Weight-Loss Outcomes After Sleeve Gastrectomy Versus Tirzepatide in a Minority Cohort With Severe Obesity: Results From a Propensity Score Matched Cohort.

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/m2 BMI reduction, compared to 12% TWL and 7 kg/m2 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.