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© 2026 John Wiley & Sons Ltd.Background: The comparative effectiveness of bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight loss among patients with obesity remains uncertain. Methods: MEDLINE, EMBASE and CENTRAL were searched to 5 October 2025. Pooled mean differences (MDs) for change in weight, body mass index (BMI), glycaemic indices, lipid profile and blood pressure were calculated using random-effects models with heterogeneity quantified by I2. Outcomes were assessed separately according to time duration. Meta-regression was performed for the primary outcome of change in BMI. Results: Fifteen studies (20 594 participants) were included. Weight loss did not differ significantly at 6 months (MD –12.19 kg; p = 0.13), but favoured BS at ≤ 1 year (MD −16.97 kg; p = 0.02) and > 1 year (MD −19.78 kg; p < 0.001). BMI reduction consistently favoured BS at 6 months (MD −6.77 kg/m2; p = 0.02), ≤ 1 year (MD −5.10 kg/m2; p < 0.001) and > 1 year (MD −6.61 kg/m2; p < 0.001). HbA1c reduction was greater with BS beyond one year (MD −1.69%; p < 0.001), and fasting glucose was lower overall with BS (MD −1.22 mmol/L; p = 0.03). Serum lipids and blood pressure showed no significant between-group differences. Meta-regression demonstrated larger BMI reductions with BS in older patients, male patients and those with higher baseline BMI. Conclusion: Although substantial heterogeneity was present, BS was associated with greater and sustained reductions observed over multi-year follow up in weight, BMI and glycaemic indices compared to GLP-1 RAs, with similar effects on serum lipids and blood pressure, supporting its use in appropriately selected adults with obesity.
Author(s): Tahir M, Meghani MA, Uddin MS, Talib A, Ahmad ZB, Khan AA, Ahmed M, Dinsmore L, Nasser A, Ahmed R, Basit A, Khan TM
Publication type: Article
Publication status: Published
Journal: Diabetes, Obesity and Metabolism
Year: 2026
Volume: 28
Issue: 6
Pages: 4901-4914
Print publication date: 01/06/2026
Online publication date: 23/03/2026
Acceptance date: 09/03/2026
ISSN (print): 1462-8902
ISSN (electronic): 1463-1326
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1111/dom.70676
DOI: 10.1111/dom.70676
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