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

Maurizio De Luca¹, Amanda Belluzzi¹, Luigi Angrisani², Giulia Bandini³, Barbara Becattini⁴, Marco Bueter⁵, Francesco Maria Carrano⁶, Sonja Chiappetta⁷, Ricardo V Cohen⁸, Catalin Copaescu⁹, Nicola Di Lorenzo¹⁰, Marloes Emous¹¹, Daniel Moritz Felsenreich¹², Martin Fried¹³, Jacques Himpens¹⁴, Antonio Iannelli¹⁵, Giuseppe Navarra¹⁶, Simon Nienhuijs¹⁷, Stefano Olmi¹⁸, Chetan Parmar¹⁹, Gerhard Prager¹², Juan Pujol-Rafols²⁰, Benedetta Ragghianti³, Rui Ribeiro²¹, Elena Ruiz-Úcar²², Nasser Sakran^{23

24}, Paulina Salminen²⁵, Daniele Scoccimarro³, Erik Stenberg²⁶, Christine Stier²⁷, Halit Eren Taskin²⁸, Ramón Vilallonga Puy²⁹, Matteo Monami³; Panel for the IFSO‐EC on the Surgical Treatment of Obesity Using Multimodal Strategies

Collaborators, Affiliations

Collaborators

Panel for the IFSO‐EC on the Surgical Treatment of Obesity Using Multimodal Strategies:
Maurizio De Luca, Amanda Belluzzi, Paulina Salminen, Marco Bueter, Juan Pujol-Rafols, Nasser Sakran, Christine Stier, Halit Eren Taskin, Sonja Chiappetta, Francesco Maria Carrano, Nicola Di Lorenzo, Simon Nienhuijs, Ramón Vilallonga Puy, Erik Stenberg, Marloes Emous, Gerhard Prager, Jacques Himpens, Daniel Moritz Felsenreich, Antonio Iannelli, Chetan Parmar, Catalin Copaescu, Martin Fried, Elena Ruiz-Úcar, Matteo Monami

Affiliations

¹ Department of General, Emergency and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy.
² Public Health Department, School of Medicine, University Federico II of Naples, Naples, Italy.
³ Diabetic Foot Unit, University of Florence and AOU-Careggi, Florence, Italy.
⁴ Department of Molecular and Clinical Medicine, Institute of Medicine, Göteborg, Sweden.
⁵ Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁶ Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
⁷ Bariatric and Metabolic Surgery Unit, Department of General and Laparoscopic Surgery, Ospedale Evangelico Betania, Naples, Italy.
⁸ The Center for Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil.
⁹ Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania.
¹⁰ Department of Surgical Sciences, University of Tor Vergata, Rome, Italy.
¹¹ Department of Bariatric and Metabolic Surgery, Medical Center, Center for Obesity Northern-Netherlands (CON), Leeuwarden, The Netherlands.
¹² Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
¹³ OB Klinika-Center for Treatment of Obesity and Metabolic Disorders, Prague, Czech Republic.
¹⁴ Delta CHIREC Hospital (Belgian Registry), Brussels, Belgium.
¹⁵ Digestive Surgery and Liver Transplantation Unit, Université Côte d'Azur, Nice, France.
¹⁶ University of Messina, Messina, Italy.
¹⁷ Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
¹⁸ San Marco Hospital GSD, Zingonia, Italy.
¹⁹ Department of Surgery, Whittington Hospital, University College, London, UK.
²⁰ HM Delfos, Barcelona, Spain.
²¹ Centro Multidisciplinar Do Tratamento da Obesidade, Hospital Lusíadas Amadora e Lisboa, Amadora, Portugal.
²² General and Digestive Surgery Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain.
²³ Department of General Surgery, Holy Family Hospital, Nazareth, Israel.
²⁴ The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
²⁵ Department of Surgery, University of Turku, Turku, Finland.
²⁶ Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
²⁷ Department of Surgery, Bariatric Endoscopy, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
²⁸ Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
²⁹ Endocrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.

PMID: 40197859
DOI: 10.1111/dom.16352

Meta-Analysis

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

Maurizio De Luca et al. Diabetes Obes Metab. 2025 Jun.

. 2025 Jun;27(6):3347-3356.

doi: 10.1111/dom.16352. Epub 2025 Apr 8.

Authors

Collaborators

Panel for the IFSO‐EC on the Surgical Treatment of Obesity Using Multimodal Strategies:
Maurizio De Luca, Amanda Belluzzi, Paulina Salminen, Marco Bueter, Juan Pujol-Rafols, Nasser Sakran, Christine Stier, Halit Eren Taskin, Sonja Chiappetta, Francesco Maria Carrano, Nicola Di Lorenzo, Simon Nienhuijs, Ramón Vilallonga Puy, Erik Stenberg, Marloes Emous, Gerhard Prager, Jacques Himpens, Daniel Moritz Felsenreich, Antonio Iannelli, Chetan Parmar, Catalin Copaescu, Martin Fried, Elena Ruiz-Úcar, Matteo Monami

Affiliations

¹ Department of General, Emergency and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy.
² Public Health Department, School of Medicine, University Federico II of Naples, Naples, Italy.
³ Diabetic Foot Unit, University of Florence and AOU-Careggi, Florence, Italy.
⁴ Department of Molecular and Clinical Medicine, Institute of Medicine, Göteborg, Sweden.
⁵ Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁶ Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
⁷ Bariatric and Metabolic Surgery Unit, Department of General and Laparoscopic Surgery, Ospedale Evangelico Betania, Naples, Italy.
⁸ The Center for Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil.
⁹ Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania.
¹⁰ Department of Surgical Sciences, University of Tor Vergata, Rome, Italy.
¹¹ Department of Bariatric and Metabolic Surgery, Medical Center, Center for Obesity Northern-Netherlands (CON), Leeuwarden, The Netherlands.
¹² Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
¹³ OB Klinika-Center for Treatment of Obesity and Metabolic Disorders, Prague, Czech Republic.
¹⁴ Delta CHIREC Hospital (Belgian Registry), Brussels, Belgium.
¹⁵ Digestive Surgery and Liver Transplantation Unit, Université Côte d'Azur, Nice, France.
¹⁶ University of Messina, Messina, Italy.
¹⁷ Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
¹⁸ San Marco Hospital GSD, Zingonia, Italy.
¹⁹ Department of Surgery, Whittington Hospital, University College, London, UK.
²⁰ HM Delfos, Barcelona, Spain.
²¹ Centro Multidisciplinar Do Tratamento da Obesidade, Hospital Lusíadas Amadora e Lisboa, Amadora, Portugal.
²² General and Digestive Surgery Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain.
²³ Department of General Surgery, Holy Family Hospital, Nazareth, Israel.
²⁴ The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
²⁵ Department of Surgery, University of Turku, Turku, Finland.
²⁶ Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
²⁷ Department of Surgery, Bariatric Endoscopy, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
²⁸ Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
²⁹ Endocrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.

PMID: 40197859
DOI: 10.1111/dom.16352

Abstract

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.

Keywords: GLP‐1 analogue; bariatric surgery; meta‐analysis; obesity therapy.

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References

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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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical