COMPARISON OF PHARMACOLOGICAL INTERVENTIONS WITH GLP-1, GIP, IGLUCAGON, BEHAVIORAL AND SURGICAL APPROACHES TO OBESITY IN WEIGHT LOSS AND WEIGHT REGAIN

Introduction: Obesity is a chronic, multifactorial, and relapsing disease that represents a major public health challenge and cardiometabolic risk. Objective: To evaluate the effect of different therapeutic strategies in the treatment of obesity, comparing pharmacological interventions based on GLP-1 receptor agonists, dual GLP-1/GIP agonists, and therapies involving the glucagon axis, as well as behavioral and surgical approaches, regarding weight loss and weight regain. Method: Integrative review using studies addressing pharmacological, behavioral, and surgical interventions in obesity management, as well as their effects on weight loss and recovery. Results: Bariatric surgery demonstrated the highest efficacy (loss >30%), followed by tirzepatide (21%) and semaglutide (15%). However, weight regain is frequent across all modalities: about two-thirds of the weight lost was regained 12 months after stopping semaglutide, and 20% to 40% of surgical patients showed significant regain within 5 years. Discussion: The chronicity of obesity requires continuous treatment, as pharmacological interruption reverses satiety mechanisms. Hybrid approaches, combining surgery and new pharmacotherapies, emerge as promising strategies for weight maintenance. Conclusion: While surgery is the gold standard in magnitude of loss, incretin-based pharmacotherapy offers high metabolic precision. Sustainable success depends on a longitudinal multidisciplinary care model, prioritizing metabolic and functional outcomes beyond absolute weight.