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This review examined changes in FFM during weight loss induced by diet and exercise interventions, incretin\u2010based therapies, and bariatric surgery, and assessed whether the relative loss of FFM differs by weight\u2010loss modality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Cochrane Library, and Embase was conducted for randomised controlled trials published from 2015 to October 21st, 2025. Eligible studies included adults with overweight or obesity (with or without type 2 diabetes), achieving \u2265\u200910% weight loss of total body weight through diet and exercise, incretin\u2010based, or surgical interventions. The studies were required to report measurements of either FFM using dual\u2010energy X\u2010ray absorptiometry or muscle mass using computed tomography or magnetic resonance imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve diet and exercise, five incretin\u2010based therapy, and four bariatric surgical studies (1334 participants) were included. The pooled changes in FFM were \u22121.8\u2009kg (95% CI: \u22122.6, \u22121.0) for diet and exercise interventions, \u22124.8\u2009kg (95% CI: \u22125.6, \u22123.9) for incretin\u2010based therapies versus placebo, and \u22129.1\u2009kg (95% CI: \u221212.3, \u22126.0) for bariatric surgery. The proportion of total weight loss attributable to FFM was 14.9% for diet with\/without exercise interventions (22.3% for diet without exercise and 7.7% for diet with exercise), 33.3% for incretin\u2010based therapies, and 34.2% for surgical interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among the included studies with \u2265\u200910% weight loss in individuals with overweight or obesity, diet and exercise interventions were associated with the smallest reductions in FFM, whereas incretin\u2010based therapies and bariatric surgery showed substantially greater losses. Given the importance of FFM, strategies to preserve FFM, particularly exercise, should be included in all weight\u2010loss approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71006","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T01:55:27Z","timestamp":1782093327000},"page":"7737-7751","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Incretin\u2010Based Therapies, Diet and Exercise Interventions, and Bariatric Surgery on Fat\u2010Free Mass in Adults With Overweight or Obesity: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"28","author":[{"given":"Laura","family":"Busk\u2010Cirera","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida \u00d8rum","family":"Carlsen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3557-4155","authenticated-orcid":false,"given":"L\u00e6rke Bruun","family":"Madsen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0590-6285","authenticated-orcid":false,"given":"Rasmus Michael","family":"Sandsdal","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen 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