The 2026 annual congress of the French and Francophone Society for Bariatric and Metabolic Surgery (SOFFCO.MM) took place in Marseille on May 21 and 22, gathering surgeons, endocrinologists, nutritionists, allied health professionals, and industry representatives at the Parc Chanot Convention Center. Hosted by Hugues Sebbag (Aix-en-Provence) and a multi-city scientific committee, this edition stood out for one reason: it confirmed, more clearly than ever, that the relationship between bariatric surgery and pharmacological treatments for obesity is no longer a question of competition — it is a question of articulation.

Five takeaways from two intense days on the Mediterranean coast.

Obesity is now consistently framed as a chronic, multifactorial disease

This may sound like an old debate, but the 2026 edition made it clear that the framing has shifted at every level. From the inaugural keynote to the GCC-CSO and AFERO sessions, every speaker built on the same foundation: obesity is a chronic, complex, multifactorial disease — not a matter of personal failure, willpower, or simple lifestyle adjustment.

This consensus has implications. It informs how care pathways are designed, how reimbursement decisions are framed, and how the medical community engages with patients and public authorities. The Coalition Obésité, mentioned during the closing institutional session (ARS — CNAM — DAP), is one expression of this collective positioning.

For practitioners, the shift opens room. It suggests that treatment plans no longer hinge on a single intervention but on a coordinated arsenal — what one speaker referred to as the "toolbox" of obesity care. Surgery, medication, behavioral therapy, physical activity, and emerging adjuncts each have a place in that toolbox. The question is no longer "which one" but "in what combination, for which patient, at which stage."

Bariatric surgery is not retreating — it is repositioning

A second observation: bariatric surgery is not contracting. It is repositioning itself.

The technical sessions of the congress were exceptionally dense. Robotic surgery occupied a prominent position, with the inaugural Friday session ("Robot-assisted bariatric surgery: what's new in France and the USA?") and a dedicated keynote from Michel Gagner on magnetic surgery. Several sessions were devoted to refining established techniques (sleeve, gastric bypass) — including the "How I improve my sleeve" and "How I improve my GBP" sessions sponsored by Johnson & Johnson MedTech, focused on practical refinements rather than radical reinventions.

A notable evolution lies in the rising prominence of revision surgery and complication management. Sessions on weight regain after sleeve, gastric bypass revisions, post-bypass ulcer management, gastro-esophageal reflux disease (GERD) after bariatric procedures, and Nissen-sleeve combinations were among the busiest. As more patients live longer with bariatric surgery in their history, and as more patients now arrive with a recent GLP-1 trajectory, the surgical question increasingly involves refining, revising, and integrating — not only initiating.

The field is also reorganizing around new procedures. The "New procedures in bariatric surgery" session presented preliminary results from prospective studies (BIPASS, YOMEGA 2, SASI, ROBOBAR) — a signal that French academic bariatric research remains active despite the pharmacological pressure on volumes.

An emerging conceptual thread: the multiple pathways of the integrated satiety signal

If we had to identify a single conceptual thread running across the congress — quieter than the surgery/pharma debate, but potentially far-reaching — it would be this: the integrated satiety signal is increasingly approached as a clinically relevant object, addressable through multiple complementary physiological pathways.

Satiety is, by nature, an integrative phenomenon. It results from the convergence of hormonal, mechanical, cognitive, and emotional signals at the level of central nervous system circuits involved in food intake regulation. For decades, clinical practice addressed satiety mostly indirectly — through portion control, behavioral counseling, or surgical restriction. The 2026 congress suggested that this is evolving.

GLP-1 therapies demonstrated that satiety perception can be modulated pharmacologically, principally through neuroendocrine pathways. Bariatric surgery, in particular sleeve and gastric bypass, acts through anatomical and mechanical pathways. And emerging non-pharmacological approaches — endoscopic, behavioral, mechanical — explore further levers.

This is the context in which complementary, non-pharmacological approaches may find relevance. GLP-1 therapies act primarily through hormonal pathways — central and peripheral neuroendocrine modulation. Surgery acts through anatomical and mechanosensitive changes. A third pathway — external mechanosensorial signaling — has been less explored.

This is one of the rationales behind GASTER control®, an external abdominal compression medical device developed in collaboration with our scientific committee. A feasibility observational study (n = 11), presented Thursday morning during the oral communications session, documented reported feasibility, tolerance, and short-term behavioral observations during use of an inflatable external abdominal belt in adults with overweight or non-morbid obesity.

The presentation, delivered by Dr Rouers on behalf of the scientific team, was followed by constructive exchanges in the room — notably on glycemic considerations and on the mechanistic rationale of mechanosensorial signaling. The discussions reflected an exploratory interest in mechanosensorial complements as part of integrated care, alongside the broader conversations on hormonal and surgical pathways.

What this may suggest for the coming years

Three convergent trajectories emerged from this edition.

The first is structural. Obesity care appears to be moving from a fragmented model — surgery in one corner, medication in another, nutrition elsewhere — toward more integrated, multidisciplinary pathways with explicit articulation between levers.

The second is conceptual. The satiety signal, long treated as a relatively opaque integrative process, is becoming a clinical object that may be supported through multiple complementary pathways — hormonal, anatomical, mechanosensorial, cognitive, behavioral — each addressing a different facet of the same integrated phenomenon.

The third is operational. The next generation of clinical questions seems less about which intervention works best in isolation, and more about sequencing: when to introduce a GLP-1, when to consider surgery, when to add a non-pharmacological adjunct, when to taper, when to maintain. This is a more nuanced practice than the binary debates of the past decade.

For the GASTER control® team, the 2026 edition supports the relevance of our exploratory positioning. The device is not, and has never been, an alternative to GLP-1 therapies or to bariatric surgery. It is approached as a potential mechanosensorial complement to existing care, designed to support eating perceptions during active treatment, during transition phases, and after discontinuation. The growing recognition that the satiety signal is integrative and multi-pathway makes the clinical investigation of mechanosensorial adjuncts increasingly worthwhile.

Going further

To explore the topics raised in this report: