Tirzepatide for Recurrent Weight Gain after Bariatric Procedures: Real-World Evidence of Efficacy and Safety

Recurrent weight gain after bariatric surgery (BS) or endoscopic bariatric therapy (EBT) remains a long-term clinical challenge, potentially undermining long-term treatment success. Tirzepatide, a dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, has shown promising results in obesity treatment, but data regarding its use in post BS or EBT recurrent weight gain are limited.

This observational cohort study evaluated the effectiveness and safety of tirzepatide in patients with recurrent weight gain after BS or EBT. Anthropometric data, BMI categories, and adverse events were collected at baseline and after 24 weeks of treatment.

A total of 34 patients (26 females, 8 males) who experienced recurrent weight gain after BS (n = 32) or EBT (n = 2) were treated with once-weekly subcutaneous tirzepatide (dosing range 2.5-10 mg/week). After 24 weeks, the mean percentage total body weight loss (%TBWL) was 18.1 ± 5.6% (p < 0.0001), with a significant reduction in waist circumference (p < 0.0001). Most patients shifted to lower BMI categories, with the majority reaching overweight or normal weight status. Adverse events were exclusively gastrointestinal (constipation, diarrhea, nausea), generally mild, and did not lead to treatment discontinuation.

Preliminary evidence suggests that tirzepatide is associated with significant weight loss and good tolerability in this observational cohort for managing recurrent weight gain after bariatric surgery and endoscopic bariatric therapy. These findings suggest a potential role for tirzepatide as a valuable nonsurgical option in the multidisciplinary management of patients experiencing recurrent weight gain after bariatric procedures.