Metabolic bariatric surgery achieved 18.15% greater total weight loss than GLP-1 receptor agonist medications across five studies encompassing 5,944 patients with obesity. The surgical group also demonstrated a substantially larger BMI reduction of 8.73 kg/m² compared to pharmaceutical intervention, with both differences reaching statistical significance despite high heterogeneity between studies. This meta-analysis provides crucial comparative data in an era where GLP-1 medications like semaglutide and tirzepatide have revolutionized obesity treatment expectations. The magnitude of difference—nearly double-digit percentage points in weight loss—underscores surgery's mechanical advantage over hormonal appetite regulation alone. However, the moderate certainty of evidence reflects inherent limitations: all included studies were observational rather than randomized controlled trials, introducing selection bias since surgical candidates typically have more severe obesity and different risk profiles than medication users. The durability question remains partially unanswered, as follow-up periods varied across studies. While GLP-1 agonists offer remarkable accessibility and safety profiles that have democratized obesity treatment, this analysis confirms surgery's continued supremacy for patients requiring maximum weight reduction. The findings support a tiered approach where medication serves as first-line therapy, with surgery reserved for severe cases or medication failures.