[Treatment of Morbid Obesity in Israel: GLP-1 Agonists Versus Bariatric Surgery - Clinical and Economic Aspects].

Morbid obesity is a major medical, social, and economic challenge worldwide and in Israel. Approximately 49% of Israeli adults aged 20 years and above are overweight or obese, and about a quarter of a million meet criteria for morbid obesity. This condition significantly increases the risk of type 2 diabetes, cardiovascular disease, cancer, and premature mortality, while imposing a substantial financial burden on the healthcare system and the national economy. Current treatment options for morbid obesity include lifestyle modification, pharmacotherapy, and metabolic surgery. Lifestyle intervention is considered first-line therapy, yet its effectiveness is often limited, particularly in cases of morbid obesity. Over the past decade, the use of glucagon-like peptide-1 receptor agonists (GLP1RA) has increased considerably, yielding an average of 10% weight loss and meaningful improvements in obesity-related comorbidities. However, these medications are associated with side effects, relatively high discontinuation rates, limited accessibility, and high long-term costs. Metabolic surgery typically results in more than 25% weight loss, substantial improvements in obesity-related diseases, and reduced mortality. Although surgery involves higher upfront costs and the potential for complications, recent studies show that it becomes more cost-effective than continuous pharmacotherapy within months to a few years.