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GLP-1 Receptor Agonists and Weight Loss Among Suboptimal Responders to Metabolic Bariatric Surgery: A Target Trial

Haisheng Wu1, Yiling Yan2, Manrong Xu3

  • 1Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Diabetes, Obesity & Metabolism
|May 8, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonist (GLP-1 RA) pharmacotherapy significantly improved weight loss in Chinese patients with suboptimal response to metabolic bariatric surgery (MBS). This real-world evidence supports GLP-1 RA integration into post-MBS care pathways in China.

Area of Science:

  • Bariatric Surgery
  • Pharmacotherapy
  • Obesity Medicine

Background:

  • Suboptimal weight loss post-metabolic bariatric surgery (MBS) affects 20%-35% of patients.
  • Limited randomized trial data exists for glucagon-like peptide-1 receptor agonist (GLP-1 RA) pharmacotherapy in this population, particularly from Chinese cohorts.

Purpose of the Study:

  • To emulate a target trial comparing GLP-1 RA initiation with standard care for suboptimal responders to MBS in a Chinese multicenter cohort.
  • To evaluate the effectiveness of GLP-1 RA in improving weight loss outcomes after bariatric surgery in a Chinese population.

Main Methods:

  • Target trial emulation using electronic health record (EHR) data from two tertiary teaching hospitals in China (March 2019 to June 2024).
  • Inclusion criteria: adults (18-65 years) post-sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with suboptimal weight loss (BMI ≥ 28 kg/m²), 12-36 months post-surgery.
  • 1:5 propensity score matching compared 104 GLP-1 RA initiators with 520 standard care patients.

Main Results:

  • At 12 months, the GLP-1 RA group achieved a mean of 7.5% total body weight loss (%TBWL) versus 1.2% in the standard care group (difference: 6.28 percentage points; P < 0.001).
  • The responder rate for ≥ 5% TBWL was 75% in the GLP-1 RA group compared to 7% in the standard care group.
  • Results remained consistent across various subgroups and sensitivity analyses.

Conclusions:

  • GLP-1 RA initiation was associated with clinically meaningful weight loss in Chinese patients with suboptimal response to MBS.
  • These findings extend Western trial evidence to a real-world Chinese setting.
  • GLP-1 RA pharmacotherapy should be considered for integration into post-bariatric care pathways in China.
Keywords:
GLP‐1bariatric surgerycohort studyweight control

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