Background

Bariatric surgery is the most effective treatment option for severe obesity in adolescents. Since adolescents with lower preoperative BMI will generally have a lower postoperative weight nadir, there is clinical value in optimizing BMI preoperatively. Within our adolescent bariatric surgery program, we consider preoperative glucagon-like peptide-1 receptor (GLP-1) agonist therapy in all patients with BMI greater than 50 kg/m2. Here we report preliminary weight reduction outcomes in adolescents treated with semaglutide preoperatively.

Methods

Adolescents enrolled in our program were offered weekly-injected semaglutide during the preoperative period if their BMI exceeded 50 kg/m2. Semaglutide was titrated to a maximum dose of 1mg weekly. Weight loss and adverse event outcomes were monitored from the time of initiation of semaglutide to the time of bariatric operation, or to most current available weight if still awaiting operation.

Results

Three patients with initial BMI greater than 50 kg/m2 (mean age 18.4±1.3 years, mean BMI 62.2±4.2, normal glucose tolerance) were prescribed weekly-injected semaglutide titrated to 1mg. Mean BMI decreased by 2.1 kg/m2 while taking semaglutide for an average of 6.0 months preoperatively. Patients reported no significant medication side effects.

Conclusions

GLP-1 receptor agonists are a potentially valuable tool for reducing preoperative BMI in adolescents with severe obesity who are anticipating bariatric surgery. In this first reported case series, we demonstrate that pharmacologic obesity treatment is feasible in young patients preparing for bariatric surgery, and the combination of medical and surgical therapy has the potential to enhance outcomes in this group.