Obesity is an increasingly widespread disease worldwide because of lifestyle changes. It is associated with an increased risk of cardiovascular disease, primarily type 2 diabetes mellitus, with an increase in major cardiovascular adverse events. Bariatric surgery has been shown to be able to reduce the incidence of obesity-related cardiovascular disease and thus overall mortality. This result has been shown to be the result of hormonal and metabolic effects induced by post-surgical anatomical changes, with important effects on multiple hormonal and molecular axes that make this treatment more effective than conservative therapy in determining a marked improvement in the patient’s cardiovascular risk profile. This review, therefore, aimed to examine the surgical techniques currently available and how these might be responsible not only for weight loss but also for metabolic improvement and cardiovascular benefits in patients undergoing such procedures. Obesity is a chronic disease, characterized by an excess of adipose tissue, whose etiology is complex and multifactorial, resulting from the interaction of numerous genetic and environmental factors . AccordiThe pathophysiological mechanisms linking obesity and the risk of cardiovascular diseases (CVDs) and adverse cardiovascular events are multiple and different . Obesity2 ..33].The AGB consists of a laparoscopic positioning of a silicone prosthesis (the band) around the stomach creating a proximal gastric pouch of approximately 20–30 mL. The prosthesis is adjustable, i.e., it has the possibility of tightening or widening the passage between the pouch above and the remaining stomach (outlet) below the banding; this occurs because the banding consists of an insufflation chamber that is connected to a valve, positioned in the subcutaneous tissue, through a catheter .The SG consists of the vertical partition of the stomach reaching a reduction of its size of about 25%.Originally, the SG was the first step to execute either a gastric by-pass (GPB) or biliopancreatic diversion (BPD) with duodenal switch (DS) but since most patients showed to successfully achieve satisfactory weight loss without the full procedure, it is now a standing-alone surgery which trend is constantly increasing . Even ifCurrently, the two most frequent malabsorptive procedures performed worldwide are BPD and DS  Figure .These procedures are thought to achieve weight loss through a controlled malabsorption of nutrients.BPD consists of the resection of approximately two distal thirds of the stomach with the closure of the duodenal stump followed by an intestinal bypass. The procedure allows the creation of two tubes: food passes through one and biliopancreatic secretions from the liver and pancreas pass through the other. The meeting of pancreatic secretion and food only takes place for a short distance, approximately 70 cm from the colon, thus resulting in reduced digestion and less food absorption . The gasTo avoid or reduce several complications related to BPD , a SG is executed instead of a distal gastric resection in the so-called BPD/DS .Roux-en-Y gastric bypass (RYGB) is a mixed restrictive and malabsorptive procedure. Weight loss is achieved through gastric restriction and decreased intestinal absorption, which is the greater the further downstream the outlet of the bilio-pancreatic secretions. It consists of the definitive separation of the stomach with the creation of a small gastric pouch of 25–30 mL. This pouch is anastomosed with the alimentary tract of a digiunal loop, while the biliopancreatic tract is anastomosed between 100 and 150 cm downstream of the gastrodigiunal anastomosis .Today, one-anastomosis gastric bypass (OAGB) is the third most commonly performed MBS surgery. It is a modification of the mini-gastric bypass that originated in 1997  and now 2), OAGB was shown to be non-inferior to RYGB with regard to weight loss in a 2 years follow-up [OAGB has been associated with a greater weight loss than RYGB . Furtherollow-up . Interesollow-up . Howeverollow-up ,48.2 or in patients with a BMI ≥ 30 kg/m2 and T2DM. In addition, MBS should be considered in patients with a BMI of 30–34.9 kg/m2 who do not achieve satisfactory weight loss despite optimal lifestyle and medical therapy [According to the 2022, American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guidelines ,50, bariNo recommendation is listed to address a patient to a specific surgical technique. Hence, local expertise, patient individual profile, and preference are the main factors to take into account during the decision-making process .There are no absolute contraindications to BS but severe heart failure, unstable coronary artery disease, end-stage lung disease, active cancer treatment, portal hypertension, drug/alcohol dependency, and impaired intellectual capacity are considered relative contraindications . MoreoveT2DM accounts for 90–95% of diabetic patients  and it iThe number of T2DM patients is dramatically grown worldwide with 151 million adults affected twenty years ago and 462 million in 2019 with a trend destined to increase in the coming years .In 1990 the prevalence of the disease was 3.9% in men and 3.5% in women, in 2019 it reached 6% in men and 5% in women . The proIn a survey conducted in China in 2007–2008, the prevalence of T2DM was higher than in other countries of the world reaching 9.7%, and has been predicted that in 2030, 2 of 10 people with T2DM in the world will live in China.Obesity is one of the major modifiable risk factors of T2DM, but it has been observed that BMI does not correlate with T2DM because it is not representative of the body fat distribution being the android model of obesity with visceral and abdominal fat deposits to have a role in the physiopathology of T2DM rather than the absolute individual weight . This asIn the last twenty years, BS has become the first-choice treatment for severe obesity with an acceptable risk of morbidity and mortality and high efficacy on T2DM control. In a recent study that included 1111 diabetic patients treated with BS, 74% of patients had diabetes remission at 1 year . The effBariatric surgery reduces the incidence of CVD through multiple hormonal mechanisms ,63,64,65The primary change after BS is weight loss, which results in several benefits . A previAfter bariatric surgery, blood levels of triglycerides and glucose are significantly reduced, while postprandial levels of adiponectin, glucagon-like peptide 1 (GLP-1), insulin, and serum insulin-like growth factor-1 (IGF-1) are significantly increased. Elevated adiponectin levels are associated with changes in total fat mass and reduced risk of atherosclerosis . IncreasWeight loss after bariatric surgery may help blood pressure control in obese patients. Previous observations have shown a remission rate of HTN between 60% and 70% in the year following weight loss surgery reaching a peak as high as 90% in a medium follow-up ,79.In this regard, the prospective, observational, unicenter BARIHTA study , has reported that patients with severe obesity scheduled to undergo bariatric surgery  showed aBariatric surgery also reduces the rates of T2DM because of better glucose control that may lead to a remission of diabetes in up to 95–100% of patients . InitialWeight loss after bariatric surgery modulates GLP-1 levels ,92,93,94Peptide YY (PYY) is a peptide released by enteroendocrine L cells in the distal small intestine and colon in response to feeding . It is mAlthough patients with T2DM openly outnumber patients with T1DM, bariatric surgery has been associated also with benefits on T1DM subjects and associated biomarkers. One study indicated that comparable benefits might be achieved by bariatric surgery on complications associated with T1DM as well as T2DM . Other eThe impact of bariatric surgery on the course of Nonalcoholic Fatty Liver Disease (NAFLD) in obese individuals has been also reported ,104,105.Bariatric surgery has been proven to achieve benefic results on cardiovascular risk, by short- and long-term effects on diabetes mellitus, HTN, dyslipidemia, and inflammation, leading to a better quality of life .Several, large cohort studies comparing BS to conventional obesity management have confirmed that patients undergoing bariatric surgery achieve diabetes remission more frequently than those on conventional therapy alone, over a follow-up period ranging from one to 5 years ,109,110.Glycemic profile improvement after bariatric surgery is largely due to the weight loss and the subsequent increase in insulin sensitivity, as it happens to patients who lose an equivalent amount of weight by using caloric restriction . A substWithin 3 months from surgery, the gut microbiome appears markedly altered, with increased diversity ,114,115.Bile acid signaling is also altered after some bariatric surgery interventions. In particular, serum bile acid concentration and composition change following RYGB and SG, but not following laparoscopic AGB. Bile acids act as hormones that bind to the farnesoid X receptor (FXR), improving glucose tolerance ,118. TheRecent meta-analyses have highlighted how different surgical techniques produce different effects on glucose homeostasis, being more drastic procedures  more effective than less drastic ones , and having laparoscopic AGB  the lowest remission rate ,120.Two hypotheses could explain the gut rearrangement that occurs early after bariatric surgery: (1) the hindgut hypothesis, under which the rapid transit of nutrients into the distal bowel, due to proximal small bowel bypass, would cause increased secretion of gut hormones; and (2) the foregut-exclusion hypothesis, by which the levels of an unidentified anti-incretin factor would decrease after exclusion of nutrients from the duodenum and the proximal jejunum ,122.Bariatric surgery leads to improvement or resolution of HTN. A systematic review and meta-analysis of prospective studies have shown that a BMI reduction of 5 corresponds to an HTN reduction of 27% after 12–24 months from surgery .Decrease in vasoconstrictors , increase in vasodilators, and natriuresis  are key factors which mediate blood pressure reduction ,125.HTN improvement after bariatric surgery is also due to obstructive sleep apnea resolution. Obstructive sleep apnea syndrome in obese people is characterized by intermittent hypoxia/hypercapnia, which causes the activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, contributing significantly to HTNBariatric surgery-induced weight loss results in significant improvement of atherogenic lipid profile, in terms of reduction in total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides, and increase in cardioprotective HDL-C ,127. HowBariatric surgery has been proven to reduce obesity-related inflammatory states. A meta-analysis of 52 studies reported a decrease in serum inflammatory markers such as CRP levels, measured by high-sensitivity assay (hs-CRP), of 61.7%, up to 34 months after bariatric surgery . SimilarThe amelioration or resolution of comorbidities typically associated with obesity, including T2DM, HTN, obstructive sleep apneas, dyslipidemia, and gastroesophageal reflux disease, after bariatric surgery, improves significantly patients’ quality of life. A meta-analysis of more than 2000 patients across 21 studies reported a marked improvement in mental health, assessed by using the Short-Form 36 (SF-36) questionnaire, after surgery . SignifiMBS is now considered the most effective treatment for obesity and its complications even in the long term ,136,137.Twelve randomized controlled trials, with a total of 874 patients with T2DM comparing surgical vs. medical therapy with follow-up from 1 to 5 years ,144,145 In these studies, the following surgical procedures have been used: RYGB (9 studies), AGB (5 studies), SG (2 studies), and BPD (1 study) . All of n = 2010) indicate that up to 44% of patients who experience initial remission had a recurrence and need to restart antihypertensive medications within 10 years. However, it should take into account that aging and weight regain might be responsible for this HTN [However, the effect of bariatric surgery on HTN in the long term is not well established yet. Data from an observational study (this HTN .p < 0.05), but with comparable benefits in a 3-year follow-up. Hence, longer follow-up is needed to better evaluate procedure-specific differences in dyslipidemia outcomes.Another study of long-term evaluation, including 1738 RYGB and 610 AGB patients, has shown that the prevalence of dyslipidemia was reduced at 7 years follow-up . In a meMBS was linked to a significantly lower incidence of Major Adverse Cardiac Events (MACE) in patients with severe obesity, T2DM, and HTN up to 10 years after surgery ,150,151.Another analysis including 14 studies with up to 29,208 patients who underwent bariatric surgery and 166,200 matched controls , surgical patients showed more than 50% reduction in mortality compared to control group . In the p < 0.001) compared with nonsurgical group (35717432). The risk of MI , stroke , cardiovascular death , and all-cause death  was significantly lower in bariatric surgery group [Also, Tang et al., in a recent review of the literature and meta-analysis of population-based cohort studies  showed MACE relative risk (RR) in the bariatric surgery group was 0.53  = 0.45–0.62, ry group . These rry group .The current literature, mainly related to observational studies, suggests that patients undergoing bariatric surgery have a lower risk of cardiovascular events and mortality compared to controls. However, future randomized studies are needed to confirm these benefits.“Globesity” and “diabesity” are increasing worldwide with a high social and medical impact.Metabolic surgery is an evolution of obesity surgery. As reported in this article, it represents a valid and feasible therapeutic option for reducing cardiovascular risk, in this class of patients, even compared with medical and lifestyle change interventions.Several studies have shown that MBS acts not only by reducing body weight but also by interacting with complex molecular and hormonal systems which dysfunction correlates closely with the onset of CVDs: in perspective, this means that MBS will have the potential of therapy for dysmetabolism rather than obesity per se.Understanding the molecular and hormonal changes that follow MBS can be useful to deepen the knowledge of the pathophysiology of cardiovascular complications in obese patients, allowing a better definition of the individual profile that can benefit the most from this kind of treatment approach. Indeed, short and long-term studies have demonstrated that MBS can control the major modifiable cardiovascular risk factors including dyslipidemia, HNT, and diabetes which severity should be taken into account in the decision-making process to improve long-term outcomes.Being the new goal of MBS the treatment of metabolic illness, a multidisciplinary approach including cardiologists, surgeons, anesthesiologists, endocrinologists, psychologists, and nutritionists seems necessary to define the most effective therapeutical strategy for each patient, making the field of bariatric surgery of great medical and surgical interest.


Bariatric surgery is one of the most effective interventions for treating obesity and weight-related complications. Since the early days of bariatric surgery, several innovations in surgical technique and periprocedural management have improved overall outcomes and reduced the risk of short and long-term complications. Bariatric surgery continues to be the treatment of choice for many patients with medically complicated obesity in whom lifestyle interventions, with or without anti-obesity medications, have been insufficient.Weight regain is a recognized complication of bariatric surgery that affects about 20 to 25% of patients and is more prevalent after the second postoperative year . Weight Ames et al.). Recognizing problematic eating behaviors and the complexity of eating behaviors offers an opportunity to tailor a behavioral treatment strategy that is effective for the patient.‘Behavioral Interventions to Attenuate Driven Overeating and Weight Regain after Bariatric Surgery’ focuses on identifying and classifying eating behaviors after bariatric surgery that lead to over-consumption of calories  This is an area of immense growth, and as more patients undergo bariatric surgery and the number of available anti-obesity medications increases, we will learn more about the efficacy, safety, and scope of these medications for this understudied patient population.Anti-obesity medications are effective therapies for treating post-bariatric weight regain. In ‘Pharmacologic Management of Weight Regain Following Bariatric Surgery‘, the authors discuss the evidence supporting the use of anti-obesity medications for weight regain in patients who have undergone bariatric surgery . This review highlights short and long-term weight loss outcomes and safety data associated with these emerging procedures. As with other treatment modalities, endoscopic therapies show superior outcomes when paired with a multidisciplinary approach to weight regain, which reinforces the importance of a comprehensive treatment strategy for patients with weight regain after bariatric surgery.‘Endoscopic Management of Weight Recurrence Following Bariatric Surgery’ highlights the role of minimally invasive, endoscopic options for managing weight regain in select patients . Understanding the contributors to weight bias internalization can help improve the patient-provider relationship and may reduce delays in patients with weight regain seeking care.A patient’s lived experience with obesity, including their interactions with the healthcare system, influences how and whether they choose to seek treatment for weight regain following bariatric surgery. This is complicated by the high level of attrition to follow-up after bariatric surgery, which may be impacted by experienced weight stigma and bias. In ‘The Role of Weight Stigma in Weight Regain in Bariatric Surgery’ the authors discuss the critical role of societal messaging, as well as messaging within the medical community towards postsurgical patients that can affect adherence and follow-up (Bariatric surgery is a safe, effective, and durable therapy for obesity and its complications. Beyond improving health, bariatric surgery also increases quality of life and life expectancy. However, obesity is a chronic disease and bariatric surgery is not curative. Significant weight regain is a reality for a small proportion of patients who undergo bariatric surgery and may be challenging to treat. The optimal management of post-bariatric weight regain acknowledges the complexity of the contributing physiological, behavioral, and anatomical factors, and that a multidisciplinary team approach can increase the likelihood of optimizing weight, health outcomes, and quality of life.AS: Writing – review & editing. MS: Writing – original draft. JA: Writing – review & editing.


Obesity is a global health concern, necessitating effective weight-loss interventions. This study aimed to compare the efficacy and safety of semaglutide, a pharmacotherapeutic option, with bariatric surgery, a commonly utilized surgical intervention, for weight reduction. A systematic review of clinical trials, including the STEP (Semaglutide Treatment Effect in People) trials, sustain trials, pioneer trials, and the STAMPEDE  trial, was conducted to evaluate the outcomes of these interventions. The analysis of the clinical trials revealed that semaglutide demonstrated significant weight reduction in participants. However, adverse effects such as gastrointestinal (GI) disturbances, increased pulse rate, and rare cases of thyroid cancer were observed. Long-term effects showed partial weight regain and a return of certain cardiometabolic variables to baseline levels after semaglutide withdrawal. Comparatively, bariatric surgery, as demonstrated in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium and supported by the STAMPEDE trial, exhibited higher efficacy in weight reduction and the management of obesity-induced complications such as diabetes. The STAMPEDE trial demonstrated that bariatric surgery, specifically Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), led to a significantly higher percentage of patients achieving desired diabetes treatment targets compared to medical therapy alone. While bariatric surgery showed superior efficacy, it also carried a higher risk of complications. In contrast, semaglutide presented a noninvasive alternative with significant weight reduction and lower incidences of adverse effects. In conclusion, this study highlights that bariatric surgery, such as Roux-en-Y gastric bypass and sleeve gastrectomy, remains a highly effective intervention for weight loss and management of obesity-induced complications. However, semaglutide represents a valuable noninvasive alternative, offering significant weight reduction and lower risks of adverse effects. The choice between these interventions should be based on individual patient characteristics and a comprehensive assessment of the risk-benefit profile. In 1975, a mere 5% of the global population fell into the category of obesity, whereas by 2014, this figure had more than doubled to 13% [The prevalence of obesity worldwide, characterized by a body mass index (BMI) of 30 kg/mAccording to some studies, gastrointestinal surgery offers unparalleled efficacy and enduring weight-loss outcomes for individuals grappling with obesity . BariatrSemaglutide, an investigational human glucagon-like peptide-1 analogue , is being developed as a potential treatment for type-2 diabetes (T2D). It shares a similar structure to liraglutide and exhibits a high degree of structural similarity (94%) to native human GLP-1 . The motIn recent years, there have been significant advancements in the field of weight loss interventions, specifically focusing on the efficacy of semaglutide treatment and bariatric surgery. This review aims to compare the effectiveness of these two treatment modalities in achieving weight loss outcomes and will acknowledge the practical limitations of using either of these approaches for long-term weight management. While both approaches have shown promise in promoting weight loss, it is crucial to consider factors such as accessibility, cost-effectiveness, sustainability, and potential adverse effects when evaluating their practicality as weight loss interventions. By critically examining the recent developments and limitations of semaglutide treatment and bariatric surgery, this review aims to provide a comprehensive understanding of their respective efficacies and practical implications for individuals seeking long-term weight management solutions.Efficacy of bariatric surgery for weight lossIn the United States, the number of bariatric procedures performed annually was estimated to be around 252,000 as of 2018. Among primary bariatric procedures, approximately 61% were sleeve gastrectomy procedures, while 17% were RYGB procedures. The AGB and biliopancreatic diversion procedures each accounted for less than 2% of the total . AccordiBariatric surgery has shown long-term effectiveness in sustaining weight loss. The mechanisms contributing to sustained weight loss include changes in appetite regulation, altered gut hormone secretion, and modifications in the gut microbiota. A study published in the New England Journal of Medicine in 2017 reported that five years after bariatric surgery, patients maintained an average weight loss of 25% of their initial body weight . The STAIn a clinical cohort study involving 1787 veterans, the effectiveness of bariatric surgery was evaluated for patients who underwent Roux-en-Y gastric bypass (RYGB) and other forms of metabolic bariatric surgeries. The results are summarized in Table As evident from the aforementioned data, at the four-year mark, veterans who underwent RYGB surgery experienced significantly more weight loss compared to those who had SG or AGB.Effectiveness and mechanism of weight loss using semaglutideGLP-1, a hormone crucial for regulating appetite and digestion, is produced in two primary locations within the body: L-cells in the gastrointestinal tract and specialized cells in the hindbrain's nucleus tractus solitarius. The effects of native GLP-1 are mediated through GLP-1 receptors present in various tissues throughout the body. GLP-1 orchestrates a wide array of physiological actions, including enhancing the feeling of fullness, diminishing appetite, and decelerating the process of gastric emptying .Semaglutide, having 94% structural homology with native human GLP-1, exhibits three important modifications. An amino acid substitution at position 8 reduces susceptibility to degradation by the dipeptidyl peptidase-4 inhibitor (DPP-4). Lysine acylation at position 26, along with a spacer and C-18 fatty di-acid chain, facilitates strong and specific binding to albumin. Additionally, an amino acid substitution at position 34 prevents unintended binding of the C-18 fatty di-acid chain. These structural modifications enhance semaglutide's stability, duration of action, and dosing convenience . SemagluThe outcomes of the STEP 1-3 trials revealed significant weight loss of 15% to 16% in participants without T2D and 9.6% in those with T2D, achieved through once-weekly subcutaneous semaglutide 2.4 mg in adults with overweight or obesity -35. In SMultiple studies have been conducted to assess the effects of semaglutide on weight loss. Some of these are summarized in Table Based on the data presented in the table, the clinical trials consistently demonstrate that semaglutide is effective in promoting weight loss across various patient populations. Semaglutide, whether administered orally or subcutaneously, consistently leads to statistically significant reductions in body weight compared to placebo or other antidiabetic agents. The weight loss achieved with semaglutide is dose-dependent, with higher doses generally resulting in greater weight reductions. Additionally, semaglutide has been shown to be effective in reducing body weight when added to insulin therapy or used in combination with other medications. These findings support the conclusion that semaglutide is an effective treatment option for weight management in patients with type 2 diabetes, obesity, or overweight individuals.Complications of metabolic surgery vs. semaglutide for weight reductionMetabolic surgery has remained one of the preferred choices for weight loss; however, despite having a plethora of benefits, it also has certain complications . These cOne of the most common complications of bariatric surgery is nutritional deficiency . MalabsoHepatobiliary complications can also occur after bariatric surgery. The formation of gallstones is a common complication . GallstoDumping syndrome is another significant complication that can occur after bariatric surgery, particularly gastric bypass . This syGastrointestinal complications can also arise after bariatric surgery. Gastric ulcers may develop due to changes in stomach acid production and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management -46. BoweNeurological complications, although rare, can occur after bariatric surgery -49. PostGynecological complications are also worth considering. Obesity itself can cause infertility due to hormonal imbalances . After bIn conclusion, bariatric surgery can lead to a range of complications affecting different systems in the body. Nutritional deficiencies, hepatobiliary complications, dumping syndrome, gastrointestinal issues, neurological complications, and gynecological complications are among the potential risks. Close monitoring, regular follow-up appointments, and appropriate management strategies are necessary to detect and address these complications effectively, ensuring the best possible outcomes for patients undergoing bariatric surgery.On the other hand, there are patients who tend to lean towards noninvasive techniques such as pharmacotherapy for weight loss, and semaglutide has proven to be markedly successful in this domain; however, like most of the other therapeutic drugs, this comes with a sideline of adverse effects. The clinical trials mentioned above for semaglutide also precipitated certain side effects, some of which are summarized in Table Based on the available information, the gastrointestinal (GI) side effects associated with semaglutide, such as nausea, diarrhea, vomiting, and constipation, are generally self-limiting. This means that they typically resolve on their own without the need for permanent treatment discontinuation. Most of these GI side effects were reported to be mild-to-moderate in severity and transient in nature.In the STEP and sustain trials, there have been reports of thyroid cancer cases in participants treated with semaglutide. However, it is important to note that the incidence of thyroid cancer in these trials was relatively low and overall not statistically significant compared to the control groups -37. In tThe main finding from the STEP 1 trial extension is that after a significant reduction in body weight during 68 weeks of treatment with once-weekly subcutaneous semaglutide plus lifestyle intervention, most of the weight loss was regained within one year after treatment withdrawal. Additionally, some cardiometabolic variables showed a similar change back to baseline levels . This fiThe choice between surgery and semaglutide for weight reduction should be based on individual factors and preferences. Bariatric surgery has demonstrated high efficacy but carries a higher risk of complications, while semaglutide offers notable weight reduction benefits with a lower risk profile. Long-term considerations, patient preferences, and multidisciplinary care should be taken into account when making a decision.While several effects and adverse effects of surgical and pharmacologic interventions for weight loss have been discussed, continuous research is required to understand the long-term outcomes of the treatment modalities. For example, the participants of the STEP trials were roughly between one and two thousand in number, which limits the trial’s ability to showcase semaglutide’s variable effects on larger populations over a longer period of time. In addition to this, the participant number for the pioneer trials remained ever lower than 1000 in instances, further perpetuating the need to have ongoing research in this field with regular follow-ups. As a result, even though research has shown promising effects of semaglutide on weight loss, further studies, including a more diverse variety of ethnicities, are required to know the precise effects of the drug before it develops this niche role for weight loss in the market.In conclusion, semaglutide shows promise as a noninvasive pharmacotherapeutic armamentarium for weight loss, demonstrating notable efficacy. However, it is important to acknowledge the potential adverse effects, such as gastrointestinal disturbances, increased pulse rate, and rare cases of thyroid cancer. While the incidence of these side effects is relatively low, ongoing research is needed to better understand their relationship with semaglutide. The long-term effects of treatment withdrawal indicate partial weight gain and the need for continued intervention. When choosing between bariatric surgery and semaglutide, individual factors and preferences should be considered. Bariatric surgery offers high efficacy but carries a greater risk of complications, while semaglutide provides significant weight reduction benefits with a lower risk profile. A comprehensive approach involving long-term considerations, patient preferences, alternative treatment modalities, and multidisciplinary care is crucial. Further research and longer follow-up studies are necessary to optimize the use of semaglutide and fully comprehend its long-term outcomes and safety profile in clinical practice. This review has gathered information from clinical trials and other forms of previously published data to provide a comparison between bariatric surgery and semaglutide for effective weight loss, which will allow readers to access updated developments in this field of medicine.