Endocrine Abstracts

Background: Overweight and obesity are an increasing concern for public health worldwide. Obesity is a chronic, progressive and relapsing disease associated with the development of several comorbidities which may improve after weight loss. The first step in the management of weight excess includes life-style modifications but, in the long-term, obesity is frequently resistant to life-style changes only. Surgical procedures and medical treatments have, therefore, been developed for improving the outcomes of this chronic disease.

Aim: Of the study was to identify the best treatment for weight loss, and their timely use, as add-on to lifestyle intervention for adults with resistant overweight and obesity complicated by metabolic comorbidities: pre-diabetes, type 2 diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease.

Methods: This systematic review and network meta-analysis (NMA) included searches of Medline/PubMed, Embase and Cochrane Library from inception to May 16, 2022, for randomized controlled trials (RCTs) of weight-lowering drugs that are available in Italy (Naltrexone/Bupropione-N/B, Orlistat, Liraglutide 3 mg/daily, Semaglutide 2.4 mg/weekly) and of bariatric surgery procedures (Sleeve gastrectomy, Roux en Y Gastric Bypass (RYGBP), Gastric Banding, and other modalities of Gastric Bypass). Target population were adults with overweight or obesity (BMI 27-40 kg/m2) and at least one of the above reported comorbidities. The study was registered with PROSPERO (CRD42022351409). From the retrieved 2928 studies, this NMA included 45 RCTs on pharmacological and 20 RCTs on surgical treatments. Weight loss. As compared with lifestyle intervention, the add-on effect of the different evaluated interventions was (mean, CI 95%):

• Orlistat, -2.93 kg (4.34 lower to 1.52 lower) (mixed evidence, certainty of the evidence moderate)

• Liraglutide, -3.85 kg (6.19 lower to 1.52 lower) (direct evidence, certainty of the evidence high)

• Semaglutide, -9.83 kg (14.12 lower to 5.5 lower) (direct evidence, certainty of the evidence high)

• N/B, -4.5 kg (8.17 lower to 0.84 lower) (mixed evidence, certainty of the evidence moderate)

• Gastric banding, -12.26 kg (15.55 lower to 8.96 lower) (mixed evidence, certainty of the evidence moderate)

• Sleeve gastrectomy, -18.05 kg (21.66 lower to 14.44 lower) (mixed evidence, certainty of the evidence moderate)

• RYGBP, -24.71 kg (27.96 lower to 21.46 lower) (mixed evidence, certainty of the evidence moderate)

• Other gastric bypass, -21.74 kg (26.96 lower to 16.52 lower) (indirect evidence, certainty of the evidence moderate).

Conclusion: This NMA quantifies the effect of drugs and surgical treatments on weight loss that improved outcomes compared to lifestyle changes only. Surgeries were more effective than pharmacological treatments.