Abstract
BACKGROUND: Obesity, a chronic disease with serious associated medical problems, remains a global health challenge. While metabolic bariatric surgery (MBS) is the most effective treatment for weight loss, GLP-1 receptor agonists (RAs) are emerging as promising alternatives or adjuncts. This study evaluates the impact of preoperative GLP-1 therapy on weight loss and obesity-related complications over three years and explores reasons for transitioning to surgery. METHODS: Patients who underwent RYGB or SG from 2015-2021 were retrospectively analyzed, excluding those with revision and conversion surgeries, postoperative GLP-1 use, or pregnancy during follow-up. Propensity score matching (1:1) was used to adjust for confounders. The primary outcome was a combined endpoint of the SF-Bari Score, incorporating weight loss, improvement of obesity-related conditions, and surgical complications until 36 months post-surgery. RESULTS: A total of 215 patients were analyzed, including 54 who received GLP-1 RAs prior to surgery, with a preoperative total body weight loss (%TWL) of 3.7 ± 4.3%. %TWL did not differ significantly between groups: at 12 months, 29.8 ± 7.7% (non-GLP-1) vs. 28.1 ± 7.6% (GLP-1); at 24 months, 28.9 ± 8.2% vs. 27.2 ± 8.4%; and at 36 months, 26.9 ± 9.1% vs. 25.4 ± 9.1%. SF-Bari Scores were similar between groups at all timepoints: 96.0 ± 24.2 vs. 93.5 ± 26.3 at 12 months, 93.8 ± 24.4 vs. 91.0 ± 25.6 at 24 months, and 89.1 ± 24.7 vs. 85.5 ± 25.8 at 36 months (non-GLP-1 vs. GLP-1). Propensity score matching confirmed comparable outcomes between groups. Patients transitioned to surgery for definitive treatment, side effects, or medication unavailability. CONCLUSION: Among patients who proceeded to surgery after GLP-1 therapy, prior GLP-1 use was not associated with different surgical outcomes.