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 study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting.
"Combining anti-obesity medications may achieve much greater pre-surgery weight loss than other methods for those with extreme obesity," said Dr Phil Schauer, Director of the Metamor Metabolic Institute at Pennington Biomedical in Baton Rouge. "Many patients who would otherwise be considered 'too sick for surgery' may now qualify."
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 this 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 of 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.
"More studies are needed to determine the optimal role of GLP-1s before and after metabolic and bariatric surgery among different patient groups," said Dr Marina S Kurian, ASMBS President and Clinical Professor, 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."
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