Weight loss between glucagon-like peptide-1 receptor agonists and bariatric surgery in adults with obesity: A systematic review and meta-analysis

Abstract

Objective: Glucagon-like peptide-1 (GLP-1) receptor agonists recently demonstrated 15% to 20% weight loss in adults with obesity, a range which has previously been achieved only with bariatric surgery. This systematic review and meta-analysis compares weight loss between GLP-1 receptor agonists and bariatric surgery. Methods: The databases MEDLINE, MEDLINE In-Process, MEDLINE Epubs Ahead of Print, Embase Classic + Embase (OvidSP), and Cochrane (Wiley) were searched from inception to April 21, 2021, for randomized controlled trials and observational studies. Two independent reviewers extracted data, reported risk of bias, and graded certainty of evidence. Random-effects models were used to pool change in weight, BMI, and glycated hemoglobin. Results: Six studies, encompassing 332 patients, were included. Among randomized controlled trials, mean difference in weight between all bariatric surgery types and GLP-1 receptor agonists was −22.68 kg (95% CI: −31.41 to −13.96), mean difference in BMI was −8.18 kg/m2 (95% CI: −11.59 to −4.77), and mean difference in glycated hemoglobin was −1.28% (95% CI: −1.94% to −0.61%). Among observational studies, mean difference in weight was −25.11 kg (95% CI: −40.61 to −9.60), and mean difference in BMI was −10.60 kg/m2 (95% CI: −17.22 to −3.98). Only one observational study reported glycemic outcomes. Conclusion: In adults with obesity, bariatric surgery still confers the highest reductions in weight and BMI but confers similar effects in glycemic control when compared with GLP-1 receptor agonists.