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The Current is a daily tech newsletter written by Kim Komando that helps you stay up to date on AI, tech, and trends in about 5 minutes a day.
Each morning she breaks down what’s happening in tech so you can quickly understand what matters without digging through a bunch of different questionable sources.
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| May 13, 2026 • Vol. 1, Issue 5 | |||
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Contact & Correspondence
We welcome inquiries, tips, letters to the editor, and article ideas from the MBS community. Reach us at [email protected] — your submissions help shape what we cover. |
Coming Soon
Invited surgeon commentaries are forthcoming. If you are interested in contributing a perspective or editorial on a topic relevant to metabolic and bariatric surgery, please contact us at [email protected]. |
Bariatric Surgery Outperforms GLP-1 Medications on Cardiovascular and Microvascular Outcomes in Older Adults with DiabetesShin TH et al. (Abstract 4719) — ASMBS 2026 Annual Meeting, San Antonio, May 6, 2026
A large real-world analysis presented at the ASMBS 2026 Annual Meeting offers the most compelling evidence to date that bariatric surgery provides durable metabolic protection beyond what GLP-1 receptor agonists deliver in older adults. The study drew on Epic Cosmos data from more than 107,000 patients age 65 and older carrying both obesity and type 2 diabetes, tracked from 2017 through 2025. Patients who underwent bariatric surgery experienced major adverse cardiovascular events (MACE) at a rate of 11.5%, compared with 13.6% among those treated with GLP-1 medications — a relative reduction of roughly 16%. The cardiovascular advantage was accompanied by striking differences in microvascular disease: kidney disease developed at 9.1% versus 12.4% (exceeding a 25% relative reduction) and diabetic retinopathy at 5.8% versus 9.0% (a 35% relative reduction). Weight loss at one year was 17.3% in the surgical cohort versus 4.2% in the pharmacotherapy group. ASMBS President Richard Peterson, MD, FASMBS, emphasized the broader implication: bariatric surgery remains “a powerful metabolic intervention that can meaningfully change the trajectory of chronic disease.” Key Finding
MACE: 11.5% (surgery) vs. 13.6% (GLP-1). Kidney disease: 9.1% vs. 12.4%. Retinopathy: 5.8% vs. 9.0%. 107,000+ patients ≥65 years, 2017–2025. Surgical candidacy evaluation should remain active — not a last resort. |
Despite GLP-1 Boom, 90 to 95 Percent of Adults with Severe Obesity Remain UntreatedReeves J et al. (Abstract 4393; co-authors: Laverde, Neel) — ASMBS 2026 Annual Meeting, San Antonio, May 5, 2026
As GLP-1 prescriptions have grown more than 300-fold over seven years, a new population-level analysis shows that the surge has not meaningfully narrowed the obesity treatment gap — and may have contributed to a reversal in bariatric surgery volume that compounds the problem. The study analyzed Epic Cosmos data covering approximately 20 million adults with severe obesity and no diabetes between 2018 and 2025. GLP-1 prescriptions climbed from 4,592 to more than 1.4 million annually. Bariatric surgery rose from roughly 20,000 to a peak of 42,615 cases in 2023, then declined to 33,429 by 2025. Despite both trends, the proportion of eligible patients receiving any treatment held at 90 to 95 percent untreated throughout. GLP-1 medications are “only reaching a fraction of the population that could benefit,” Reeves noted. The recent decline in surgical volume — occurring precisely as GLP-1 enthusiasm peaks — represents an additional concern, as a substitution effect without commensurate pharmaceutical penetration leaves the treatment gap intact or wider. Structural Reality
GLP-1 Rx up 300-fold. Bariatric surgery peaked 2023 (42,615 cases), declined to 33,429 by 2025. Treatment gap: unchanged at 90–95% untreated. Access, affordability, and system capacity remain the binding constraints. |
Artificial Intelligence in Bariatric Surgery: A Scoping Review Finds Postoperative Applications Dominate, Preoperative Use LagsBrar K, Chattha I, Gobraeil S, Mocanu V, Corcelles R, Kroh M, Shin T, Dang JT, Lee Y — SOARD (pre-proof). DOI: 10.1016/j.soard.2026.05.002. May 4, 2026
A scoping review published ahead of print in SOARD mapped 58 studies from database inception through November 2024, offering a structured snapshot of where AI has taken hold in the perioperative pathway of metabolic and bariatric surgery. Postoperative AI applications accounted for 60.3% of the published literature. Intraoperative applications comprised 12.1% of studies, preoperative applications just 6.9%, and large language model (LLM) research 18.9%. Neural network architectures appeared in 55.3% of studies; ChatGPT featured in 90.9% of LLM work, illustrating how quickly a single platform has come to dominate early research in this category. A 2025 Delphi consensus process endorsed AI applications in bariatric surgical education and patient selection, lending guideline-level support to two areas where human judgment has historically been difficult to standardize. The review identifies a clear imbalance: preoperative decision support — where AI could assist with risk stratification, patient selection, and informed consent preparation — remains the least developed application despite arguably having the highest yield for patient safety. Research Gap
Postoperative AI applications: 60.3% of literature. Preoperative: 6.9%. LLM research: 18.9%, with ChatGPT in 90.9% of those studies. Delphi consensus endorses AI for education and patient selection — the two least-developed application areas. |
Staple Line Reinforcement in Gastric Bypass Reduces Bleeding and Stricture, but Does Not Affect Leak RateLi X, Yuan L, Zhang J, Hu H, Liao J, Wei K, Ma S, Liu Q, Chen G, Tian Y — SOARD (pre-proof). DOI: 10.1016/j.soard.2026.05.010. May 4, 2026
A meta-analysis of 3,680 patients across 10 studies (3 RCTs, 7 cohort studies; PROSPERO CRD420251246939) finds that staple line reinforcement (SLR) during Roux-en-Y gastric bypass significantly reduces bleeding and stricture while having no measurable effect on anastomotic leak — providing the most comprehensive quantitative synthesis to date on a technique that remains inconsistently applied across high-volume bariatric programs. The relative risk of staple line bleeding in reinforced versus non-reinforced cases was 0.23 (P=0.002, I²=0%), indicating a large, consistent reduction. Stricture formation showed a similarly large risk reduction (RR=0.25, P=0.03), though with higher heterogeneity (I²=60%). By contrast, the relative risk of leak did not reach statistical significance (RR=0.30, P=0.23). Reinforcement was also associated with a shorter hospital stay. Clinical Implication
SLR: strong case for bleeding reduction (RR=0.23, P=0.002). Stricture reduction encouraging (RR=0.25, P=0.03) but heterogeneous. Leak prevention: not supported by pooled data (P=0.23). Programs justifying SLR on leak grounds should revisit that rationale. |
TAP Blocks Support Opioid-Sparing Protocols in Gastric Bypass Without Reducing Early Postoperative PainDrumm C, Davey MG, Moore S, Keating T, Donlon NE — Obesity Surgery 2026. DOI: 10.1007/s11695-026-08711-4. May 6, 2026
A systematic review and meta-analysis (PROSPERO CRD42025638050; PRISMA 2020) pooled data from 5 RCTs encompassing 481 patients undergoing Roux-en-Y gastric bypass. TAP blocks produced no statistically significant reduction in pain scores at recovery, 6 hours, or 12 hours postoperatively. At 24 hours, a modest but significant reduction emerged (mean difference −0.57, 95% CI −0.96 to −0.17, P=0.005), though heterogeneity was high (I²=92%). The opioid-sparing effect was the most clinically striking finding: patients receiving TAP blocks had significantly lower odds of requiring breakthrough opioid analgesia (OR 0.09, 95% CI 0.02–0.32, P=0.0003, I²=51%) — a roughly 10-fold reduction in odds. Time to first ambulation was meaningfully shorter (mean difference −1.65 hours, P<0.00001, I²=0%). TAP blocks should not be positioned as analgesics in the traditional sense. Their value lies within ERABS frameworks as an opioid-sparing adjunct — a role the evidence clearly supports. ERABS Role
Breakthrough opioid OR=0.09 (roughly 10-fold reduction in odds). Ambulation earlier by −1.65 hrs. Pain scores: not significantly reduced <12 hrs. TAP blocks belong in multimodal protocols for opioid reduction, not pain control per se. |
Surgery and Lifestyle Weight Loss Produce Opposite Eating Behavior Patterns, Pointing to Distinct Physiological MechanismsVuorela L, Berntzen BJ et al. — PLoS One 21(4): e0346240. DOI: 10.1371/journal.pone.0346240. April 27, 2026
A longitudinal study from the University of Helsinki tracked validated eating behavior measures in matched cohorts over 12 months, finding that bariatric surgery and lifestyle-based weight loss generate nearly mirror-image patterns in cognitive restraint while converging on reductions in binge eating and external cue responsiveness. The study enrolled 19 bariatric surgery patients (7 RYGB, 12 OAGB) and 19 lifestyle participants, assessed with TFEQ, DEBQ, and Binge Eating Scale at enrollment, 5–6 months, and 12 months. Total weight loss differed substantially: surgery patients lost 28.1±8.1 kg versus 8.9±7.9 kg in the lifestyle group (P<0.001). On cognitive restraint, the groups diverged sharply: lifestyle participants showed a substantial increase (TFEQ score +6.4±0.9) while surgical patients remained stable or slightly decreased (−0.05±0.7, P<0.001 between groups). This pattern persisted when controlling for the amount of weight lost, indicating the divergence reflects mechanism rather than magnitude. The investigators interpret the surgical pattern as reflecting physiological modification of hunger and cue-reactivity consistent with gut hormone signaling alterations. For clinical care: surgical patients who struggle postoperatively are less likely to benefit from traditional cognitive restraint coaching and may be better served by approaches targeting physiological adaptation and hedonic hunger. Clinical Distinction
Cognitive restraint increased sharply post-lifestyle (+6.4) and was unchanged post-surgery (−0.05). Both groups improved binge eating and external cue responsiveness. Post-surgical eating behavior concerns require physiological framing — not willpower coaching. |
Orforglipron Maintains Injectable GLP-1 Weight Loss for One Year in ATTAIN-MAINTAIN TrialAronne LJ, Horn DB, le Roux CW et al. — Nature Medicine 2026. DOI: 10.1038/s41591-026-04386-7. May 13, 2026
Oral orforglipron (Foundayo), the once-daily nonpeptide GLP-1 receptor agonist approved by the FDA in April 2026, successfully maintained weight achieved with injectable GLP-1 and GIP/GLP-1 therapies for 52 weeks in a phase 3b RCT — providing the first prospective evidence for a pharmacological bridge strategy in obesity management. The ATTAIN-MAINTAIN trial (Eli Lilly-funded; 29 U.S. sites) enrolled 376 participants who had completed 72 weeks of tirzepatide or semaglutide in SURMOUNT-5, then randomized 3:2 to orforglipron versus placebo. In Cohort 1 (post-tirzepatide, n=205), 74.7% of orforglipron-treated patients maintained at least a threshold level of prior weight loss versus 49.2% on placebo (ETD 25.5 pp, 95% CI 14.5–36.5, P<0.001). In Cohort 2 (post-semaglutide, n=171), 79.3% maintained weight on orforglipron versus 37.6% on placebo (ETD 41.7 pp, 95% CI 24.4–59.0, P<0.001). Both cohorts ended at a mean weight of ~95.9 kg. The authors characterize orforglipron as offering “a globally scalable option for minimizing weight changes after injectable therapy.” Key limitations: no head-to-head comparison with continuing injectable therapy; U.S.-only sites; 52-week follow-up. Bridge Strategy
Post-tirzepatide maintenance: 74.7% vs. 49.2% (ETD 25.5 pp). Post-semaglutide: 79.3% vs. 37.6% (ETD 41.7 pp). First evidence base for patients transitioning off injectable GLP-1 agents — cost, access, side effects, or preference. |
TOS, OMA, and OAC Issue First Joint Obesity Pharmacotherapy Guidance Since 2016, Elevate Semaglutide, Tirzepatide, and Bupropion-Naltrexone to Strong RecommendationsAlexander L, Purnell JQ, Burridge K, Cornier MA, Golden A, Horn DB, Look M, Nadglowski J et al. — Obesity Pillars 18(2026):100254. DOI: 10.1016/j.obpill.2026.100254. March 5, 2026
Three major obesity medicine societies jointly released the most comprehensive U.S. pharmacotherapy guidance in a decade, applying the GRADE evidence framework to eight FDA-approved medications across 15 clinical questions. The Epistemonikos database search ran through May 29, 2025 and was structured around 15 PICO questions covering drugs, maintenance management, and obesity-related complications including OSA, HFpEF, MASLD/MASH, osteoarthritis, MACE, and type 2 diabetes. Four agents received strong recommendations based on moderate-certainty evidence: semaglutide, tirzepatide, bupropion-naltrexone, and setmelanotide (in patients with relevant genetic deficiency). The most unambiguous finding: continuing obesity medications rather than stopping them prevented approximately 16 kg more weight regain — graded as strong recommendation with high certainty of evidence. Running through the document is a stark equity concern: approximately 1.6% of eligible adults currently receive any pharmacological obesity treatment. The guidance explicitly challenges legacy framing: “Obesity medications should no longer be considered an ‘adjunct’ to lifestyle” — a reframing that aligns pharmacotherapy with the level of clinical priority the evidence now demands. GRADE Highlights
Strong recommendations: semaglutide, tirzepatide, bupropion-naltrexone, setmelanotide. Stopping medications: ~16 kg additional weight regain. Only 1.6% of eligible adults currently treated. Medications no longer “adjunctive.” |
PCOS Gets a New Name — and a New Identity: Polyendocrine Metabolic Ovarian SyndromeTeede H et al. (lead author, Monash University) — Endocrine Society press release / The Lancet. May 12, 2026
After 14 years of global collaboration involving more than 50 patient and professional organizations and more than 22,000 survey responses, one of the most prevalent and undertreated conditions in women’s endocrine health has a new name. Polycystic Ovary Syndrome (PCOS) is now Polyendocrine Metabolic Ovarian Syndrome — PMOS. The name change was announced May 12, 2026 by the Endocrine Society and published simultaneously in The Lancet. The old name was scientifically inaccurate in at least one critical respect: there is no actual increase in abnormal ovarian cysts in the condition. That mischaracterization narrowed clinical attention toward reproductive features and away from what makes PMOS so consequential — its metabolic dimensions. The condition affects 1 in 8 women worldwide (more than 170 million) and is defined by fluctuating hormone levels with downstream effects on weight, metabolic health, mental health, skin, and the reproductive system. The renaming process was designed around patient benefit, scientific accuracy, avoidance of stigma, and cultural appropriateness. A three-year transition period is now underway; full implementation expected in the 2028 International Guideline update. Rachel Morman, Chair of Verity (PCOS UK), captured the significance: “the new name now leads with hormones and recognizes the metabolic dimension of the condition.” MBS Relevance
PMOS: insulin resistance, weight dysregulation, elevated metabolic risk — overlaps substantially with bariatric patient populations. Clinicians caring for women with obesity and metabolic syndrome should screen for PMOS as both a driver and a modifiable target. |
Global Obesity Is Not One Story: Rates Plateau in Wealthy Nations While Accelerating Across Low- and Middle-Income CountriesNCD Risk Factor Collaboration (lead: Majid Ezzati, Imperial College London) — Nature, May 13, 2026. Reported by Cooney E, STAT News, May 13, 2026
A major analysis challenges the monolithic framing of a global “obesity pandemic” by showing that trajectories of weight gain diverge sharply by national income level — and by introducing the “velocity of obesity,” a conceptual lens tracking not prevalence but rate of change. The NCD Risk Factor Collaboration drew on data from 232 million participants across more than 4,000 population-based studies spanning 1980–2024. In 2024, obesity velocity was at its highest point in the entire 45-year study period in 84 of 200 countries for women and 109 of 200 countries for men — concentrated almost entirely in low- and middle-income settings. In most high-income countries, rise in obesity rates has leveled off; in France, Italy, and Portugal, rates may be declining, though durability is unconfirmed. The United States presents a nuanced picture: obesity in children and adolescents has plateaued, but adult rates continue to climb. American adults have obesity prevalence of 40–43%. Lead researcher Majid Ezzati offered a finding that cuts against fatalism: “The rise is not inevitable.” Yet the forces driving obesity in most of the world — rapid urbanization, ultra-processed food displacement, sedentary environments — remain largely intact and accelerating in many regions. Global Context
Highest-ever obesity velocity in 84 countries (women) and 109 countries (men) in 2024. U.S. adult obesity: 40–43%. Japan: single digits. GLP-1s’ role in bending global curves: too early to assess. Prevention infrastructure will determine trajectory in lower-income countries. |
Two-Thirds of U.S. Physicians Now Use OpenEvidence — The AI Clinical Search Tool Most Patients Don’t Know AboutPerlo J — NBC News, May 13, 2026
An AI-powered clinical search platform called OpenEvidence has quietly become the most widely adopted physician technology in American medical history. Approximately 650,000 U.S. physicians — roughly two-thirds of the active physician workforce — use the platform, logging 27 million clinical encounters in April 2026 alone. Another 1.2 million clinicians use it internationally. OpenEvidence functions as an evidence-based clinical decision support tool: physicians enter natural-language queries and receive synthesized answers sourced from licensed peer-reviewed literature, with direct links to supporting papers. Unlike general-purpose AI tools, OpenEvidence has licensing agreements with NEJM, JAMA, the American Diabetes Association, and the National Comprehensive Cancer Network. “We think of AI as search glue,” said CEO Daniel Nadler. The platform is free to verified healthcare providers (NPI-based signup) and funded through pharmaceutical and medical device advertising. Valued at $1 billion in early 2025, it reached a $12 billion valuation in early 2026 after raising $700 million in under a year (Sequoia, Google Ventures, Nvidia, Andreessen Horowitz). In March 2026, Mount Sinai Health System (47,000 employees) integrated it directly into its EHR portal. For MBS Programs
OpenEvidence strength lies in cross-specialty queries — precisely the territory bariatric surgeons occupy. 60% of its 90M platform queries involve complex patients with comorbidities. Caveat: one unreviewed study found accurate answers to complex questions in fewer than 45% of cases. |
Johnson & Johnson’s OTTAVA Robotic System Meets Endpoints in Bariatric Surgery Pivotal Trial, Files for FDA De Novo ClearanceJ&J press release — ASMBS 2026 Annual Meeting, San Antonio, May 5, 2026
Johnson & Johnson has taken a direct shot at the robotic surgery market in bariatric procedures, announcing that its investigational OTTAVA™ soft-tissue robotic surgical system met all primary safety and performance endpoints in a pivotal clinical study evaluating Roux-en-Y gastric bypass. J&J has submitted data from the trial to the FDA in support of a De Novo classification application. The FORTE Study (Safety and Performance of the OTTAVA™ Robotic System: A Prospective Multi-Center Evaluation) was a single-arm, open-label trial across six U.S. sites with a 30-patient cohort, tracking safety and performance through 30 days post-procedure. All procedures were completed robotically without conversion. Average weight loss at 30 days was 30 pounds. A logistically notable finding: OTTAVA was successfully deployed in five of six sites in operating rooms never previously used for robotic surgery, including rooms historically considered challenging due to space constraints — a differentiator J&J emphasizes versus the Intuitive Surgical da Vinci platform, which requires dedicated OR configurations. OTTAVA represents the most credible competitive challenge to Intuitive Surgical’s dominance in bariatric robotics yet brought to clinical validation. Market Watch
FORTE Study: all primary safety and performance endpoints met. 30-patient cohort; 6 U.S. sites; 30-day follow-up. De Novo application filed with FDA. OTTAVA deployed in non-dedicated ORs — a key flexibility advantage over da Vinci. |
BALANCE Model: What Bariatric Surgeons Need to Know About CMS’s GLP-1 Coverage Initiative — and Its DelaysKFF analysis — 2026. CMS BALANCE model and Medicare GLP-1 Bridge program
The Centers for Medicare and Medicaid Services (CMS) launched the BALANCE model — Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth — as its signature initiative to expand GLP-1 medication access for obesity in Medicare and Medicaid. A Kaiser Family Foundation analysis of the program clarifies both what the model promises and where it falls short, arriving as implementation has been indefinitely delayed. The model has two components. For Medicaid, BALANCE would expand GLP-1 coverage through participating state agencies beginning May 2026 through December 2031. As of January 2026, only 13 states covered GLP-1s for obesity under Medicaid — down from 16 in 2025, attributed to rising drug costs and federal funding cuts. For Medicare, a bridge program covers Wegovy and semaglutide for Part D beneficiaries at a $50 copayment (July 1, 2026 through December 31, 2027). A significant equity concern: beneficiaries who qualify for the Part D Low-Income Subsidy cannot apply those subsidies to bridge program GLP-1 prescriptions — a $50 copayment that represents a genuine barrier for the lowest-income Medicare population. CMS has since announced an indefinite delay to full BALANCE model implementation. MBS Pipeline Impact
If BALANCE expands GLP-1 access in Medicare/Medicaid, it will reshape surgical candidate pipelines and referral patterns. Current state: delayed implementation, 13-state participation, equity gap in bridge program. Treatment gap documented this issue (Section A) remains structural, not policy-resolved. |
FDA Moves to Permanently End Large-Scale GLP-1 Compounding, Proposing Exclusion of Semaglutide and Tirzepatide from 503B Bulk ListCNBC / FDA docket / STAT News / UPI / Orrick analysis — April 30, 2026
The FDA on April 30, 2026 proposed excluding semaglutide, tirzepatide, and liraglutide from the 503B bulk drug substances list — the regulatory mechanism that authorizes outsourcing facilities to compound medications at commercial scale. If finalized, the proposal would effectively end large-scale compounding of GLP-1 active ingredients by 503B outsourcing facilities, unless these drugs return to the FDA’s official shortage list. A public comment period is open through June 29, 2026. The proposal follows the FDA’s earlier termination of drug shortage designations for both semaglutide and tirzepatide, which had been the legal basis for the wave of compounded GLP-1 products that emerged as Ozempic, Wegovy, Zepbound, and Mounjaro faced supply constraints. Markets responded immediately: Novo Nordisk shares rose nearly 6% and Eli Lilly surged more than 10% on the day of the announcement. Compounding pharmacies and telehealth platforms that built significant revenue around 503A and 503B GLP-1 products now face an existential regulatory transition if the proposed rule is finalized. For the MBS community, the practical significance lies in access: compounded semaglutide and tirzepatide have served as de facto affordable alternatives for patients unable to access branded medications through insurance. As that pathway narrows and BALANCE implementation remains delayed, the access gap may widen in the near term. Regulatory Timeline
FDA proposed exclusion: April 30, 2026. Comment period closes June 29, 2026. Market response: NVO +6%, LLY +10% on announcement day. Impact: compounded semaglutide/tirzepatide access narrowing; affordability gap widening for uninsured and underinsured patients. |
| Sector | Ticker | Company | Feb 9 Open | May 13 Close | 90-Day Chg |
|---|---|---|---|---|---|
| Robotics/MIS | ISRG | Intuitive Surgical | $492.84 | $437.44 | −11.2% |
| MedTech | MDT | Medtronic | $100.83 | $76.00 | −24.6% |
| MedTech | BSX | Boston Scientific | $74.12 | $53.17 | −28.3% |
| MedTech | TFX | Teleflex | $105.90 | $123.25 | +16.4% |
| Pharma/GLP-1 | LLY | Eli Lilly | $1,042.93 | $1,015.26 | −2.7% |
| Pharma/GLP-1 | NVO | Novo Nordisk | $47.62 | $47.08 | −1.1% |
| Pharma | AMLX | Amylyx Pharmaceuticals | $14.22 | $14.99 | +5.4% |