Efficacy and Safety of Pharmacological, Endoscopic, and Surgical Treatments for Obesity: A GRADE ‐Based Network Meta‐Analysis
Authors' conclusion
MBS appears superior in the long term (particularly for higher-efficacy procedures, such as RYGB, SG, SADI, and BPD). EBP, except ESG, was less effective than newer OMM. Semaglutide and tirzepatide showed no inferior short-term results in comparison with MBS.
Study context
- Population
- Adults with obesity; RCTs from MEDLINE and Embase searched up to December 1, 2024139 RCTs
- Comparison
- OMM, endoscopic bariatric procedures (EBP) and metabolic bariatric surgery (MBS) vs lifestyle intervention, placebo or no therapy (LSI/Pbo/NT) or active comparators
- OMMn = 5,991
- EBPn = 2,934
- MBSn = 61,961
- Outcome
- Total body weight loss percentage (TBWL%)
- Follow-up
- 26-52, 53-104, 105-156, and ≥ 156 weeks
Methodological detailsGRADE-based
- GRADE-based
Pooled result
As reported in the abstract
TBWL% · 26-52 weeks
- Most treatments showed significant effects vs the reference
- TBWL% exceeded 10% with most surgeries and tirzepatide
Further pooled results
TBWL% over time · long term
- Long-term data lacking for most OMM and all EBP
- Most treatments maintained efficacy over time, except greater curvature plication
Safety
Serious adverse events (SAE)
- EBP and MBS generally associated with higher SAE risk than OMM
- BPD showed the highest long-term SAE incidence
Original publication
Efficacy and Safety of Pharmacological, Endoscopic, and Surgical Treatments for Obesity: A GRADE ‐Based Network Meta‐Analysis. Obesity (Silver Spring). Published 15 January 2026. doi:10.
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