Comparison of lifestyle, surgery, and semaglutide for weight management in endometrial cancer: a prospective observational study.

BACKGROUND: To compare sleeve gastrectomy, semaglutide therapy, and the Diet, Exercise, Accompany and Refresh (DEAR) weight management programme for weight control, metabolic improvement, and oncological outcomes in patients with endometrial cancer receiving fertility-sparing treatment. METHODS: In this prospective observational study, 53 patients received sleeve gastrectomy ( = 10), semaglutide therapy ( = 23), or the DEAR programme ( = 20) after multidisciplinary assessment and shared decision-making. Anthropometric and metabolic measures and tumour response were assessed over two years. RESULTS: At 1 year, all groups lost weight; the sleeve gastrectomy group had the largest body mass index reduction compared with the semaglutide group (difference = 4.04 kg/m, < 0.05) and the DEAR group (difference = 2.12 kg/m, < 0.05). By 2 years, weight regain was less frequent in the DEAR group (14.3%) than in the semaglutide (55.6%) and sleeve gastrectomy (66.7%) groups ( = 0.037). The DEAR group showed more stable metabolic improvements and the highest complete tumour remission rate (85.0%), followed by the semaglutide group (73.9%) and the sleeve gastrectomy group (60.0%). CONCLUSION: Sleeve gastrectomy produced rapid short-term weight loss, whereas the DEAR programme showed better medium-term weight maintenance, metabolic stability, and tumour response. Integrated lifestyle support may be a useful medium-term strategy for patients seeking fertility preservation.