Efficacy of GLP-1 Receptor Agonists on Weight Loss, BMI, and Waist Circumference for Patients With Obesity or Overweight: A Systematic Review, Meta-analysis, and Meta-regression of 47 Randomized Controlled Trials

Jan 22, 2025Diabetes care

Effectiveness of GLP-1 Drugs on Weight, BMI, and Waist Size in Overweight and Obese Patients

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Abstract

GLP-1 receptor agonists are associated with a mean weight reduction of -4.57 kg in individuals with overweight or obesity.

A total of 47 randomized controlled trials included 23,244 patients.
Mean BMI reduction was -2.07 kg/m2, and mean waist circumference reduction was -4.55 cm compared to placebo.
The weight loss effects were consistent regardless of diabetes status, type of GLP-1 RA, or administration route.
Greater benefits were observed in younger, female patients without diabetes, who had higher baseline weight and BMI.
Statistical heterogeneity was noted, which may improve generalizability by encompassing diverse study designs and populations.

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OBJECTIVE: To provide an updated synthesis on effects of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) on weight, BMI, and waist circumference incorporating newer randomized controlled trials (RCTs), particularly in individuals with overweight or obesity.

RESEARCH DESIGN AND METHODS: We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs published from inception to 4 October 2024. The search was limited to RCTs evaluating the use of GLP-1 RAs for mean differences from baseline in weight, BMI, and waist circumference in adults with obesity or overweight with or without diabetes. Two independent reviewers performed the literature search and data extraction, resolving disagreements via consensus or third-reviewer consultation.

RESULTS: Forty-seven RCTs were included, with a combined cohort of 23,244 patients. GLP-1 RAs demonstrated a mean weight reduction of -4.57 kg (95% CI -5.35 to -3.78), mean BMI reduction of -2.07 kg/m2 (95% CI -2.53 to -1.62), and mean waist circumference reduction of -4.55 cm (95% CI -5.72 to -3.38) compared with placebo. This effect was consistent across diabetes status, GLP-1 RA used, and route of administration. The greatest treatment benefit appeared to favor patients who were younger, female, without diabetes, with higher baseline weight and BMI but lower baseline HbA1c, and treated over a longer duration. Limitations include substantial statistical heterogeneity, in part due to broad inclusion criteria. However, this heterogeneity may improve generalizability by reflecting a wide range of study designs and patient populations.

CONCLUSIONS: GLP-1 RAs demonstrated significant weight, BMI, and waist circumference reduction benefits in this meta-analysis.

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Efficacy of GLP-1 Receptor Agonists on Weight Loss, BMI, and Waist Circumference for Patients With Obesity or Overweight: A Systematic Review, Meta-analysis, and Meta-regression of 47 Randomized Controlled Trials

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