Obesity medications in patients with recurrent weight gain or suboptimal clinical response following bariatric surgery: a meta-analysis

Abstract

Background: Postoperative recurrent weight gain or suboptimal clinical response are important concerns; however, there is no consensus regarding the use of pharmacotherapy to manage weight after bariatric surgery. Hence, it is reasonable to combine the available data to provide a practical guideline for clinicians about the administration of obesity medications for patients with recurrent weight gain or suboptimal clinical response after bariatric surgery.

Methods: We conducted a search of electronic databases, including Scopus, PubMed/Medline, and the Web of Science, up to December 2024. The eligible studies included randomized controlled trials or retrospective studies that assessed the effects of obesity medications on weight, body mass index (BMI), or percentage total weight loss (%TWL) in patients experiencing recurrent weight gain or a suboptimal clinical response following bariatric surgery.

Results: This meta-analysis reviewed 26 relevant studies and demonstrated that glucagon-like peptide-1 (GLP-1) receptor agonists reduced weight by 8.38 kg (95% CI: -9.68 to -7.08) and BMI by 3.76 kg/m² (95% CI: -4.50 to -3.01). The overall %TWL was 9.94% (95% CI: 8.34 to 11.53). After subgroup analysis, we found that the effect of semaglutide on %TWL was significantly greater than that of liraglutide. In terms of non-GLP-1 receptor agonists, patients achieved a weight loss of 2.97 kg (95% CI: -4.00 to -1.95), a BMI loss of 1.41 kg/m² (95% CI: -2.28 to -0.53), and a % TWL of 4.50% (95% CI: 2.86 to 6.15). The subgroup analysis suggested that combination therapy had more pronounced effects on outcomes than monotherapy.

Conclusion: Our results indicated that obesity medications may be an effective adjunctive therapy to maintain weight loss post-bariatric surgery.