Significant increase of weight loss drugs before bariatric surgery

There has been a 16-fold increase in the use of weight loss drugs among patients before metabolic and bariatric surgery, signalling an evolution in the management of obesity and type 2 diabetes, according to presentation, ‘Preoperative Glucagon-Like Peptide-1 Receptor Agonist Utilization Has Surged Among Bariatric Surgery Patients’, at the American College of Surgeons (ACS) Clinical Congress 2025.

"There's no one-size-fits-all approach to treating obesity, metabolic syndrome, or diabetes and its related conditions," said Dr Patrick J Sweigert, senior author of the study and a bariatric and foregut surgeon at The Ohio State University Wexner Medical Center in Columbus, OH. "We're entering a new world of multidisciplinary care pathways and a new frontier of weight management that is important for patients and surgeons to think about."

The research team performed a cross-sectional study looking at glucagon-like peptide-1 receptor agonists (GLP-1s) semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) among patients undergoing metabolic and bariatric surgery. Sweigert and colleagues analysed nearly 365,000 patients who underwent primary metabolic and bariatric surgery between 2018 and 2024. They used the Epic Cosmos database, which includes more than 300 million patient records from institutions across the country, to examine prescription patterns for semaglutide and tirzepatide.

The preliminary findings indicate the proportion of patients receiving at least one GLP-1 prescription in the year leading up to surgery increased from 1.8% in the first quarter of 2020 to 29.4% in the fourth quarter of 2024, a 16-fold rise. Use surged across patients with and without diabetes, underscoring the expanding role of these medications in obesity treatment, independent of diabetes status.

Among patients without type 2 diabetes, preoperative GLP-1 use rose 11-fold over the past three years from 2.1% in the first quarter of 2022 to 23.2% in the fourth quarter of 2024. By comparison, use among patients with type 2 diabetes increased four-fold, from 11.3% to 45.2% over the same period.

The median age of patients was 43 years, the median preoperative body mass index (BMI) of these patients was 46. Women made up 80% of the sample and 33% had a diagnosis of type 2 diabetes.

"While patients previously believed they had to choose between GLP-1 receptor agonists and surgery, we're now seeing that people are using both," said lead author, Dr Stefanie C Rohde, a general surgery resident at The Ohio State University Wexner Medical Center. "We know that patients can use GLP-1s after bariatric surgery to amplify their weight loss. But all of this is still very new in terms of how to manage patients effectively."

Going forward, she added, real-world data such as that from Epic Cosmos can support the development of evidence-based guidelines for when to start, combine, or transition between treatment approaches, whether before surgery or during the postoperative period.

The investigators acknowledged limitations in their analysis, including potential inaccuracies in health record data and uncertainty about whether patients filled or took their prescribed medications.