One in seven MBS patients use GLP-1s

An increasing proportion of patients who undergo metabolic and bariatric surgery MBS start taking glucagon-like 1 peptide receptor agonist (GLP-1) weight-loss drugs in the years after their surgery, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

“These findings make clear that GLP-1 drug therapy after bariatric surgery is increasingly common,” said study senior author, Dr Hemalkumar Mehta, an associate professor in the Bloomberg School’s Department of Epidemiology. “This suggests that we need to learn more about how to optimise this combination of treatments for patients.”

The researchers analysed de-identified national electronic health records covering 112,858 individuals who underwent bariatric surgery from January 2015 to May 2023. They found that 14% of those patients used a GLP-1 such as semaglutide (Wegovy) or tirzepatide (Zepbound) during a follow-up period of up to ten years after surgery.

Severe obesity or related conditions such as type 2 diabetes pre-surgery was associated with the outcome, as was being female and a sleeve gastrectomy. Individuals with lower post-operative weight loss were more likely to use GLP-1.

In the study, the researchers evaluated a large electronic health records database kept by a health care technology company called TriNetX. Their primary analysis focused on 112,858 American adult patients in the database who underwent one sleeve gastrectomy or Roux-en-Y gastric bypass during the period from January 2015 through May 2025 and did not use GLP-1s for the year before surgery, and met other inclusion criteria.

In follow-up periods that lasted for at least two and up to ten years, a total of 15,749 patients (14%) began using GLP-1s. About 21% of the latter began using the drugs within two years of surgery, and about 53% within four years.

The study found that, after holding other factors constant, female bariatric-surgery patients were about 61% more likely to use GLP-1 drugs compared to male patients, Black patients 27% more likely than white patients, sleeve gastrectomy patients 42% more likely than Roux-en-Y patients, and type 2 diabetes patients 34% more likely than non-diabetic patients.

The researchers also found that greater pre-operative weight was associated with higher chance of GLP-1 use. Analysing obesity classification based on body mass index (BMI), the researchers found that compared to overweight patients (BMI between 25 and 29.9), the chances of GLP-1 use were 1.73 times higher among class 1 obesity patients (BMI between 30 and 34.9), 2.19 times higher among class 2 obesity patients (BMI between 35 and 39.9), and 2.69 times higher among patients with class 3 obesity (BMI 40 or higher).

“These findings raise important questions for future obesity research,” added Mehta. “For example, what is the optimal clinical threshold for prescribing a GLP-1 in terms of timing and the patient’s relative weight after bariatric surgery?”

To Mehta and his colleagues, the substantial frequency of bariatric surgery plus drug therapy suggests this surgery-plus-drug combination has become routine for some patients and is by now well studied.

“We think in the future, obesity treatment will follow that paradigm for some patients,” he says. “People won’t just use surgery or GLP-1s, they’ll often use both.”

The findings were reported in the paper, 'Use of Glucagon-like Peptide 1 Agonists Among Individuals Undergoing Bariatric Surgery in the US', published in JAMA Surgery. To access this paper, please click here