Interest in Treatment with GLP-1 Receptor Agonists for the Management of Insufficient Weight Loss or Weight Regain After Bariatric Surgery.

Background: Bariatric surgery (BS) is the most effective treatment for severe obesity, but a significant proportion of patients experience insufficient weight loss (IWL) or weight regain. Glucagon-like peptide-1 receptor agonists (arGLP-1) have emerged as a promising adjunctive therapy for managing these suboptimal outcomes. This study evaluates the efficacy and safety of arGLP-1 in patients with IWL or WR after BS.

Methods: A retrospective analysis was conducted on 100 patients who underwent BS (96 sleeve gastrectomy, 4 gastric bypass) and received arGLP-1 therapy (semaglutide or dulaglutide) for IWL (defined as < 50% excess weight loss (EWL) from baseline), and WR (a ≥ 10 kg increase from the nadir weight post-surgery). Data on weight loss, comorbidities, and adverse events were collected over a median follow-up of 1 year. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and chi-squared tests.

Results: At 1 year, patients achieved significant weight loss with a median total weight loss (%TWL) of 25.5% and a median excess weight loss (%EWL) of 66.3% compared to 16.6% and 40.8%, respectively, at treatment initiation with BMI reduction of 3.7 kg/m. Significant improvements were observed in comorbidities, including reductions in obstructive sleep apnea (- 30%), hypertension (- 40%), and arthralgia (- 56.5%). Glycated hemoglobin levels decreased by 0.8 points. Treatment was well-tolerated, with nausea being the most common side effect (5% discontinuation rate).

Conclusion: arGLP-1 are effective and safe for managing IWL or WR after BS, leading to significant weight loss, comorbidity improvement, and sustained %TWL. These findings support their use as a valuable adjunctive obesity management medication (OMMs) in post-bariatric care, though long-term adherence and cost-effectiveness require further investigation.