Impact of Sleeve Gastrectomy Versus Intensive Lifestyle Modifications with Obesity Management Medications on BMI Trajectory and Target Attainment: a Prospective Matched Cohort Study

Obesity is a complex and largely preventable disease affecting over a third of the global population. As of 2022, more than 1 billion individuals worldwide were living with obesity, and projections indicate that by 2030, 38% of the adult population will be overweight, with an additional 20% affected by obesity. This condition significantly increases the risk of chronic diseases, including type 2 diabetes (T2D), cardiovascular disease (CVD), certain cancers, and mental health disorders such as depression, as well as premature mortality.

Given the rising prevalence of obesity, effective intervention strategies are critical. Bariatric and metabolic surgery remains the most effective approach for sustained weight loss, with procedures recommended for individuals with a body mass index (BMI) ≥35 kg/m², regardless of comorbidities. Metabolic surgery has demonstrated superior outcomes in reducing blood glucose levels and achieving higher remission rates of T2D compared to lifestyle and pharmacological interventions. However, surgical interventions are typically reserved for individuals who have failed prior dietary and exercise-based interventions, have adequate motivation, and do not suffer from severe psychiatric conditions.

For individuals who are ineligible for or unwilling to undergo bariatric surgery, alternative treatment options are necessary. One such option is semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, which mimics endogenous GLP-1 to suppress appetite, reduce glucagon release, and promote satiety. Studies have shown that GLP-1 receptor agonists contribute to significant weight loss and metabolic improvements.

This study aims to compare the efficacy of intensive lifestyle modifications combined with obesity management medications (ILM/OMMs) versus sleeve gastrectomy (SG) in terms of BMI trajectory and metabolic outcomes over a 1-year period. The primary endpoint is the change in BMI at 1 year, while secondary endpoints include changes in weight, plasma glucose levels, lipid profiles, and obesity-related comorbidities such as hypertension, CVD, dyslipidemia, and T2D.

Methods Study Design This study is a 1-year, prospective, multicenter, matched cohort study comparing ILM/OMMs with SG. Patients were recruited from the weight-loss clinics of Sapienza University Hospital and Catholic University Hospital in Rome, Italy. Eligible patients were allocated to either ILM/OMMs or SG. Ninety-five patients per arm were matched in a 1:1 ratio, based on sex, age, BMI, and diabetes duration.