Mixed
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.
If you have Class III obesity (BMI >39.9), surgery is the most effective treatment available. Medications like semaglutide are significantly less effective than surgery for this group. If you are not a candidate for surgery or refuse it, medication is still an option, but you should expect less weight loss compared to surgical outcomes.
Higher degrees of obesity could be more effectively treated with MBS, the efficacy of which, with the notable exception of LAGB and GCP, appears superior to other treatments, especially in the long term.
Why this rating
Network meta-analysis of RCTs.
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
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