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Background/objectives <p>Optimizing patients with a body mass index (BMI) ≥ 70 kg/m² for metabolic surgery (MS) is challenging. However, pre-operative weight loss may be important for improving the safety of MS for these high-risk patients. Multi-modal anti-obesity medications (mmAOM) may enhance preoperative weight loss compared to non-pharmacologic medically supervised weight loss (NP-MSWL) or glucagon-like peptide-1 receptor agonist monotherapy (Mono-GLP-1) alone.</p> Subjects/methods <p>This retrospective study analyzed 113 patients with BMI ≥ 70 kg/m² at a single metabolic disease treatment institute.</p> Interventions/methods <p>Patients were categorized into NP-MSWL (<i>n</i> = 13), Mono-GLP-1 (<i>n</i> = 54), and mmAOM (<i>n</i> = 46) groups. The primary outcome was mean percent total body weight loss (%TBWL). Secondary outcomes included %TBWL across time intervals (0–23, 23–51, 51–88, and 88+ weeks).</p> Results <p>The mmAOM group achieved the highest average - 13.07% - and median (9.93% [5.57–14.29]) %TBWL; followed by Mono-GLP-1 (5.58% [0.98–10.19]); and NP-MSWL (5% [2.97–7.02]). Significant differences among groups were confirmed by Kruskal-Wallis test (<i>p</i> = 0.0047). The highest median %TBWL was at 51–88 weeks (10.25 [6.49–16.45]) (<i>p</i> = 0.0093).</p> Conclusions <p>mmAOM treatment yields the highest %TBWL, especially within the first 51 weeks of preoperative preparation, demonstrating superior efficacy over Mono-GLP-1 and NP-MSWL in patients with BMI ≥ 70 kg/m². These findings suggest that incorporating mmAOM in preoperative protocols could optimize weight loss and improve surgical outcomes for high BMI patients.</p>

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Multi-modal neo-adjuvant anti-obesity medications may be more effective than medically supervised weight loss or GLP-1 therapy alone in preparing BMI≥70 patients for metabolic surgery

  • 期刊论文

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  • 发表日期：

    2025年6月2日

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  • Michael Kachmar,
  • Florina Corpodean,
  • Iryna Popiv,
  • Kyle B. LaPenna,
  • Denise M. Danos,
  • Michael W. Cook,
  • Brian A. Saunders,
  • Jean J. Domercant,
  • Vance L. Albaugh,
  • Philip R. Schauer

摘要

Background/objectives

Optimizing patients with a body mass index (BMI) ≥ 70 kg/m² for metabolic surgery (MS) is challenging. However, pre-operative weight loss may be important for improving the safety of MS for these high-risk patients. Multi-modal anti-obesity medications (mmAOM) may enhance preoperative weight loss compared to non-pharmacologic medically supervised weight loss (NP-MSWL) or glucagon-like peptide-1 receptor agonist monotherapy (Mono-GLP-1) alone.

Subjects/methods

This retrospective study analyzed 113 patients with BMI ≥ 70 kg/m² at a single metabolic disease treatment institute.

Interventions/methods

Patients were categorized into NP-MSWL (n = 13), Mono-GLP-1 (n = 54), and mmAOM (n = 46) groups. The primary outcome was mean percent total body weight loss (%TBWL). Secondary outcomes included %TBWL across time intervals (0–23, 23–51, 51–88, and 88+ weeks).

Results

The mmAOM group achieved the highest average - 13.07% - and median (9.93% [5.57–14.29]) %TBWL; followed by Mono-GLP-1 (5.58% [0.98–10.19]); and NP-MSWL (5% [2.97–7.02]). Significant differences among groups were confirmed by Kruskal-Wallis test (p = 0.0047). The highest median %TBWL was at 51–88 weeks (10.25 [6.49–16.45]) (p = 0.0093).

Conclusions

mmAOM treatment yields the highest %TBWL, especially within the first 51 weeks of preoperative preparation, demonstrating superior efficacy over Mono-GLP-1 and NP-MSWL in patients with BMI ≥ 70 kg/m². These findings suggest that incorporating mmAOM in preoperative protocols could optimize weight loss and improve surgical outcomes for high BMI patients.