Using weight loss drugs beforehand can help

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Researchers say drugs such as Ozempic can improve the outcomes of bariatric surgery. NurPhoto/Getty Images
  • Researchers report that people who lose weight prior to bariatric surgery reduce their risk of complications.
  • They said the people with a body mass index of more than 70 before their surgery are at the greatest risk for complications.
  • They said that losing weight before bariatric surgery can “jump start” weight loss.

People with extreme obesity who are considering bariatric surgery may benefit from losing weight with a combination of GLP-1 agonist medications such as Ozempic before their procedure.

That’s according to research presented at the American Society for Metabolic and Bariatric Surgery’s 2024 annual scientific meeting.

The study, which hasn’t been published yet in a peer-reviewed journal, included 113 participants with more than 70 of them attempting to lose weight before bariatric surgery through various ways.

Those methods included:

  • Medically supervised diet and exercise
  • Single GLP-1 medication (semaglutide was used most often)
  • Multimodal therapy that included more than one GLP-1

The researchers reported that those on multiple medications for between 6 months and 12 months had the most significant weight loss, losing an average of 13% of body weight.

Participants taking a single GLP-1 had the second most weight loss (8%), and those using diet and exercise had the least (6%).

“I do agree and prefer patients lower their BMI [body mass index] to be in the 50s before surgery,” said Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California. “We can’t always use GLPs as they aren’t always covered by insurance and they can be too expensive without the insurance.

“In those cases, we have the patient work with a diet counselor,” Ali, who wasn’t involved in the study, told Medical News Today. “Sometimes, we recommend a liquid diet. Losing weight before surgery can be quite helpful. It can provide a jump start to weight loss that continues after the surgery.”

“Overall, metabolic surgery is safe – safer than gall bladder surgery, which is considered safe and routine,” Ali added.

Researchers said that weight loss before bariatric surgery can lower the risk of complications. The scientists indicated that people with a BMI higher than 70 had the greatest risk of complications. Lifestyle or first-generation medications hadn’t significantly lowered potential complications.

“Combining anti-obesity medications may achieve much greater pre-surgery weight loss than other methods for those with extreme obesity,” said Dr. Phil Schauer, the director of the Metamor Metabolic Institute at Pennington Biomedical in Louisiana, said in a press release. “Many patients who would otherwise be considered ‘too sick for surgery’ may now qualify.”

Body mass index (BMI) is a ratio of a person’s height to weight that can help estimate body fat.

A normal BMI is between 18.5 and 24.9. Between 25 and 29.9 is considered overweight. A BMI of 30 and above is considered having obesity.

BMI does not account for age, gender, or ethnicity. It also does consider muscle mass. According to Yale Medicine, someone with a high level of muscle and very little fat can have the same BMI as a person with obesity. An athlete or someone who is active can show up in the overweight or obese range when measuring only BMI.

Medical professionals using BMI as an overweight/obesity indicator should take into consideration factors such as different ethnicities before using it. The World Health Organization (WHO) issued guidance for using BMI for Asian populations. For example, people in this population with a high risk for type 2 diabetes and cardiovascular disease show the risk at a substantially lower BMI than white European populations.

BMI should be used in conjunction with other risk measurements, such as visceral fat, body adiposity, body composition, genetic factors, and metabolic factors, according to Yale Medicine.

In 2022, there were nearly 280,000 metabolic and bariatric surgeries in the United States. This was only about 1% of those who met eligibility for the surgery based on their BMI.

Obesity affects about 42% of adults in the United States, according to the Centers for Disease Control and Prevention. Excess weight can potentially weaken or impair the immune system and increase chronic inflammation. People with obesity are more at risk of developing cardiovascular disease, stroke, type 2 diabetes, and some cancers.

“More studies are needed to determine the optimal role of GLP-1s before and after metabolic and bariatric surgery among different patient groups,” Dr. Marina Kurian, ASMBS president and a clinical professor in the Department of Surgery, Division of Bariatric Surgery at the NYU Grossman School of Medicine in New York who was not involved in the study, said in a press release. “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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