Objective:This study aimed to systematically evaluate the efficacy of glucagon-like peptide-1(GLP-1) receptor agonists and multi-target analogs on weight reduction and cardiometabolic outcomes in non-diabetic individuals with obesity, and to compare the efficacy and safety across different GLP-1 receptor agonists.Methods:Randomized controlled trials(RCTs) published between January 2000 and March 2025 were identified through a systematic search of CNKI, Wanfang, Web of Science, PubMed, and Cochrane databases. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Meta-analysis was performed using RevMan 5.4.1 software. Results:A total of 16 RCTs involving 11 032 non-diabetic individuals with obesity were included. Meta-analysis showed that GLP-1 receptor agonists significantly reduced body weight(ΔWeight=-8.71 kg, 95% CI -10.68 to -6.74, P<0.001) and BMI(ΔBMI=-3.01 kg/m 2, 95% CI -3.77 to -2.25, P<0.001), as well as improved systolic blood pressure(ΔSBP=-4.13 mmHg, 1 mmHg=0.133 kPa, 95% CI -4.87 to -3.39, I2=60%) and diastolic blood pressure(ΔDBP=-1.39 mmHg, 95% CI -2.32 to -0.46, I2=95%). Tirzepatide showed the most pronounced effects on both weight and blood pressure reduction. In addition, GLP-1 receptor agonists significantly lowered LDL-C, TC, and TG, while moderately increasing HDL-C levels. In terms of safety, GLP-1 receptor agonists were associated with an increased risk of gastrointestinal adverse events, but did not significantly increase the risk of hypoglycemia. Conclusion:GLP-1 receptor agonists are effective in reducing weight, BMI, and blood pressure, and in improving lipid profiles in non-diabetic individuals with obesity. However, gastrointestinal side effects should be closely monitored. Given the variability in efficacy and safety among various GLP-1 receptor agonists, personalized treatment approaches are recommended.

With the rising obesity rates and increased demand for weight-loss methods in China, there is a need for safer and more effective solutions to improve metabolic disorders associated with obesity and enhance patients' quality of life. Current bariatric surgery, while being the most effective method, faces limitations such as insufficient weight loss, weight regain, and complications. However, advancements in bariatric surgery techniques, the development of less invasive endoscopic bariatric procedures, the emergence of new anti-obesity drugs with single and multiple targets, and the application of artificial intelligence in metabolic and bariatric surgery are addressing these issues and revealing the rapid progress of obesity metabolism research and its clinical applications. This paper reviews relevant research published in 2024, explores emerging hotspots and potential research directions, and provides references for further exploring advancements in bariatric surgery techniques, combination anti-obesity drug therapies, and AI-assisted applications.

Based on the actual situation of rapid increase in obesity prevalence and the current lack of a professional weight loss and bariatric surgery treatment platform in Macao, coupled with the continouous rise in the obesity population, the further development and refine-ment of obesity treatment methods has become particularly urgent. Against this backdrop, the authors conduct an in-depth discussion to analyze how Macao, leveraging its unqiue geographical location and favorable policy advantages within the broader context of collaborative development in the Guangdong-Hong Kong-Macao greater bay area, can actively explore future development paths and potential challenges in the fields of bariatric and metabolic medicine and surgery, with the aim to provide a robust reference for advancing related medical technologies in Macao, thereby enhancing the overall level of obesity treatment in the region.

Based on the actual situation of rapid increase in obesity prevalence and the current lack of a professional weight loss and bariatric surgery treatment platform in Macao, coupled with the continouous rise in the obesity population, the further development and refine-ment of obesity treatment methods has become particularly urgent. Against this backdrop, the authors conduct an in-depth discussion to analyze how Macao, leveraging its unqiue geographical location and favorable policy advantages within the broader context of collaborative development in the Guangdong-Hong Kong-Macao greater bay area, can actively explore future development paths and potential challenges in the fields of bariatric and metabolic medicine and surgery, with the aim to provide a robust reference for advancing related medical technologies in Macao, thereby enhancing the overall level of obesity treatment in the region.

Objective:This study aimed to systematically evaluate the efficacy of glucagon-like peptide-1(GLP-1) receptor agonists and multi-target analogs on weight reduction and cardiometabolic outcomes in non-diabetic individuals with obesity, and to compare the efficacy and safety across different GLP-1 receptor agonists.Methods:Randomized controlled trials(RCTs) published between January 2000 and March 2025 were identified through a systematic search of CNKI, Wanfang, Web of Science, PubMed, and Cochrane databases. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Meta-analysis was performed using RevMan 5.4.1 software. Results:A total of 16 RCTs involving 11 032 non-diabetic individuals with obesity were included. Meta-analysis showed that GLP-1 receptor agonists significantly reduced body weight(ΔWeight=-8.71 kg, 95% CI -10.68 to -6.74, P<0.001) and BMI(ΔBMI=-3.01 kg/m 2, 95% CI -3.77 to -2.25, P<0.001), as well as improved systolic blood pressure(ΔSBP=-4.13 mmHg, 1 mmHg=0.133 kPa, 95% CI -4.87 to -3.39, I2=60%) and diastolic blood pressure(ΔDBP=-1.39 mmHg, 95% CI -2.32 to -0.46, I2=95%). Tirzepatide showed the most pronounced effects on both weight and blood pressure reduction. In addition, GLP-1 receptor agonists significantly lowered LDL-C, TC, and TG, while moderately increasing HDL-C levels. In terms of safety, GLP-1 receptor agonists were associated with an increased risk of gastrointestinal adverse events, but did not significantly increase the risk of hypoglycemia. Conclusion:GLP-1 receptor agonists are effective in reducing weight, BMI, and blood pressure, and in improving lipid profiles in non-diabetic individuals with obesity. However, gastrointestinal side effects should be closely monitored. Given the variability in efficacy and safety among various GLP-1 receptor agonists, personalized treatment approaches are recommended.

With the rising obesity rates and increased demand for weight-loss methods in China, there is a need for safer and more effective solutions to improve metabolic disorders associated with obesity and enhance patients' quality of life. Current bariatric surgery, while being the most effective method, faces limitations such as insufficient weight loss, weight regain, and complications. However, advancements in bariatric surgery techniques, the development of less invasive endoscopic bariatric procedures, the emergence of new anti-obesity drugs with single and multiple targets, and the application of artificial intelligence in metabolic and bariatric surgery are addressing these issues and revealing the rapid progress of obesity metabolism research and its clinical applications. This paper reviews relevant research published in 2024, explores emerging hotspots and potential research directions, and provides references for further exploring advancements in bariatric surgery techniques, combination anti-obesity drug therapies, and AI-assisted applications.

At present, the prevalence of overweight and obesity is increasing rapidly. Baria-tric and metabolic surgery is an effective means to treat obesity and related comorbidities, but only a few obesity patients have received bariatric surgery, and most patients choose to accept drugs to lose weight. Glucagon-like peptide-1 receptor agonists (GLP-1RA), as an emerging drug, has a signi-ficant effect on overweight and obesity patients, and can be used as a beneficial supplement for bariatric surgery, which has a profound impact on bariatric surgery. Based on the relevant literature, the authors discuss the application and influence of GLP-1RA in bariatric and metabolic surgery.

Objective:To investigate the clinical efficacy of single-port and mini-three-port laparoscopic sleeve gastrectomy (MTP-SG) for obesity.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 364 obesity patients in the Chinese Obesity and Metabolic Surgery Database who were admitted to The First Affiliated Hospital of Jinan University from July 2016 to December 2023 were collected. There were 79 males and 285 females, aged (31±9)years. Of 364 patients, 67 cases undergoing single-port laparoscopic sleeve gastrectomy (SP-SG) were divided into the SP group, and 297 cases undergoing MTP-SG were divided into the MTP group. Propensity score matching was done by the 1∶1 nearest neighbor matching method. The clamp value was set as 0.1. Measurement data with normal distribution were expressed as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q1), and the rank sum test was used for comparison between groups. Count data were expressed as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 364 patients, 126 cases were successfully matched, including 63 cases in the SP group and 63 cases in the MTP group. After propensity score matching, the confounding bias of gender, body mass, body mass index (BMI), waist circumference, waist hip ratio were eliminated between the two groups. (2) Intraoperative and post-operative conditions. Both groups of patients successfully completed laparoscopic sleeve gastrectomy. After propensity score matching, the operation time, volume of intraoperative blood loss, number of postoperative painkillers used, number of postoperative antiemetics used, duration of postoperative hospital stay, duration of total hospital stay, surgical cost, and total hospitalization cost of the 63 pati-ents in SP group were 101(90,120)minutes, 10(10,10)mL, 1.0(1.0,2.5)times, 3.0(1.0,5.0)times, 4(3,5)days, 7(5,8)days, 4.1(3.5,4.3) ten thousand yuan, and (6.4±0.8) ten thousand yuan, respectively. The above indicators of the 27 patients in MTP group were 100(90,120)minutes, 10(10,15)mL, 2.0(1.0,4.0)times, 4.0(3.0,5.0)times, 3(3,4)days, 5(5,6)days, 3.2(2.8,4.2) ten thousand yuan, and (5.8±0.8) ten thousand yuan, respectively. There were significant differences in number of postoperative antiemetics used, duration of postoperative hospital stay, duration of total hospital stay and total hospitalization cost between the two groups ( Z=-2.39, -3.93, -3.03, t=4.04, P<0.05), and there was no significant difference in operation time, volume of intraoperative blood loss, number of post-operative painkillers used and surgical cost between the two groups ( Z=-0.49, -1.00, -1.23, -1.47, P>0.05). (3) Follow-up. One hundred and ninety five of the 364 patients conducted postoperative 1 month follow-up, including 25 patients in the SP group and 170 patients in the MTP group, and no patient experienced complications such as gastric leakage, infection, or incisional hernia. Both groups of patients had good surgical incisions. After propensity score matching, the change in BMI (ΔBMI), percentage of total weight loss (%TWL), and percentage of excess weight loss (%EWL) of 24 patients in the SP group were (3.7±1.4)kg/m 2, 11.0%±3.0%, 52.6%±30.0%, respectively. The above indicators of 40 patients in the MTP group were (4.1±1.3)kg/m 2, 11.1%±2.8%, 41.8%±19.1%, respectively. Patients who conducted the postoperative 12 month follow-up were 21 and 131 in the SP group and the MTP group, respectively. After propensity score matching, the ΔBMI, %TWL and %EWL of 15 patients in the SP group were (8.7±4.1)kg/m 2, 26.2%±9.8%, 130.0%±45.1%, respectively. The above indicators of 36 patients in the MTP group were (9.8±4.0)kg/m 2, 27.2%± 8.7%, 107.1%±40.7%, respectively. Conclusion:Both SP-SG and MTP-SG can be used to treat obesity patients and achieve satisfactory short-term results.

Obesity poses a serious threat to human health, and although bariatric surgery has been proven effective treatment for morbidly obese patients, its surgical risks and high medical costs limit its clinical application and popularity. Endoscopic sleeve gastroplasty (ESG), as a relatively new endoscopic surgery technique for weight loss, has satisfactory weight loss effects compared to laparoscopic sleeve gastrectomy and lifestyle interventions, while preserving the normal structure of the stomach. Its weight loss effects and safety have been validated in multicenter studies abroad. Although, ESG has not yet been widely performed in China, with the gradual maturity of this technique, its prospects are worth attention in the field of weight loss. In the future, large-scale, long-term, multi-center studies are urgently needed in China to clarify the long-term effects, remission of comorbidities, and occurrence of complications of ESG surgery in obese and metabolic disease patients.