Abstract: Novel anti-obesity medications, particularly glucagon-like peptide-1 receptor agonists and multi-agonist incretin-based therapies, have substantially improved the magnitude of nonsurgical weight loss and associated metabolic benefits.Meanwhile, the indications for metabolic and bariatric surgery have progressively expanded toward patients with lower body mass index values.Consequently, individuals with moderate obesity have become the population in whom the indications for pharmacotherapy and surgery overlap most prominently and in whom treatment decisions remain particularly controversial.Patients with moderate obesity frequently present with type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, obstructive sleep apnea, hypertension, and reproductive or endocrine disorders.Nevertheless, obesity-related organ damage may still be partially reversible, making this stage a critical window for altering the course of disease.Treatment decisions should therefore not be based solely on body mass index, but should incorporate visceral adiposity, metabolic disease burden, the severity of organ impairment, previous weight-loss attempts, treatment adherence, affordability, accessibility, and patient preferences.Lifestyle intervention combined with pharmacotherapy may be prioritized in patients at relatively low risk, whereas metabolic and bariatric surgery should be discussed early in those with a high metabolic risk, progressive complications, or repeated failure of nonsurgical treatment.Pharmacotherapy and surgery should not be regarded as mutually exclusive alternatives.Anti-obesity medications may be used for preoperative optimization, as a strategy to delay or avoid surgery in selected patients, and as adjunctive treatment for insufficient weight loss or weight recurrence after surgery.Future obesity care should move toward an integrated “medication-surgery-follow-up” pathway based on risk stratification, multidisciplinary collaboration, dynamic treatment adjustment, and long-term clinical outcomes, thereby maximizing the complementary and sequential value of different therapeutic modalities.

Key words: moderate obesity; glucagon-like peptide-1 receptor agonists; metabolic and bariatric surgery; anti-obesity medications