Abstract
BACKGROUND: Previous studies have shown an increase in obesity prevalence in the inflammatory bowel disease (IBD) population. The popularity of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) has increased in recent years due to their effectiveness in weight management. In this comprehensive review, we evaluate the efficacy of GLP-1 RAs in the management of obesity in patients with IBD. METHODS: We performed a systematic search of PubMed, Embase, Scopus, and Web of Science up to October 2025 for studies that reported changes in anthropometric variables in IBD cases treated with GLP-1 RAs. The primary outcome was weight loss after treatment, and the secondary outcome was changes in patients' metabolic profiles. We pooled the mean raw changes (MRAW) in weight, body mass index (BMI), Glycated hemoglobin (HbA1c), Total cholesterol, high-density lipoprotein (HDL), and Low-density lipoprotein (LDL) from baseline to follow-up. This study was registered in PROSPERO (CRD420251063158). RESULTS: Overall, eight retrospective cohort studies involving 1236 patients were included. The pooled weight change following GLP-1 RAs treatment was - 5.71 Kg (95% CI, -9.56 to -1.86; P = 0.01; I² = 78.0%). The weight loss was also significant in the semaglutide subgroup (MRAW: -5.59 Kg; 95% CI, -10.37 to -0.81; P = 0.03; I² = 80.0%). Furthermore, the pooled MRAW of three studies on BMI changes showed a significant reduction (-2.18 Kg/m(2); 95% CI, -3.66 to -0.69; P < 0.01), while heterogeneity was high (I² = 81.1%). The certainty of evidence was rated as "Low" for weight change and "Very Low" for all other outcomes, according to the GRADE framework. CONCLUSION: The GLP-1 RAs could be an effective option for obesity management in IBD. However, the robustness of the current study's results is limited by potential bias in the included studies and small sample sizes in the secondary outcomes analysis. Further prospective studies are needed prior to broader prescription of GLP-1 RAs in the IBD population.