Comparative Efficacy of Metabolic/Bariatric Surgery Versus GLP ‐1 Receptor Agonists: A Network Meta‐Analysis of Randomized Controlled Trials
Authors' conclusion
Both MBS and GLP-1 RAs provide substantial metabolic benefits. MBS remains superior, but tirzepatide is a promising nonsurgical option supporting personalized obesity care.
Study context
- Population
- Adults with overweight or obesity
- Participants
- 20,015 adults30 RCTs
- Comparison
- Metabolic/bariatric surgery (MBS) vs GLP-1 RAs
- Outcome
- %TWL and BMI
Methodological detailsrandom-effects models, lifestyle intervention as common comparator, indirect MBS vs GLP-1 RA comparisons
- Random-effects models
- Lifestyle intervention as common comparator
- Indirect MBS vs GLP-1 RA comparisons
Pooled result
As reported in the abstract
< 104 weeks
ETD
−10.3 %
P = 0.001
%total weight loss (TWL); greater reduction with MBS
BMI; greater reduction with MBS
−4.5 kg/m²
P < 0.001
Further pooled results
| Outcome | Estimate | P value |
|---|---|---|
| Body weight, waist circumference, HbA1c · < 104 weeksMBS vs GLP-1 RAs · body weight | −11.7 kg | P < 0.001 |
| Body weight, waist circumference, HbA1c · < 104 weeksMBS vs GLP-1 RAs · waist circumference | −12.6 cm | P < 0.001 |
| Body weight, waist circumference, HbA1c · < 104 weeksMBS vs GLP-1 RAs · HbA1c | −0.5 % | P = 0.033 |
| %TWL and body weight · ≥ 104 weeksMBS vs GLP-1 RAs · %TWL | −9.1 % | P = 0.022 |
| %TWL and body weight · ≥ 104 weeksMBS vs GLP-1 RAs · body weight | −14.6 kg | P = 0.049 |
Tirzepatide-only analyses
- Differences of tirzepatide vs MBS were not significant
Participants with T2D
- MBS produced greater reductions in BMI, weight, waist and %TWL, with similar HbA1c improvement
Original publication
Comparative Efficacy of Metabolic/Bariatric Surgery Versus GLP ‐1 Receptor Agonists: A Network Meta‐Analysis of Randomized Controlled Trials. Obesity (Silver Spring). Published 1 December 2025. doi:10.
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