Effects of preoperative glucagon-like peptide-1 receptor agonist therapy on weight loss following bariatric surgery

📖 Top 20% JournalJun 9, 2025Surgical endoscopy

How pre-surgery treatment with GLP-1 drugs may affect weight loss after weight-loss surgery

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Abstract

Among 323 diabetic patients undergoing bariatric surgery, 132 (40.9%) were on a GLP-1 receptor agonist at the time of their procedure.

GLP-1 receptor agonist naive patients were less likely to have high cholesterol compared to those on GLP-1RAs (57% vs 69%).
GLP-1 receptor agonist naive patients were more likely to undergo Roux-en-Y gastric bypass surgery than those on GLP-1RAs (84.82% vs 62.88%).
No differences were observed in 30-day postoperative outcomes between the two groups.
At one year post-surgery, GLP-1 receptor agonist naive patients experienced greater weight loss compared to patients on GLP-1RAs (24.1% vs 20.5%).
By five years post-surgery, weight loss between the groups was similar, with GLP-1 receptor agonist naive patients at 19.8% total body weight loss compared to 19.4% for those on GLP-1RAs.

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INTRODUCTION: GLP-1 receptor agonists (GLP-1RAs) are increasingly prescribed for management of obesity and diabetes. In this context, we aim to determine the effect of preoperative GLP-1RA use on surgical outcomes and long-term weight loss following bariatric surgery.

METHODS: We retrospectively identified diabetic patients undergoing primary bariatric surgery at an academic institution between 2014 and 2024. Patients on a GLP-1RA at the time of surgery were compared with GLP-1RA naive patients. Pearson's chi-squared and Fisher's exact tests were used where appropriate to compare the differences in baseline characteristics. A 1:1 nearest neighbor propensity match was used to assess the differences in postoperative outcomes. Mixed-effects models were created to account for repeated weight measures postoperatively with the interactions of GLP-1RA therapy on percent total body weight loss (%TBWL). These models were adjusted for procedure type, patient age, sex, and race.

RESULTS: 323 patients met the inclusion criteria. 132 (40.9%) patients were on a GLP-1RA at the time of their procedure while 191 (59.1%) were not. On univariate comparison, GLP-1RA naive patients were less likely to have hyperlipidemia (57% v 69%, p = 0.03) and more likely to undergo RYGB than GLP-1RA patients (84.82% vs 62.88%, p < 0.001). There were no differences in any 30-day postoperative outcomes. GLP-1RA naive patients had better weight loss at one year postoperatively than GLP-1RA patients (TBWL 24.1% vs 20.5%, p = .003). As the follow-up period extended, the weight loss between the groups became more similar. At 5 years postoperatively, the GLP-1RA naive patients had 19.8% TBWL vs. 19.4% TBWL in the GLP-1RA group (p = 0.80).

CONCLUSIONS: Preoperative GLP-1RA use is safe prior to bariatric surgery but is associated with inferior early postoperative weight loss in diabetic patients. GLP-1RA naive patients appear to experience greater weight recidivism when compared to patients on a GLP-1RA prior to surgery, resulting in comparable long-term weight loss.

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Abstract

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