Obesity remains a major global health concern, and the optimal treatment strategy for adults without significant comorbidities is still debated. While surgical, endoscopic, and pharmacological approaches have shown efficacy, direct comparative evidence between these modalities is limited. This network meta-analysis aimed to compare and rank the efficacy of laparoscopic adjustable gastric banding (LAGB), intragastric balloon (IGB), and semaglutide versus standard care in adults with pure obesity, focusing on changes in body weight (BW), body mass index (BMI), and percentage of total body weight loss (%TBWL).

A systematic search of PubMed, ScienceDirect, Taylor & Francis, and ClinicalTrials.gov was performed to identify randomized controlled trials comparing LAGB, IGB, semaglutide, and standard care in adults with obesity (BMI > 30 kg/m²) and minimal comorbidities. Six studies (n = 1,195) met inclusion criteria. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A random-effects network meta-analysis was conducted, and interventions were ranked according to the surface under the cumulative ranking curve (SUCRA) for each outcome.

LAGB demonstrated the highest efficacy across all outcomes, achieving SUCRA values of 83.8% for BW reduction, 79.9% for BMI reduction, and 72.9% for %TBWL. Semaglutide consistently ranked second (74.9%, 68.1%, and 62.9%), while IGB showed moderate efficacy (38.8%, 47.0%, and 56.1%). Standard care ranked lowest across all parameters (SUCRA < 10%). The consistency of findings across league tables, forest plots, and SUCRA rankings supported the robustness of the analysis.

LAGB remains the most effective weight-loss intervention in adults with obesity and no major comorbidities, outperforming both pharmacological and endoscopic therapies. Semaglutide represents a potent, less invasive alternative that surpasses IGB in efficacy. Standard care alone provides minimal benefit, underscoring the importance of active interventional strategies for optimal weight management in this population.