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Introduction <p>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.</p> Methods <p>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.</p> Results <p>Five retrospective observational studies (<i>n</i> = 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; <i>p</i> &lt; 0.0001; I² = 95%) and larger BMI reduction (MD 8.73&#xa0;kg/m²; 95% CI 5.87 to 11.58; <i>p</i> = 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.</p> Conclusions <p>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.</p>

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Metabolic Bariatric Surgery versus GLP-1 Receptor Agonists for Obesity Management: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Lucas Monteiro Delgado,
  • Gabriel Barone,
  • Giulia Garcia,
  • Giovanna Pilon,
  • Patrícia Viana,
  • Fabio Israel Lima Castelo Branc Marques,
  • Cristina Bellotti Formiga Bueno,
  • Leonardo Del Grande,
  • Cláudia Theis,
  • Sérgio Poli de Figueiredo,
  • Bernardo Fontel Pompeu

摘要

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.