3rd Edition of International Obesity and Metabolism Conference 2027

Abstract

The projection that 1.1 billion adults will be living with obesity worldwide by 2030 underscores the magnitude of a chronic disease whose management requires therapeutic strategies capable of sustaining weight and metabolic benefits. In this context, bariatric surgery is an important therapeutic strategy for obesity management; nevertheless, insufficient weight loss and weight recurrence remain challenges in the long-term management of the disease. Following weight loss, reduced energy stores may trigger compensatory homeostatic responses characterized by increased orexigenic signaling and reduced anorexigenic signaling, thereby favoring weight regain. This study aimed to evaluate the efficacy and safety of semaglutide as adjunctive therapy in adults who had previously undergone bariatric surgery. A narrative literature review was conducted using a structured PubMed search with the terms “Semaglutide,” “Glucagon-Like Peptide-1 Receptor Agonists,” and “Weight Recurrence,” prioritizing studies addressing weight-related outcomes, safety, dose regimens, post-surgical settings, and comparisons with liraglutide. Among the evidence analyzed, a systematic review and meta-analysis included 27 studies, 19 of which contributed to quantitative analyses of incretin receptor agonists. With semaglutide, total weight loss was 5.36% at 3 months, 9.34% at 6 months, and 9.02% at 12 months. Comparative studies also showed greater weight loss with semaglutide than with liraglutide. Regarding safety, the pooled proportion of participants experiencing at least one adverse event was 24.41%, with reported events being predominantly nonserious and gastrointestinal. In a retrospective cohort of 207 adults with weight recurrence, semaglutide 1.0 mg weekly (n=115) was associated with a mean 12-month weight loss of 12.92%, compared with 8.77% with liraglutide 3.0 mg daily (n=92; p<0.001). No statistically significant interaction was identified between the comparative treatment effect and the explored subgroups defined by age, sex, or bariatric procedure. In BARI-STEP, a randomized, double-blind, placebo-controlled trial, 70 adults were randomized to semaglutide 2.4 mg weekly or placebo, with lifestyle intervention in both groups. At 68 weeks, mean weight change was −18.0% with semaglutide, corresponding to −20.7 kg, versus +0.4% with placebo, corresponding to +0.5 kg. Semaglutide also significantly reduced body mass index, glycated hemoglobin, and fat mass. These findings support the role of semaglutide as adjunctive pharmacotherapy in post-bariatric management, complementing surgery and multidisciplinary follow-up in the long-term treatment of obesity. However, between-study heterogeneity and limited long-term data underscore the need for further investigation and individualized treatment.