Bonelli et al. have elaborated on the intricacies of managing idiopathic intracranial hypertension (IIH), highlighting that weight loss is the mainstay of disease modifying therapy [1]. The role of bariatric surgery in effectively facilitating concurrent reduction in intracranial pressure (ICP) has been remarkable, with maximum benefit being directly proportional to the magnitude of weight loss and achieving remission in patients with IIH [1, 2]. Mollan et al. have demonstrated that the extent of weight loss was directly associated with the predicted reduction in ICP in women with active IIH and a body mass index (BMI) > 35 kg/m2; the amount of weight loss required to normalise the ICP to a level of ≤25cmCSF was 24% of baseline body weight over 12 months [2]. It was noted that in order to achieve this, amongst the patients allocated to the metabolic bariatric surgery (MBS) arm; Roux-en-Y gastric bypass (RYGB) was the superior procedure for weight loss, ICP reduction, and improvement in both papilloedema measures and headache outcomes, when compared with the other surgical procedures or lifestyle alone.

In this context, the impact of the role of newer ‘twincretin’ tirzepatide, that functions as a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1RA) cannot be underestimated [3,4,5]. Dual and triple incretin mimetics could achieve the range of weight loss approaching that of common MBS operations, raising the feasibility of a ‘medical bypass’ [3]. These drugs predominantly by replicating the clinical effects of MBS through non-surgical interventions [4, 5], may be foreseeable in the near future of promoting precision medicine in obesity therapeutics especially with triple-hormone-receptor agonist retatrutide, on the horizon [3]. In the SURMOUNT-1 and SURMOUNT-2 trials, of participants with obesity (BMI > 30); 10 mg, or 15 mg of tirzepatide once weekly provided substantial and sustained reductions in body weight of more than 20–25% at 72-weeks [4, 5].

Ophthalmologists and Endocrinologists work together in managing patients with diabetic retinopathy, and in joint thyroid-eye clinics. The management of people with obesity and IIH is yet another pathway to foster a collaborative approach and streamline the treatment strategies for this at-risk group, as ‘medical bypass’ is soon becoming a reality at least in terms of weight loss efficacy [3].