Purpose: Obesity remains a significant global health issue, contributing to increased mortality due to associated comorbidities such as type 2 diabetes and cardiovascular disease. Both bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) achieve notable weight loss, reducing both morbidity and mortality. However, there is a lack of systematic reviews comparing BMS and GLP-1RAs on all-cause mortality in obese patients. Methodology: A search of PubMed, Embase, and Cochrane CENTRAL databases was conducted through January 2025, following PRISMA guidelines. Studies examining mortality outcomes in patients treated with BMS or GLP-1RAs were included. Data from the selected studies were aggregated, and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: This meta-analysis included 10 studies with over 300,000 participants. BMS was associated with a significantly lower risk of all-cause mortality compared to GLP-1RAs (pooled RR: 0.69; 95% CI: 0.60–0.79, p < 0.0001), reflecting a 31% reduction in mortality risk. Additionally, BMS was associated with greater weight loss and higher rates of type 2 diabetes remission compared to GLP-1RAs. Conclusion: Both GLP-1RAs and BMS are linked to reductions in mortality among obese individuals. However, BMS is associated with a more significant decrease in all-cause mortality, offering greater weight loss and metabolic improvements than GLP-1RAs. These findings suggest BMS may be a more effective strategy for managing obesity and reducing cardiovascular risk, highlighting its potential as an essential treatment option for eligible patients.