Obesity Abstracts

Background: Visceral adipose tissue (VAT) drives cardio-renal-hepatic-metabolic (CRHM) risks, necessitating effective reduction strategies. This meta-analysis compares lifestyle and GLP-1 receptor agonist-based (GLP1RAT) interventions for VAT reduction in adults.

Methods: Following PRISMA guidelines, we searched PubMed (January 2010–August 2025) for randomised controlled trials (RCTs) assessing VAT in adults (≥18 years) using bioelectrical impedance analysis, CT, MRI, or DEXA, excluding Type 1 diabetes, gestational diabetes, pregnancy, or organ insufficiency. Percentage VAT change, total fat, BMI, and weight were analysed across diet, exercise, diet plus exercise, and GLP1RAT interventions using random-effects models. Meta-regression explored moderators (age, sex, Type 2 diabetes). Registered in PROSPERO (CRD420251123149).

Results: Thirty-six RCTs (5,769 participants) were included. Diet plus exercise yielded the most significant VAT reduction, followed by GLP1RATs, diet alone, and exercise (Table 1). Very low energy diets (-23.14%) outperformed low-calorie (-14.12%) and low-fat diets (-7.83%). Tirzepatide (-21.84%) and retatrutide (-27.70%) led GLP1RATs; high-dose semaglutide (>1.0 mg) enhanced VAT reduction beyond weight loss. Weight loss correlated with VAT reduction (r =0.72–0.90). Outcomes varied by age, Type 2 diabetes, and adiposity. CT and MRI detected larger reductions than BIA.

Table 1. Pooled % VAT Reductions by Intervention Category

Intervention | % VAT Change | 95% CI ---------- | ----- | ------ ---- Diet + Exercise | -18.19 | [-27.26, -9.12] GLP1RAT | -14.23 | [-18.80, -9.66] Diet | -10.64 | [-15.21, -6.07] Exercise | -0.61 | [-5.45, 4.23]

Conclusion: Combined diet-exercise, very low energy diets, and GLP1RATs (tirzepatide, retatrutide, high-dose semaglutide) effectively reduce VAT, mitigating CRHM risks, guiding endocrinology practice.

Keywords: Visceral adipose tissue, GLP-1 receptor agonists, diet, exercise, meta-analysis, randomised controlled trials, obesity, Type 2 diabetes