Understanding of the therapeutic role of MBS for T2DM remained limited among the general public

Researchers from Saudi Arabia have reported that although general awareness of obesity’s metabolic impact is high, understanding of the therapeutic role of metabolic bariatric surgery for T2DM remained limited. Despite that fact that injectable therapies were more frequently preferred than surgical options, their study did not find definitive conclusions regarding the underlying drivers of these preferences.

“These findings highlight the need for structured public education initiatives to address misconceptions and improve metabolic literacy,” the researchers from Batterjee Medical College, Jeddah, Saudi Arabia, noted. “The results reflect public perceptions rather than clinical decision-making or treatment effectiveness.”

Despite robust evidence supporting the clinical effectiveness of MBS, surgery remains underutilised and public perceptions appear to influence treatment uptake. Misconceptions regarding surgical safety, long-term outcomes, candidacy criteria and metabolic benefits, along with cultural beliefs, fear of complications, and social stigma, may shape decision-making. In Saudi Arabia, where obesity and diabetes prevalence are high, understanding public beliefs is essential for guiding health policy, patient education, and clinical counselling strategies.

In addition, pharmacological management of obesity and T2DM has evolved substantially and have gained broad attention for their effects on weight loss and glycaemic improvement. This growing visibility may shift preferences toward less invasive modalities; however, real-world understanding of mechanisms, limitations, and long-term outcomes remains variable.

Therefore, the researchers conducted a study to regarding MBS and injectable therapies to provide an in-depth analysis of public awareness, perceptions, and treatment preferences for T2DM among adults in Saudi Arabia using a large cross-sectional survey. This study was intentionally designed as a descriptive, perception-based investigation. It did not aim to evaluate clinical outcomes, treatment efficacy or guideline adherence, but rather to explore community-level awareness and beliefs regarding metabolic treatment options.

The survey was distributed online via social media platforms and between May 2025 and August 2025. However, as the survey link was disseminated publicly through multiple channels, a response rate could not be calculated. In addition, because this was a convenience-based online survey, the study was not intended to generate population-representative estimates for Jeddah. Findings reflect the perceptions of surveyed participants rather than the entire population of the city.

Treatment preferences were assessed by comparing participants’ willingness to undergo MBS versus injectable therapy. Participants selected their preferred treatment modality and provided reasons underlying their choice, allowing exploration of cultural, psychological, and informational factors influencing treatment decision-making.

The study focused on three main outcome domains:

• The first domain assessed awareness-related outcomes, including participants’ knowledge of obesity as a modifiable risk factor for type 2 diabetes, awareness of metabolic improvement following MBS and familiarity with injectable pharmacological therapies such as GLP-1 receptor agonists.

• The second domain evaluated clinical burden outcomes, including the prevalence of type 2 diabetes, self-reported diabetes-related complications and the number of antidiabetic medications used.

• The third domain examined treatment preference outcomes, specifically participants’ preference for surgical versus non-surgical management strategies and the factors influencing these choices, such as perceived safety, effectiveness, cost and invasiveness.

Outcomes

A total of 582 participants completed the survey and the majority of respondents were female, with most participants in younger age groups, particularly those aged 18-25 years and 26-35 years. Most participants were Saudi nationals and educational attainment varied, with bachelor’s degree holders constituting the largest subgroup. Nearly half of the participants reported previous attempts at weight-loss interventions; however, only a minority perceived these attempts as successful.

BMI classification demonstrated a high prevalence of excess weight within the sample. Overweight and obesity were common, with obesity classes I-III accounting for the largest proportion of participants, reflecting the substantial burden of obesity in the community.

Regarding diabetes status, approximately half of the participants reported having T2DM, while the remainder reported no diabetes diagnosis. This finding should be interpreted cautiously, as diabetes status was self-reported and not verified clinically, which may reflect misunderstanding or misclassification.

Among participants with diabetes, only a small proportion reported confirmed complications, whereas the majority selected “I don’t know,” indicating considerable uncertainty regarding their complication status. When asked about specific perceived complications, sensory loss, visual problems, and cardiovascular conditions were most frequently reported, while kidney disease and hearing impairment were less commonly identified.

Medication use varied widely, with most participants reporting no diabetes medications, fewer reporting one or two agents, and only a small fraction reporting the use of four or more medications. Several comorbid conditions, including obesity, hypertension, asthma, gastroesophageal reflux disease, and obstructive sleep apnoea, were also prevalent, further highlighting the metabolic burden within the cohort.

Participants demonstrated substantial awareness of obesity and its metabolic implications. Although general metabolic awareness was high, this knowledge did not consistently extend to advanced therapeutic interventions.

Only a minority reported having surgery. However, familiarity with different surgical procedures was relatively high, with sleeve gastrectomy being the most recognised procedure, followed by gastric bypass, mini-gastric bypass and gastric banding. These findings reflect recognition of procedure names rather than procedures actually undertaken. Despite this familiarity, the willingness to pursue surgical intervention was low, with most participants expressing reluctance or uncertainty. Furthermore, the majority perceived previous weight-loss attempts as unsuccessful, underscoring the chronic and relapsing nature of obesity.

Awareness of injectable pharmacotherapies for weight loss and glycaemic control was comparatively higher. Most participants reported awareness of injectable therapies, and this awareness translated into a stronger preference for pharmacological treatment over surgical options when considering clinician-recommended interventions.

When participants were asked to identify potential benefits of surgery, many acknowledged advantages such as improved insulin sensitivity, reduced medication burden, and prevention of long-term complications. Nevertheless, the level of agreement remained lower than that observed for injectable therapies.

Overall, these findings indicate substantial heterogeneity in public understanding of metabolic treatment strategies. While general awareness of obesity as a contributor to type 2 diabetes was high, knowledge regarding the metabolic role of bariatric surgery in improving glycaemic outcomes remained limited.

Conversely, awareness of injectable pharmacotherapies was higher and accompanied by a greater preference for pharmacological approaches. Given the community-based online sampling design, the researchers said these results should be interpreted as reflecting participant perceptions rather than population-level estimates.

“This large community-based study highlights that while awareness of obesity as a key modifiable risk factor for type 2 diabetes is high in Saudi Arabia, knowledge about the metabolic benefits of bariatric surgery remains limited,” the researchers concluded. “Injectable pharmacotherapies, particularly GLP-1-based agents, were more widely recognised and preferred, despite evidence supporting the superior long-term metabolic outcomes of surgical interventions. The findings are intended to inform future public education strategies and hypothesis-generating research rather than guide clinical practice or policy decisions.”

The findings were reported in the paper, 'Public Awareness, Perceptions, and Treatment Preferences Regarding Metabolic (Bariatric) Surgery and Injectable Pharmacotherapies for Type 2 Diabetes in Jeddah, Saudi Arabia: A Cross-Sectional Analysis', published in Cureus. To access this paper, please click here