A recent study by researchers at Mass General Brigham has found that taking semaglutide before undergoing bariatric surgery does not enhance overall weight loss or improve safety outcomes. The findings suggest that opting for surgery first may lead to better results for patients seeking obesity treatment.
The research, published in JAMA Surgery, offers valuable insights for patients and healthcare providers weighing the choice between medical and surgical weight-loss strategies. Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA) marketed as Ozempic and Wegovy, has gained widespread recognition for its role in weight management. However, this study challenges the assumption that taking the medication before surgery provides additional benefits.
The study examined 350 patients, including 182 who received semaglutide prior to undergoing bariatric surgery. These patients were retrospectively matched with counterparts who had similar health profiles but proceeded directly to surgery without prior medication use. Researchers analyzed weight loss progression, health improvements, and safety outcomes across both groups.
While patients who took semaglutide before surgery exhibited greater weight loss in the first three months post-operation, those who had surgery alone quickly caught up. By the six-, nine-, and 12-month marks, total weight loss between both groups had plateaued at similar levels. Furthermore, there was no significant difference in major postoperative complications such as bleeding, leakage, infection, reoperation rates, readmissions, or surgery duration. Diabetes remission rates after one year were also comparable.
Dr. Eric G. Sheu, senior author of the study and chief of the Section of Bariatric and Foregut Surgery at Brigham and Women’s Hospital, expressed surprise at the findings. “We expected that patients who combined semaglutide with surgery would experience greater total weight loss,” Sheu noted. “However, our results indicate that starting with medication does not confer an advantage in long-term outcomes.”
Bariatric surgery remains the most effective and sustainable treatment for severe obesity and its associated risks, including heart disease, stroke, cancer, and diabetes. While previous studies suggest that semaglutide may be beneficial after weight-loss surgery to aid in further weight reduction or maintenance, its preoperative use appears to offer no additional advantage.
“Determining the optimal timing for integrating weight-loss medications and surgery is crucial,” Sheu explained. “Key questions remain, such as when patients should start and stop medication relative to surgery, and whether the type of bariatric procedure influences the drug’s effectiveness.”
The study underscores the need for prospective clinical trials to refine obesity treatment protocols. As researchers continue to explore the most effective sequencing of medical and surgical interventions, the findings suggest that the order in which treatments are applied may significantly impact their success.
“Weight-loss strategies may not follow a simple additive formula,” Sheu concluded. “Understanding the right order of interventions could be the key to maximizing patient outcomes.”
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