Pre-surgery GLP-1 agonists reduce post-operative risks in extreme obesity

A combination of GLP-1 agonists taken before metabolic and bariatric surgery may help patients with extreme obesity lower the risk of post-operative complications, according to a new study presented today at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting.

Patients with extreme obesity, a body mass index (BMI) of 70 or more, face a higher risk of complications from surgery compared to patients with lower BMIs. Studies have shown weight loss before surgery can mitigate risk but lifestyle intervention or first generation anti-obesity medications have not led to enough weight loss to make a difference.

In the study, 113 patients with BMI >70 attempted to lose weight prior to metabolic and bariatric surgery with either medically supervised diet and exercise, a single GLP-1 medication (mostly semaglutide) or multimodal therapy of more than one GLP-1. Patients were treated for an average of 72.9 days.

Individuals on multiple medications had the greatest percentage total body weight loss (13.1%), followed by single GLP-1 therapy (8.14%) and diet and exercise (5.95%). BMI reductions were highest for those treated for six to 12 months with combination drug therapy.

Combining anti-obesity medications may achieve much greater pre-surgery weight loss than other methods for those with extreme obesity. Many patients who would otherwise be considered 'too sick for surgery' may now qualify." 

Phil Schauer, MD, Director of the Metamor Metabolic Institute at Pennington Biomedical in Baton Rouge

The ASMBS reports that in 2022 nearly 280,000 metabolic and bariatric procedures were performed in the U.S., which represents only about 1% of those who meet eligibility requirements based on BMI. According to the U.S. Centers for Disease Control and Prevention (CDC), obesity effects 42.4% of Americans. Studies show the disease can weaken or impair the body's immune system and cause chronic inflammation and increase the risk of many other diseases and conditions including cardiovascular disease, stroke, type 2 diabetes, and certain cancers. 

"More studies are needed to determine the optimal role of GLP-1s before and after metabolic and bariatric surgery among different patient groups," said Marina S. Kurian, MD, ASMBS President and Clinical Professor, Dept. of Surgery, Division of Bariatric Surgery, who was not involved in the study. "Obesity must be viewed like other chronic diseases where sometimes more than one therapy is necessary over time and for different reasons."