GLP-1 Drugs Before Bariatric Surgery Can Help People With Extreme Obesity

A new study looked at the impact of taking GLP-1 drugs before bariatric surgery. Halfpoint/Getty Images

• New research finds that using GLP-1 drugs like Ozempic before bariatric surgery can help improve the health of people with extreme obesity.
• Extreme obesity is defined as having a body mass index (BMI) of 70 or more.
• In 2022, there were nearly 280,000 metabolic and bariatric surgeries in the United States.

People with extreme obesity can reduce their risk of complications from bariatric or metabolic surgery by taking GLP-1 drugs before the procedures, according to a study presented over the weekend at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting. The results of the study haven’t yet been published in a peer-reviewed scientific journal.

Extreme obesity, which is defined as having a body mass index (BMI) of 70 or more, presents patients and doctors with complications during and after weight-loss surgery compared to patients with lower BMIs. The research presented at the ASMBS meeting suggests that GLP-1 drugs like Ozempic, Wegovy, Zepbound, or Mounjaro can be the most effective way to lose that weight before undergoing such surgeries.

Taking multiple types of weight loss drugs was most effective

The study documented 113 patients with a BMI greater than 70 who attempted to lose weight ahead of metabolic and bariatric surgery with either medically supervised diet and exercise, one GLP-1 medication (mostly semaglutide), or multimodal therapy involving more than one GLP-1.

Patients were treated for an average of 72.9 days.

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

Who should be taking GLP-1 drugs before surgery?

John Morton, MD, professor of surgery (bariatric, minimally invasive) at the Yale School of Medicine and Yale Medicine bariatric surgeon, told Healthline that people considering such surgery should ultimately consult a healthcare professional in advance to determine what those risks are and how much weight they ultimately need to lose.

Morton was not involved in the study.

“I look for two things. One, their motivation: Why do they want to lose weight? I ask them that, and I also ask them how much weight they want to lose,” Morton said. “And to the degree that they’re fairly accurate with their weight-loss goals, then that tells me how ready they are and also if their motivations are appropriate—in other words, to improve their health or to interact more with their families or be more productive at work. I think the main takeaway from this study is we have a lot of options for people who have extra weight and you should go to accredited centers to help figure out what’s the best path forward.”

What are the risks of bariatric surgery?

Around 42% of adults in the United States have obesity, according to the Centers for Disease Control and Prevention, putting them at risk for inflammation, cancer, and type 2 diabetes.

Researchers have linked obesity to many health complications, some of which can be life threatening if not treated:

• type 2 diabetes
• heart disease
• high blood pressure
• certain cancers (breast, colon, and endometrial)
• stroke
• gallbladder disease
• fatty liver disease
• high cholesterol
• sleep apnea and other breathing problems
• arthritis
• infertility

In 2022, there were nearly 280,000 metabolic and bariatric surgeries in the United States. Morton said this type of surgery has risks but is overall quite safe.

“It has one of the safest safety records in surgery,” Morton said. “The mortality rate from bariatric surgery is less than hip or knee replacement or removal of a gallbladder.”

Morton added that losing 5-10% of total body weight can help with diabetes, blood-pressure or cholesterol issues, and 15% percent can help with problems like sleep apnea or fatty liver. But people with severe obesity need to lose more to counter the potential health problems that they face.

“If you want to reduce your risk from cancer associated with obesity, then you probably have to lose 25% of your total body weight,” Morton said. “Bariatric surgery affords you the most weight loss. And again, the risk is quite low. You do need to take into account the risk of doing nothing. And the risk of doing nothing carries significant risk. People who carry extra weight who are obese reduce their lifespan on the order of 10 to 15 years.”

Mir Ali, MD, board certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, told Healthline that patients with BMI in the 60s or 70s have high risks for surgery because anesthesia can be difficult to configure, and moving a patient with that level of BMI during surgery can be complicated.

Ali was not involved in the study.

“The higher their BMI, the higher their risk,” Ali said. “But also recovery is harder when the patient is extremely large. So there’s a lot of different factors that go into play. So these medications can be used to have somebody lower their weight and reduce their surgical risks to some extent.”

“There’s no set number, it’s very much dependent on the patient, their body habitus, their age, general health, other risk factors,” Ali said. “We can have a pre-op evaluation by different specialists; they could see the anesthesiologist ahead of time to see if they’re acceptable [as far as] risks for their airway for the anesthesia. So it just depends on the patient. If they have more heart or lung factors, we might have them lose more weight.”

Takeaway

A study presented over the weekend suggested that for people with extreme obesity taking GLP-1 agonists like Ozempic or Wegovy before bariatric or metabolic surgery was the most effective method of losing weight to reduce surgical or recovery complications.

Extreme obesity is defined as having a body mass index of more than 70; it can lead to multiple health conditions and make anesthesia difficult to assess for bariatric surgery.

Experts say meeting with a doctor to tailor the appropriate plan for pre- and post-surgical approaches is ultimately the best plan for each patient.