Hormonal
For patients with Class I obesity (BMI 30–34.9 kg/m2), newer obesity management medications (OMM) such as tirzepatide and semaglutide provide total body weight loss (TBWL) efficacy equivalent to major metabolic bariatric surgeries (MBS) like Roux-en-Y gastric bypass (RYGB) and One-Anastomosis Gastric Bypass (OAGB), while offering superior safety and tolerability profiles.
If you have Class I obesity (BMI 30-34.9), you no longer need to choose between surgery and medication as your first step. Newer medications like tirzepatide and semaglutide can help you lose as much weight as major surgeries like gastric bypass, but with fewer risks and side effects. This makes medication a highly effective and safer first-line treatment for this specific group.
In patients affected by mild to moderate obesity, newer OMMs (i.e., tirzepatide and semaglutide) appear to be valid alternatives to EBP and MBS. They could be preliminarily chosen as a first-line option based on similar efficacy and greater safety and tolerability.
Why this rating
Based on a network meta-analysis of randomized controlled trials (RCTs) with high-quality GRADE methodology.
Source
Efficacy and safety of European Medicines Agency ( <scp>EMA</scp> )‐approved pharmacological, endoscopic, and surgical treatments in different classes of obesity: A network meta‐analysis of randomised controlled trials for the development of the <scp>SIO</scp> (Società Italiana Obesità) Italian guidelines for the diagnosis and treatment of overweight and obesity
Rocco Barazzoni et al. · Diabetes Obesity and Metabolism · 2025
DOI 10.1111/dom.70204
More from this paper
- For patients with Class II obesity (BMI 35-39.9 kg/m2), tirzepatide is significantly superior to other medications and endoscopic procedures, but its weight loss efficacy is inferior to major surgeries like Roux-en-Y gastric bypass (RYGB) and One-Anastomosis Gastric Bypass (OAGB).Strong
- For patients with Class III obesity (BMI >39.9 kg/m2), metabolic bariatric surgery (MBS) is significantly more effective than any currently approved medication, with BilioPancreatic Diversion (BPD) showing the highest estimated weight loss.Strong
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
This is one finding among thousands. Every one is graded and traced to its source, so you can see what the evidence actually supports. Browse the research →