Can taking semaglutide before bariatric surgery boost weight loss? Here's what scientists found

People who struggle to lose weight naturally through diet and exercise often opt for weight-loss drugs or bariatric surgery. When consulting a medical practitioner, such individuals often struggle to decide whether to try weight loss medications or surgery first. A new study from Mass General Brigham may have found an answer that could give further clarity on the issue.

There are also patients who chose to take semaglutide before having weight loss surgery, hoping that it could lead to better outcomes. But is it true? To understand this, the researchers studied if taking semaglutide, one of the new glucagon-like peptide-1 agonist (GLP-1 RAs) drugs, also known as Ozempic and Wegovy, before bariatric surgery could help patients with obesity and metabolic disease lose weight. Contrary to popular belief, a retrospective analysis of 350 patients found that using semaglutide prior to the surgery did not lead to better overall weight loss. The findings, published in JAMA Surgery, suggest that going for surgery first may lead to better overall obesity treatment outcomes for patients, rather than the other way around.

“Many people are familiar with the new GLP-1 medicines that are available. These drugs are good options for patients to consider, and they can be used in combination with surgery. You might expect patients to lose more weight if they take medication prior to surgery. However, we were surprised to find that the group of patients who went on medicines first and then had surgery had the same combined total weight loss. This contrasts with previous studies that have found that taking semaglutide after surgery can further help patients lose weight,” Eric G. Sheu, MD, PhD, of the Laboratory for Surgical and Metabolic Research, chief of the Section of Bariatric and Foregut Surgery at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system and the senior author said in a statement. Bariatric surgery is often considered the most effective and durable treatment for weight loss and also reduces the risk of death from heart disease, stroke, cancer, and diabetes.

Previous studies have suggested that taking semaglutide after the surgery may help lose more weight or maintain weight, however, more research is required to confirm it. The result of taking semaglutide prior to the surgery was unknown until now.

“We are trying to figure out the best timing for these strategies to maximize their effectiveness and safety. When a patient should start the medicine when they should stop taking it before surgery, and when they should have the surgery are things that still need to be evaluated,” Sheu said. “We also need to understand if the type of bariatric surgery matters for how patients respond to the medicines. We will need to conduct more research to answer the remaining questions, but there's at least a suggestion that the most effective weight loss strategy isn’t as simple as 1 + 1 = 2,” Sheu said. “The order of strategies may be key.”
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