Effects of neoadjuvant glucagon-like-peptide 1 receptor agonists on weight loss after bariatric surgery

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prevalent medications used to treat patients with obesity. While bariatric surgery remains the most successful single intervention, many surgical patients have been on a GLP-1RA.

This study aims to determine if the neoadjuvant use of GLP-1RA affects surgical weight loss.

University Hospital, United States.

This retrospective cohort study compared outcomes of patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) who were treated preoperatively with and without GLP-1RAs from July 2022 to June 2023. T-tests and multivariable analyses were utilized to determine significant differences in weight loss.

Of 422 patients, 36 (8.5%) received neoadjuvant GLP-1RAs and 386 (91.5%) did not. Mean preoperative body mass index (BMI) was 47 for both groups. Median time for GLP1-RAs was 12 months prior to bariatric surgery but not resumed after. There was a significant difference between patients who received neoadjuvant GLP1-RAs versus those who did not at 2 weeks (mean change in BMI of -4.9 vs -3.8, P = .006), but not at 3- (-9 vs -8.4, P = .25), 6- (-12.4 vs -11.2, P = .13), or 12 months (-14.2 [n = 21] vs -12.9 [n = 249], P = .25) postoperatively. Multivariable analysis showed no difference in weight loss at any time point when adjusting for operation type.

Although neoadjuvant GLP-1RAs did not significantly impact weight loss after bariatric surgery, there was an additive weight loss effect.