Incretin polyagonists as an alternative to bariatric surgery to manage obesity

doi:10.4291/wjgp.v17.i1.118132

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Mar 22, 2026 (publication date) through Mar 20, 2026

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World Journal of Gastrointestinal Pathophysiology

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2150-5330

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pathophysiol. Mar 22, 2026; 17(1): 118132
Published online Mar 22, 2026. doi: 10.4291/wjgp.v17.i1.118132

Incretin polyagonists as an alternative to bariatric surgery to manage obesity

Rohit Jacob Manoj, Cornelius J Fernandez, Sunil Nair, Joseph M Pappachan

Rohit Jacob Manoj, Department of Internal Medicine, Aster DM Healthcare, Dubai 8703, Dubai, United Arab Emirates

Cornelius J Fernandez, Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, Lincolnshire, United Kingdom

Sunil Nair, Joseph M Pappachan, Department of Endocrinology, Countess of Chester Hospital NHS Foundation Trust, Chester CH2 1UL, Cheshire West and Chester, United Kingdom

Sunil Nair, Faculty of Health, Medicine and Society, The University of Chester, Chester CH1 1SF, Cheshire West and Chester, United Kingdom

Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, Greater Manchester, United Kingdom

Joseph M Pappachan, Department of Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India

Author contributions: Manoj RJ and Fernandez CJ contributed to the initial article drafting, created the figures, and revision of the paper; Nair S also participated in the literature search and interpretation of relevant data with supervision of the article drafting and revision process; Pappachan JM conceived the idea, contributed to the conceptualization and design of the article, revision and overall supervision of the article drafting process and contributed to the revision of the paper. All authors have read and approved the final version of the manuscript.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Corresponding author: Joseph M Pappachan, MD, MRCP, FRCP, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, Oxford Road, Manchester M15 6BH, Greater Manchester, United Kingdom. drpappachan@yahoo.co.in

Received: December 24, 2025
Revised: January 10, 2026
Accepted: February 12, 2026
Published online: March 22, 2026
Processing time: 86 Days and 7.3 Hours

Core Tip

Core Tip: Incretins are gut hormones involved in metabolic homeostasis of human body and disorders of the incretin system is recognized as the main reason for the pathobiology of metabolic dysfunction and obesity. Incretin polyagonists are transforming the landscape of obesity treatment by offering potent, non-surgical alternatives to bariatric procedures with remarkable improvements in complications of adiposity including type 2 diabetes and metabolic dysfunction-associated fatty liver disease. Recent clinical trials demonstrate that dual and triple agonists can produce weight reductions comparable to, or in some cases approaching, those seen with bariatric surgery, while simultaneously improving glycemic control, lipid profiles, liver fat, and cardiovascular risk factors. This review discusses the current evidence base for optimal use of incretin polyagonists as an alternative to bariatric surgery.