Meta‐analysis of randomized controlled trials for the development of the International Federation for Surgery of Obesity and Metabolic Disorders‐European Chapter (IFSO‐EC) guidelines on multimodal strategies for the surgical treatment of obesity

Apr 8, 2025Diabetes, obesity & metabolism

Combined approaches for surgery to treat obesity: a review of clinical trials to guide European recommendations

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Abstract

The addition of either obesity management medication or endobariatric procedures to metabolic bariatric surgery is associated with a significantly lower BMI.

In a meta-analysis of 25 randomized controlled trials, combining metabolic bariatric surgery with obesity management medication or endobariatric procedures resulted in a significant BMI reduction (p = 0.040).
Liraglutide, when added to metabolic bariatric surgery, was linked to a greater percentage of excess weight loss, although no significant differences were found for total weight loss (p = 0.008).
The addition of liraglutide as a therapy was associated with a significant reduction in HbA1c levels (p = 0.007).
No mortality was reported in the included trials, indicating a safety aspect of the combined interventions.

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BACKGROUND: Randomized, controlled trials (RCTs) comparing the effectiveness of metabolic bariatric surgery (MBS) in addition to one or more treatment interventions for obesity (i.e., lifestyle structured interventions-LSI, medical therapy-MT, obesity management medication-OMM or endobariatric procedures-EP) are lacking. This study aims to assess the effectiveness of multiple simultaneous (before or immediately after MBS) interventions for treating obesity.

METHODS: We performed a meta-analysis including all RCTs enrolling patients undergoing different MBS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus MBS alone, with a duration of at least 6 months. The primary outcome was BMI at the end-point; secondary end-points included percentage total and excess weight loss (%TWL%, and EBWL%), total weight loss (TWL), fasting plasma glucose (FPG), HbA1c, surgical and non-surgical severe adverse events (SAE), mortality, remission of type 2 diabetes, hypertension, dyslipidemia and health-related quality of life (HR-QoL).

RESULTS: A total of 25 RCTs were retrieved. The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon-IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p = 0.040). The addition of liraglutide only to MBS was associated with a greater %EWL%, but not %TWL and TBWL (p = 0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to MBS (p = 0.007). There was no mortality.

CONCLUSIONS: MBS combined with non-surgical approaches appears more effective than MBS alone in reducing BMI. Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity.

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Meta‐analysis of randomized controlled trials for the development of the International Federation for Surgery of Obesity and Metabolic Disorders‐European Chapter (IFSO‐EC) guidelines on multimodal strategies for the surgical treatment of obesity

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