GLP-1 Receptor Agonists in the Management of Post-bariatric Weight Regain and Dysglycemia: A Systematic Review and Meta-Analysis

Weight regain, insufficient weight loss, and metabolic relapse (including dysglycemia) are increasingly recognized long-term challenges following bariatric surgery. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have been explored as a potential adjunctive therapy in this setting, though evidence on their effects in post-bariatric populations remains limited and variable. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of electronic databases identified studies evaluating GLP-1 RA therapy in adults following bariatric surgery for weight regain, insufficient weight loss, or persistent/recurrent dysglycemia. Thirteen studies met the inclusion criteria and were included in the quantitative meta-analysis of weight outcomes. A random-effects model was used to pool mean weight change, with heterogeneity assessed via the I² statistic. Publication bias was evaluated using funnel plots and Egger's regression test. Across the 13 studies, GLP-1 RA therapy was associated with a pooled mean weight reduction of 7.45 kg (95% CI -8.78 to -6.11). However, substantial heterogeneity was present (I² = 89.8%), likely attributable to differences in study designs, patient characteristics, bariatric procedures, GLP-1 RA agents/doses, and follow-up durations. Funnel plot inspection and Egger's test (p = 0.29) did not indicate significant publication bias or small-study effects. While these findings suggest that GLP-1 RAs may offer a non-invasive adjunctive option for managing post-bariatric weight regain and inadequate weight loss, the high heterogeneity and predominance of observational studies limit the strength of conclusions. GLP-1 RAs appear promising in addressing appetite dysregulation and metabolic signaling in this population, but further high-quality, randomized controlled trials with longer follow-up are needed to confirm efficacy, optimize treatment regimens, and better evaluate glycemic outcomes.