Comparative Efficacy of Metabolic/Bariatric Surgery Versus <scp>GLP</scp> ‐1 Receptor Agonists: A Network Meta‐Analysis of Randomized Controlled Trials
Lucas Sabatella, Patricia Ortega, Víctor Valentí, Fernando Rotellar, Adriana Uriz Pagola, Ahmed R. Ahmed, Sanjay Purkayastha, Carlota Tuero Ojanguren, Nuria Blanco, Manuel F. Landecho
Abstract
OBJECTIVE: This study compared the efficacy of metabolic/bariatric surgery (MBS) and GLP-1 receptor agonists (GLP-1 RAs), including dual GLP-1/GIP analogues, for weight and metabolic outcomes in adults with obesity. METHODS: A network meta-analysis of randomized controlled trials compared MBS or GLP-1 RAs versus lifestyle intervention in adults with overweight or obesity. Primary outcomes were percent total weight loss (TWL) and BMI; secondary outcomes included body weight, waist circumference, HbA1c, and systolic blood pressure. Random-effects models used lifestyle intervention as the common comparator; all MBS versus GLP-1 RA comparisons were indirect. RESULTS: ; p < 0.001), body weight (-11.7 kg; p < 0.001), waist circumference (-12.6 cm; p < 0.001), and HbA1c (-0.5%; p = 0.033). At ≥ 104 weeks, differences remained for %TWL (-9.1%; p = 0.022) and body weight (-14.6 kg; p = 0.049). In tirzepatide-only analyses, differences versus MBS were not significant. Among participants with type 2 diabetes, MBS produced greater reductions in BMI, weight, waist, and %TWL, with similar HbA1c improvement. CONCLUSIONS: Both MBS and GLP-1 RAs provide substantial metabolic benefits. MBS remains superior, but tirzepatide is a promising nonsurgical option supporting personalized obesity care.