When do you prefer bariatric surgery such as sleeve gastrectomy or gastric bypass over an initial trial of a GLP-1 receptor agonist in patients with severe obesity and painful knee or hip osteoarthritis?

I believe that this type of decision should be made by obesity specialists and not by rheumatologists. However, we can anticipate that the patient's choice is paramount: some prefer radical options such as surgery, while others cannot bear to hear about it. The decision should only be made through d...

I do discuss evidence that GLP-1 drugs also reduce inflammation, and there is a suggestion that they reduce OA pain potentially by more than just producing weight loss. I have been advising OA patients with significant obesity to try these drugs (but discuss with PCP as well).