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Preoperative GLP-1 therapy delivers the greatest weight reduction in patients with severe obesity, optimizing surgical outcomes and redefining standards in obesity care.
New research from the University of Oklahoma-Tulsa Comprehensive Weight Loss and Bariatric Surgery Program shows that glucagon-like peptide-1 (GLP-1) receptor agonists remarkably enhance preoperative weight loss in patients with severe obesity, outperforming lifestyle modification and other anti-obesity medications (AOMs).
This cohort study examined the efficacy and safety of GLP-1–based therapies and other AOMs for prehabilitation—the phase of preparation before bariatric surgery—in a population with extremely high body mass index (BMI) levels. Researchers retrospectively analyzed data from April 2018 to February 2023, including 206 patients who underwent bariatric surgery. Of these, 79 patients had an initial BMI ≥ 49.5 kg/m² (mean age 44 ± 11.2 years; 75.9% female).
Preoperative weight loss was the primary focus, with one-year total weight loss as a secondary measure. Data on AOM type and duration, serial weight and BMI measurements, and available genetic testing were analyzed. Weight-loss outcomes across treatment groups were compared using the Kruskal–Wallis test. Notably, 43% of the high-BMI patients (34 out of 79) carried obesity-related genes. The average baseline weight was 165.9 kg with a mean BMI of 58.5 kg/m². The median preoperative weight loss varied significantly across intervention groups, as shown in Table 1:
At 1 year post-surgery, the mean total weight loss reached 61.97 ± 20.9 kg, corresponding to 65.6 ± 20.8% excess weight loss. The findings demonstrate that GLP-1 receptor agonists attain the highest preoperative weight loss and the most significant BMI reduction among all medical strategies evaluated. To sum up, preoperative GLP-1 therapy can be a valuable tool for optimizing surgical readiness in those with extreme obesity, potentially minimizing surgical risks and improving postoperative outcomes.
Surgical Endoscopy
Bariatric outcomes of high BMI patients with preoperative anti-obesity medications
Alex D. Obermark et al.
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