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Meta-Analysis
. 2025 Mar;35(3):808-822.
doi: 10.1007/s11695-025-07733-8. Epub 2025 Feb 13.

Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Suboptimal Initial Clinical Response and Weight Gain Recurrence After Bariatric Surgery: a Systematic Review and Meta-analysis

Yuntao Nie  1 , Yiran Zhang  2 , Baoyin Liu  1 , Hua Meng  3
Affiliations
Meta-Analysis

Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Suboptimal Initial Clinical Response and Weight Gain Recurrence After Bariatric Surgery: a Systematic Review and Meta-analysis

Yuntao Nie et al. Obes Surg. 2025 Mar.

Abstract

Background: Suboptimal initial clinical response (SICR) and weight gain recurrence (WGR) are challenging issues following bariatric surgery. Recently, the promising weight loss effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been applied to bariatric patients. We aimed to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of GLP-1 RAs in the treatment of SICR and WGR after bariatric surgery.

Methods: A literature search was performed across online databases. The primary outcomes were percentage of total weight loss (%TWL) and absolute weight loss. Secondary outcomes included changes in biochemical markers and adverse effects (AEs).

Results: Nineteen studies including 1290 patients were included. After at least 3 months of treatment, the pooled %TWL was 9.24% for liraglutide, 11.38% for semaglutide, and 15.50% for tirzepatide, with corresponding weight reductions of 8.56 kg, 11.62 kg, and 12.60 kg, respectively. Additionally, %TWL and weight loss with liraglutide use were 7.65% and 7.47 kg for ≤ 6 months, 10.22% and 9.30 kg for 6-12 months, and 10.80% and 9.72 kg for ≥ 12 months. For semaglutide, the %TWL and weight reduction were 10.18% and 9.43 kg at 6 months, and 13.15% and 14.68 kg at 12 months. Biochemical markers including triglycerides, total cholesterol, low-density lipoprotein cholesterol, glycated hemoglobin, and alanine aminotransferase levels showed significant reductions after GLP-1 RA treatment. Common AEs were nausea (23%), vomiting (6%), diarrhea (6%), constipation (10%), headache (6%), fatigue (8%), abdominal pain (2%), and abdominal bloating (2%). The proportion of patients who discontinued the treatment due to AEs was 3%.

Conclusions: GLP-1 RAs are effective and safe for treating SICR and WGR after bariatric surgery.

Keywords: Bariatric surgery; GLP-1 receptor agonists; Suboptimal initial clinical response; Weight gain recurrence.

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Conflict of interest statement

Declarations. Ethics Approval: This article does not contain any studies with human participants or animals performed by any of the authors. Informed Consent: Informed consent does not apply. Conflict of Interest: The authors declare no competing interests.

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