The paradigm of obesity treatment is rapidly evolving with the introduction and widespread adoption of glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Semaglutide, the representative agent, has demonstrated substantial weight reduction and cardiometabolic benefits across multiple pivotal clinical trials, reshaping societal perceptions of anti-obesity pharmacotherapy. In parallel, sleeve gastrectomy (SG) has become the most commonly performed metabolic and bariatric surgical procedure worldwide due to its technical simplicity, strong safety profile, and durable outcomes. The use of anti-obesity medication in the preoperative setting of metabolic and bariatric surgery has been previously explored; however, its clinical benefit has long remained controversial and inconsistent. Recent evidence suggests that GLP-1 RAs can safely achieve greater preoperative weight loss than earlier pharmacologic agents. Furthermore, GLP-1 RAs have emerged as an effective treatment option for postoperative weight regain, demonstrating significant weight-loss benefits in both SG and gastric bypass patients compared with conventional therapies. As GLP-1-based therapies continue to advance, future strategies should shift toward a multimodal treatment model analogous to oncology, integrating pharmacologic and surgical interventions throughout all phases of obesity care. Further research is needed to establish the ideal timing, duration, safety, and long-term weight loss and metabolic effects of GLP-1 RA administration in both pre- and postoperative phases.
