Obesity surgery · 2026
Metabolic Bariatric Surgery versus GLP-1 Receptor Agonists for Obesity Management: A Systematic Review and Meta-Analysis.
Систематический обзорСтатьяМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Delgado Lucas Monteiro, Barone Gabriel, Garcia Giulia, Pilon Giovanna, Viana Patrícia, Marques Fabio Israel Lima Castelo Branc, Bueno Cristina Bellotti Formiga, Del Grande Leonardo, Theis Cláudia, Poli de Figueiredo Sérgio, Pompeu Bernardo Fontel
Аннотация
INTRODUCTION: Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are both effective strategies for obesity management, but their comparative efficacy remains uncertain. This systematic review and meta-analysis aimed to compare weight loss outcomes between MBS and GLP-1 RA therapy in adults with obesity.
METHODS: A systematic search of PubMed, Scopus, and Cochrane Library was conducted from inception to September 22, 2025. Eligible studies included randomized and observational comparisons between MBS-specifically sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB)-and GLP-1 RA therapy in adults with obesity. Pooled mean differences (MDs) for total weight loss (TWL) and body mass index (BMI) change were calculated using a DerSimonian-Laird random-effects model. Risk of bias was assessed using ROBINS-I V2, and certainty of evidence was graded with GRADE.
RESULTS: Five retrospective observational studies (n = 5,944; 3,489 MBS, 2,455 GLP-1 RA) met the inclusion criteria. Pooled analysis showed significantly greater TWL in the MBS group (MD - 18.15%; 95% CI 16.41 to 19.90; p < 0.0001; I² = 95%) and larger BMI reduction (MD 8.73 kg/m²; 95% CI 5.87 to 11.58; p = 0.0001; I² = 94.6%). Sensitivity analyses confirmed the robustness of these results. Overall risk of bias was moderate, primarily due to non-randomized designs and treatment selection bias. Certainty of evidence was rated as moderate.
CONCLUSIONS: MBS achieves significantly greater and more durable weight loss compared with GLP-1 RA therapy, reaffirming its role as the most effective intervention for severe obesity. While GLP-1 RAs represent valuable noninvasive or adjunctive options, surgery remains the benchmark for sustained metabolic and weight outcomes.
METHODS: A systematic search of PubMed, Scopus, and Cochrane Library was conducted from inception to September 22, 2025. Eligible studies included randomized and observational comparisons between MBS-specifically sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB)-and GLP-1 RA therapy in adults with obesity. Pooled mean differences (MDs) for total weight loss (TWL) and body mass index (BMI) change were calculated using a DerSimonian-Laird random-effects model. Risk of bias was assessed using ROBINS-I V2, and certainty of evidence was graded with GRADE.
RESULTS: Five retrospective observational studies (n = 5,944; 3,489 MBS, 2,455 GLP-1 RA) met the inclusion criteria. Pooled analysis showed significantly greater TWL in the MBS group (MD - 18.15%; 95% CI 16.41 to 19.90; p < 0.0001; I² = 95%) and larger BMI reduction (MD 8.73 kg/m²; 95% CI 5.87 to 11.58; p = 0.0001; I² = 94.6%). Sensitivity analyses confirmed the robustness of these results. Overall risk of bias was moderate, primarily due to non-randomized designs and treatment selection bias. Certainty of evidence was rated as moderate.
CONCLUSIONS: MBS achieves significantly greater and more durable weight loss compared with GLP-1 RA therapy, reaffirming its role as the most effective intervention for severe obesity. While GLP-1 RAs represent valuable noninvasive or adjunctive options, surgery remains the benchmark for sustained metabolic and weight outcomes.