whether surgery left these patients better off than not having surgery. Registry data also reflects who was selected for an operation. Surgeons at accredited centers decide which patients to schedule, and the healthiest candidates within any BMI band are the likeliest to reach the operating room. That selection almost certainly makes the reported complication rates lower than they would be if every person at these BMIs had surgery. Finally, MBSAQIP covers accredited centers. Results from non-accredited settings are not captured here and may differ.