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

📖 Top 20% JournalOct 29, 2025Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

How pre-surgery GLP-1 treatments affect weight loss after weight-loss surgery

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Abstract

Of 422 patients, 36 (8.5%) received neoadjuvant GLP-1 receptor agonists (GLP-1RAs) before bariatric surgery.

Neoadjuvant GLP-1RA treatment was associated with a greater mean change in body mass index (BMI) at 2 weeks compared to no treatment (-4.9 vs -3.8, P = .006).
No significant differences in weight loss were observed at 3 months (-9 vs -8.4, P = .25), 6 months (-12.4 vs -11.2, P = .13), or 12 months (-14.2 vs -12.9, P = .25) postoperatively.
Multivariable analysis indicated that operation type did not alter weight loss outcomes between the groups.
The median duration of GLP-1RA treatment prior to surgery was 12 months.

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BACKGROUND: 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.

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

SETTING: University Hospital, United States.

METHODS: 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.

RESULTS: 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.

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

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