- Summary of included studies overall and by type of anti-obesity medications evaluated (N=59).
| Variables | Overall | Receptor agonists | ||||
|---|---|---|---|---|---|---|
| GLP-1 | Dual GIP/GLP-1 | Non-GLP-1 | GLP-1 and non-GLP-1 | Not reported | ||
| Studies | 59 (100.0) | 39 (66.1) | 5 (8.5) | 12 (20.3) | 2 (3.4) | 1 (1.7) |
| Year of publication | ||||||
| 2014-2019 | 13 (22.0) | 11 (28.2) | 0 (0.0) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
| 2020-2024 | 46 (78.0) | 28 (71.8) | 5 (100.0) | 10 (83.3) | 2 (100.0) | 1 (100.0) |
| Study design | ||||||
| Cohort studies | 37 (62.7) | 29 (74.4) | 3 (60.0) | 5 (41.7) | 0 (0.0) | 0 (0.0) |
| Case report/series | 7 (11.9) | 5 (12.8) | 2 (40.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Cross-sectional studies | 5 (8.5) | 1 (2.6) | 0 (0.0) | 1 (8.3) | 2 (100.0) | 1 (100.0) |
| Randomized controlled trial | 6 (10.2) | 1 (2.6) | 0 (0.0) | 5 (41.7) | 0 (0.0) | 0 (0.0) |
| Non-randomized controlled trial | 3 (5.0) | 2 (5.1) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Cost-effectiveness analysis | 1 (1.7) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Control arm | 11 (18.6) | 2 (5.1) | 0 (0.0) | 9 (75.0) | 0 (0.0) | 0 (0.0) |
| Country | ||||||
| Saudi Arabia | 23 (39.0) | 19 (48.7) | 0 (0.0) | 2 (16.7) | 1 (50.0) | 1 (100.0) |
| UAE | 12 (20.3) | 8 (20.5) | 3 (60.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Egypt | 7 (11.9) | 4 (10.3) | 0 (0.0) | 2 (16.7) | 1 (50.0) | 0 (0.0) |
| Kuwait | 6 (10.2) | 4 (10.3) | 2 (40.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Iraq | 6 (10.2) | 2 (5.1) | 0 (0.0) | 4 (33.3) | 0 (0.0) | 0 (0.0) |
| Qatar | 2 (3.4) | 1 (2.6) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Jordan | 1 (1.7) | 0 (0.0) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Lebanon | 1 (1.7) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Saudi Arabia, Jordan | 1 (1.7) | 0 (0.0) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Funded studies | 13 (22.0) | 9 (23.1) | 1 (20.0) | 2 (16.7) | 1 (50.0) | 0 (0.0) |
| Risk of bias | ||||||
| High | 21 (35.6) | 10 (25.6) | 4 (80.0) | 4 (33.3) | 2 (100) | 1 (100) |
| Moderate | 22 (37.3) | 16 (41.0) | 1 (20.0) | 5 (41.7) | 0 (0.0) | 0 (0.0) |
| Low | 3 (5.1) | 2 (5.1) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Not applicable* | 13 (22.0) | 11 (28.2) | 0 (0.0) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
| Sample size† | ||||||
| Median (IQR) | 91 (50-180) | 80 (38-180) | 115 (1-115) | 100 (60-145) | 279 (96-462) | 316§ |
| Range | 1-3,686 | 1-2,092 | 1-3,686 | 50-404 | 96-462 | |
| Age, years§ | ||||||
| Median (IQR) | 43.0 (37.7-48.0) | 42.5 (37.4-48.7) | 38.8 (20.5-48.6) | 44.9 (42.2-49.0) | Not mentioned | 28§ |
| Range | 20.0-60.4 | 29.0-60.4 | 20.0-54.1 | 40.0-53.0 | Not mentioned | |
| Female (%)¶ | ||||||
| Median (IQR) | 71.0 (55.2-81.0) | 71.2 (56.6-77.7) | 80.9 (60.0-100.0) | 63.6 (34.1-78.8) | 99.2 (98.4-100.0) | 38.5§ |
| Range | 0.0-100.0 | 0.0-100.0 | 59.2-100.0 | 0.0-88.0 | 98.4-100.0 | |
| Population/diagnosis | ||||||
| Obesity | 29 (49.2) | 18 (46.2) | 2 (40.0) | 7 (58.3) | 2 (100.0) | 0 (0.0) |
| Type 2 diabetes | 9 (15.3) | 8 (20.5) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Obesity undergone bariatric surgery | 7 (11.9) | 6 (15.4) | 1 (20.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Type 2 diabetes and obesity | 7 (11.9) | 5 (12.8) | 1 (20.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Type 2 diabetes and dyslipidemia | 1 (1.7) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Type 2 diabetes, obesity, and MASLD | 1 (1.7) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| NAFLD | 1 (1.7) | 0 (0.0) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Metabolic syndrome | 1 (1.7) | 0 (0.0) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Obesity and osteoarthritis | 1 (1.7) | 0 (0.0) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Obesity and prediabetes | 1 (1.7) | 0 (0.0) | 1 (20.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Primary healthcare visitors | 1 (1.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (100.0) |
| Type of anti-obesity medications# | ||||||
| Liraglutide | 32 (54.2) | 29 (74.4) | 1 (20.0) | - | 2 (100.0) | - |
| Semaglutide | 12 (20.3) | 9 (23.1) | 2 (40.0) | - | 1 (50.0) | - |
| Dulaglutide | 4 (6.8) | 4 (10.3) | - | - | - | - |
| Exenatide | 2 (3.4) | 2 (5.1) | - | - | - | - |
| Tirzepatide | 5 (8.5) | - | 5 (100.0) | - | - | - |
| Orlistat | 8 (13.6) | - | - | 6 (50.0) | 2 (100.0) | - |
| Metformin | 5 (8.5) | - | - | 4 (33.3) | 1 (50.0) | - |
| Lorcaserin and phentermine | 1 (1.7) | - | - | 1 (8.3) | - | - |
| Naltrexone/Bupropion | 1 (1.7) | - | - | 1 (8.3) | - | - |
| Non-prescribed WRPs | 1 (1.7) | - | - | 1 (8.3) | - | - |
| Not reported | 1 (1.7) | - | - | - | 1 (100.0) | |
| Route | ||||||
| Subcutaneous | 40 (67.8) | 35 (89.7) | 5 (100.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Oral | 12 (20.3) | 1 (2.6) | 0 (0.0) | 11 (91.7) | 0 (0.0) | 0 (0.0) |
| Subcutaneous and oral | 2 (3.4) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 1 (50.0) | 0 (0.0) |
| Not reported | 5 (8.5) | 2 (5.1) | 0 (0.0) | 1 (8.3) | 1 (50.0) | 1 (100.0) |
| Primary outcome category | ||||||
| Anthropometric outcomes | 28 (47.5) | 20 (51.3) | 2 (40.0) | 5 (41.7) | 1 (50.0) | 0 (0.0) |
| Anthropometric and cardiometabolic outcomes | 14 (23.7) | 11 (28.2) | 0 (0.0) | 3 (25.0) | 0 (0.0) | 0 (0.0) |
| Safety and tolerability | 4 (6.8) | 2 (5.1) | 2 (40.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| PROs | 3 (5.1) | 1 (2.6) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 1 (100.0) |
| Biomarkers and biochemical effects | 3 (5.1) | 2 (5.1) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Cardiometabolic outcomes | 3 (5.1) | 1 (2.6) | 1 (20.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Health behaviors/practices | 2 (3.4) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 1 (50.0) | 0 (0.0) |
| Biomarkers/biochemical effects and PROs | 1 (1.7) | 0 (0.0) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Health economics | 1 (1.7) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Primary outcome (anthropometric) | ||||||
| TBW | 27 (45.8) | 22 (56.4) | 2 (40.0) | 3 (25.0) | 0 (0.0) | 0 (0.0) |
| BMI | 23 (39.0) | 14 (35.9) | 1 (20.0) | 7 (58.3) | 1 (50.0) | 0 (0.0) |
| Weight loss proportion (%) | 17 (28.8) | 13 (33.3) | 2 (40.0) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
| Waist circumference | 4 (6.8) | 2 (5.1) | 0 (0.0) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
| More than one anthropometric measurement† | 21 (35.6) | 15 (38.5) | 2 (40.0) | 4 (33.3) | 0 (0.0) | 0 (0.0) |
| Primary outcome (cardiometabolic) | ||||||
| HbA1c | 12 (20.3) | 10 (25.6) | 1 (20.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Lipid profile | 6 (10.2) | 2 (5.1) | 0 (0.0) | 4 (33.3) | 0 (0.0) | 0 (0.0) |
| Secondary outcome | ||||||
| Cardiometabolic outcomes | 17 (28.8) | 14 (35.9) | 1 (20.0) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
| Anthropometric and cardiometabolic outcomes | 4 (6.8) | 4 (10.3) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Anthropometric outcomes | 3 (5.1) | 1 (2.6) | 1 (20.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Safety and tolerability | 2 (3.4) | 1 (2.6) | 0 (0.0) | 0 (0.0) | 1 (50.0) | 0 (0.0) |
| Inflammatory and oxidative stress markers | 3 (5.1) | 1 (2.6) | 0 (0.0) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
| Not reported | 30 (50.8) | 18 (46.2) | 3 (60.0) | 7 (58.3) | 1 (50.0) | 1 (100.0) |
| Side effect | ||||||
| GI side effect with additional symptoms | 9 (15.3) | 4 (10.3) | 2 (40.0) | 1 (8.3) | 2 (100.0) | 0 (0.0) |
| GI side effects only | 6 (10.2) | 3 (7.7) | 0 (0.0) | 3 (25.0) | 0 (0.0) | 0 (0.0) |
| GI side effects with serious complications | 4 (6.8) | 4 (10.3) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Non-GI side effects | 2 (3.4) | 1 (2.6) | 0 (0.0) | 1 (8.3) | 0 (0.0) | 0 (0.0) |
| Not reported | 38 (64.4) | 27 (69.2) | 3 (60.0) | 7 (58.3) | 0 (0.0) | 1 (100.0) |
BMI: body mass index, Dual GIP: dual glucose-dependent insulinotropic polypeptide, GLP-1: glucagon-like peptide-1, GI: gastrointestinal, HbA1c: hemoglobin A1c, IQR: interquartile range, MASLD: metabolic dysfunction - associated steatotic liver disease, NAFLD: nonalcoholic fatty liver disease, TBW: total body weight, WC: waist circumference, WRP: weight-reduction product
↵* Risk of bias assessment not applicable; studies available only as abstracts or as an economic analysis study.
↵† Sample size reported for 57 studies (2 studies did not report sample size).
‡ IQR and range values are not reported because they are derived from a single study only.
↵§ Age reported for 49 studies (10 studies did not report age).
↵¶ Gender proportion reported for 52 studies (7 studies did not report the gender proportion).
↵# Some studies are counted more than once because they include multiple types of anti-obesity medication.
** Number of studies reported at least 2 anthropometric measurements (TBW, BMI, WC, or weight loss proportion %).