Drugs are not cutting it: Patient motivations for metabolic and bariatric surgery despite glucagon-like peptide-1 use.

Abstract

In treating obesity and related comorbidities, novel glucagon-like peptide-1 receptor agonists have risen in popularity. Among patients with glucagon-like peptide-1 receptor agonist exposure, there is a subset that opts to undergo metabolic and bariatric surgery. We aimed to understand patient motivations to transition to metabolic and bariatric surgery following glucagon-like peptide-1 receptor agonist utilization. This was a qualitative single-institution study that recruited adult patients planning to undergo primary metabolic and bariatric surgery with prior or current use of novel glucagon-like peptide-1 receptor agonists. Semistructured interviews were conducted to elucidate factors that impacted patient decision-making to pursue metabolic and bariatric surgery. A comprehensive codebook was continually developed, and interview data were analyzed using conventional content analysis. Fourteen patients with a history of glucagon-like peptide-1 receptor agonist use were recruited prior to undergoing primary metabolic and bariatric surgery and underwent semistructured interviews. Six themes emerged from the interview data: preference for a long-term, durable treatment option; desire to reduce comorbidities and health risks; adverse aspects of prior treatment modalities; barriers to treatment access; social influences; and differences in health care support systems. Despite the efficacy and growing appeal of glucagon-like peptide-1 receptor agonists, some patients with obesity continue to opt for metabolic and bariatric surgery because of multifactorial considerations. The themes identified in this study suggest that this is driven by a complex interplay of the perceived durability of surgery, limitations and adverse aspects of glucagon-like peptide-1 receptor agonists, access and insurance constraints, as well as the desire for a robust, comprehensive improvement in health. These findings underscore the patient-centered benefits of discussing multimodal therapies, including metabolic and bariatric surgery, among patients taking glucagon-like peptide-1 receptor agonists.