Background

Glucagon-like peptide 1(GLP-1) agonists have been shown to have a significant weight loss effect in diabetic and nondiabetic patients. Setmelanotide, a melanocortin‐4 receptor agonist, helps treatment of obesity in patients with Bardet‐Biedl Syndrome (BBS). This study describes outcomes of a university-based bariatric program in use of anti-obesity medications (AOM) before and after bariatric surgery.

Methods

All patients referred to the University of Oklahoma bariatric program (July 2020 to November 2022) underwent a multidisciplinary evaluation. They were optimized preoperatively including pharmacotherapy for weight loss. Patients with BMI>45 kg/m2 were optimized with GLP-1 agonist if covered by insurance and this was continued after surgery until weight loss goals achieved. Genetic testing was performed in patients with childhood obesity, family history of obesity, and those with poor weight loss before surgery. Setmelanotide was used in patients with BBS in preoperative and postoperative period(Figure). Outcomes and complications of medical and surgical treatment were measured.

Results

Out of 792 patients with obesity(297 patients in bariatric program), 192(24.2%) underwent genetic testing. 32 (16.7%) patients were diagnosed with BBS and Setmelanotide was prescribed. 10 patients were approved by payors and received Setmelanotide (not tolerated in one patient) with significant improvement in weight loss. 69 (36.5%) Surgical patients on GLP-1 agonists had a higher weight loss both before and after surgery. All patients with 12-month follow-up achieved excess weight loss >50%.

Conclusions

A combination multidisciplinary approach including GLP-1 agonist medication and genetic testing for targeted therapy can optimize patients for bariatric surgery and enhance postoperative weight loss.