Multi-modal neo-adjuvant anti-obesity medications may be more effective than medically supervised weight loss or GLP-1 therapy alone in preparing BMI≥70 patients for metabolic surgery.

Abstract

Optimizing patients with a body mass index (BMI) ≥ 70 kg/m² for metabolic surgery (MS) is challenging. However, pre-operative weight loss may be important for improving the safety of MS for these high-risk patients. Multi-modal anti-obesity medications (mmAOM) may enhance preoperative weight loss compared to non-pharmacologic medically supervised weight loss (NP-MSWL) or glucagon-like peptide-1 receptor agonist monotherapy (Mono-GLP-1) alone. This retrospective study analyzed 113 patients with BMI ≥ 70 kg/m² at a single metabolic disease treatment institute. Patients were categorized into NP-MSWL (n = 13), Mono-GLP-1 (n = 54), and mmAOM (n = 46) groups. The primary outcome was mean percent total body weight loss (%TBWL). Secondary outcomes included %TBWL across time intervals (0-23, 23-51, 51-88, and 88+ weeks). The mmAOM group achieved the highest average - 13.07% - and median (9.93% [5.57-14.29]) %TBWL; followed by Mono-GLP-1 (5.58% [0.98-10.19]); and NP-MSWL (5% [2.97-7.02]). Significant differences among groups were confirmed by Kruskal-Wallis test (p = 0.0047). The highest median %TBWL was at 51-88 weeks (10.25 [6.49-16.45]) (p = 0.0093). mmAOM treatment yields the highest %TBWL, especially within the first 51 weeks of preoperative preparation, demonstrating superior efficacy over Mono-GLP-1 and NP-MSWL in patients with BMI ≥ 70 kg/m². These findings suggest that incorporating mmAOM in preoperative protocols could optimize weight loss and improve surgical outcomes for high BMI patients.