Background

Glucagon-like-peptide-1 receptor agonists (GLP1RA) can induce weight loss, however, there is little data on their use prior to bariatric surgery and whether variation exists.

Methods

Using a state-wide bariatric specific data registry, we identified all patients who were prescribed a GLP1RA and underwent bariatric surgery between 2015 and 2022 (n=1,247). We compared preoperative total body weight loss (TBWL%) between patients who used a GLP1RA preoperatively to a matched cohort who did not. In addition, we compared patient characteristics among GLP1RA users who were in the top and bottom tercile for preoperative TBWL%.

Results

Among GLP1RA users, the mean age was 49.6 years and mean body mass index (BMI) was 47.0 kg/m2. Patients were more likely to be female (72.0%), Caucasian (67.3%) and undergo sleeve gastrectomy (72.7%). Mean TBWL% prior to surgery was similar between GLP1RA users and non-users (3.7% vs. 3.5%, p=0.0687) over similar time frames (48.3 days vs. 53.9 days, p=0.5621). GLP1RA patients who were in the top tercile for preoperative weight loss (8.8% TBWL) were more likely to have a higher preoperative body mass index BMI (48.8 kg/m2 vs. 45.4 kg/m2, p<0.0001) and less likely to be insulin dependent (29.4% vs. 37.2%, p=0.0188) when compared to patients in the lowest tercile (-2.3% TBWL).

Conclusions

GLP1RA use prior to surgery yielded similar weight loss when compared to a matched cohort. However, variation in preoperative weight loss among GLP1RA users exists, with maximal weight loss occurring among patients with a higher preoperative BMI and lower diabetes severity.