ABSTRACT Objective This review compared antiobesity strategies—obesity management medications (OMM), endoscopic bariatric procedures (EBP), and metabolic bariatric surgery (MBS)—with lifestyle intervention, placebo, or no therapy (LSI/Pbo/NT). Methods This network meta‐analysis included randomized clinical trials comparing OMM, EBP, and MBS versus LSI/Pbo/NT or active comparators in adults with obesity. MEDLINE and Embase were searched up to December 1, 2024. The primary endpoint was total body weight loss percentage (TBWL%), analyzed at 26–52, 53–104, 105–156, and ≥ 156 weeks. This study was registered with PROSPERO (CRD42024623707). Results Of 139 RCTs, 54 evaluated MBS ( n = 61,961), 21 EBP ( n = 2934), and 64 OMM ( n = 5991). At 26–52 weeks, most treatments showed significant effects versus the reference. TBWL% exceeded 10% with most surgeries and tirzepatide. Long‐term data were lacking for most OMM and all EBP. Most treatments maintained their efficacy over time, except greater curvature plication. EBP and MBS were generally associated with a higher SAE risk than OMM; BPD showed the highest long‐term SAE incidence. Conclusions MBS appears superior in the long term (particularly for higher‐efficacy procedures, such as RYGB, SG, SADI, and BPD). EBP, except ESG, was less effective than newer OMM. Semaglutide and tirzepatide showed no inferior short‐term results in comparison with MBS.
Luca et al. (Thu,) studied this question.