{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T16:07:00Z","timestamp":1779293220434,"version":"3.51.4"},"reference-count":67,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Obesity is a chronic, relapsing disease with multifactorial origins and significant global health implications. Historically, bariatric surgery has been the most effective intervention for achieving sustained weight loss and metabolic improvement, especially in individuals with moderate to severe obesity. However, the therapeutic landscape is rapidly evolving. Recent advances in pharmacotherapy\u2014including GLP-1 receptor agonists, dual and triple incretin agonists, and amylin-based combination therapies\u2014have demonstrated unprecedented efficacy, with some agents inducing 15\u201325% weight loss, approaching outcomes once exclusive to surgical intervention. These developments challenge the continued applicability of existing bariatric surgery criteria, which were established in an era of limited medical alternatives. In this narrative review, we examine the evolution of surgical eligibility thresholds and critically assess the potential role of novel pharmacotherapies in redefining treatment algorithms. By comparing the efficacy, safety, metabolic benefits, and cost-effectiveness of surgery versus next-generation drugs, we explore whether a more stepwise, pharmacotherapy-first approach may now be justified, particularly in patients with BMI 30\u201340 kg\/m2. We also discuss future directions in obesity management, including personalized treatment strategies, perioperative drug use, and the integration of pharmacologic agents into long-term care pathways. As the field advances, a paradigm shift toward individualized, minimally invasive interventions appears inevitable\u2014necessitating a timely re-evaluation of current bariatric surgery guidelines to reflect the expanding potential of medical therapy.<\/jats:p>","DOI":"10.3390\/medicina61071292","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T10:10:38Z","timestamp":1752833438000},"page":"1292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3994-8216","authenticated-orcid":false,"given":"Safi G.","family":"Alqatari","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7740-4730","authenticated-orcid":false,"given":"Abrar J.","family":"Alwaheed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9342-7887","authenticated-orcid":false,"given":"Manal A.","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6056-8616","authenticated-orcid":false,"given":"Reem J.","family":"Al Argan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4022-5181","authenticated-orcid":false,"given":"Marj M.","family":"Alabdullah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8483-6080","authenticated-orcid":false,"given":"Mohammed D.","family":"Al Shubbar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam 31441, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"155217","DOI":"10.1016\/j.metabol.2022.155217","article-title":"A 2022 update on the epidemiology of obesity and a call to action: As its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on","volume":"133","author":"Boutari","year":"2022","journal-title":"Metabolism"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"284","DOI":"10.7861\/clinmed.2023-0168","article-title":"Causes of obesity: A review","volume":"23","author":"Masood","year":"2023","journal-title":"Clin. 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