Efficacy and safety of European Medicines Agency ( EMA )‐approved pharmacological, endoscopic, and surgical treatments in different classes of obesity: A network meta‐analysis of randomised controlled trials for the development of the SIO (Società Italiana Obesità) Italian guidelines for the diagnosis and treatment of overweight and obesity
Authors' conclusion
In patients affected by mild to moderate obesity, newer OMMs (i.e., tirzepatide and semaglutide) appear to be valid alternatives to EBP and MBS. They could be preliminarily chosen as a first-line option based on similar efficacy and greater safety and tolerability. Higher degrees of obesity could be more effectively treated with MBS, the efficacy of which, with the notable exception of LAGB and GCP, appears superior to other treatments, especially in the long term.
Study context
- Population
- Adults with overweight or obesity (overweight BMI 25–29.9; class I 30–34.9; class II 35–39.9; class III >39.9 kg/m²); Randomised clinical trials (RCTs) in Medline and Embase up to 31st January 2025
- Comparison
- EMA-approved OMM, EBP and MBS vs lifestyle intervention/placebo/no therapy or active comparators, by BMI-based obesity class
- Outcome
- Total body weight loss (TBWL%)
- Follow-up
- 26-52, 53-104, 105-156, and ≥156 weeks
Methodological detailsrandom effect models
- Random effect models
Pooled result
As reported in the abstract
TBWL%
- Class I obesity: tirzepatide equally effective to OAGB and RYGB, significantly superior to all other comparisons
- Class II obesity: tirzepatide significantly superior to all other comparisons and inferior to OAGB and RYGB
- Semaglutide associated with higher TBWL% than other OMMs (except tirzepatide), equally effective to EBP, GCP and LAGB
- Mean BMI >40 kg/m²: highest estimated weight loss with BPD
- Mean BMI >40 kg/m²: semaglutide statistically less effective than SG and gastric bypass, not inferior to GCP and LAGB
- Mean BMI >40 kg/m²: RYGB and OAGB superior to SG
Original publication
Efficacy and safety of European Medicines Agency ( EMA )‐approved pharmacological, endoscopic, and surgical treatments in different classes of obesity: A network meta‐analysis of randomised controlled trials for the development of the SIO (Società Italiana Obesità) Italian guidelines for the diagnosis and treatment of overweight and obesity. Diabetes Obes Metab. Published 20 October 2025. doi:10.
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