Recurrent Weight Gain after Weight Loss Induced by Lifestyle Intervention, Metabolic and Bariatric Surgery, or Semaglutide in Adults with Obesity: A Systematic Review of Randomized Controlled Trials.

Obesity management is challenged by high rates of recurrent weight gain following initial loss. We systematically reviewed 29 randomized controlled trials comparing long-term outcomes of lifestyle interventions, semaglutide, and metabolic and bariatric surgery (MBS). Databases were searched to March 2025, and data were synthesized using pairwise and network meta-analysis. Lifestyle interventions ranked highest in preventing recurrent weight gain, while semaglutide may support sustained weight reduction during ongoing therapy but is followed by rebound after discontinuation. MBS demonstrated relatively sustained weight loss (> 10% maintained at 5-10 years), although RCT evidence was limited. These findings highlight the need for long-term, structured maintenance strategies and further high-quality trials with standardized outcomes.