A groundbreaking new study led by researchers at the Johns Hopkins Bloomberg School of Public Health reveals a significant shift in the management of obesity following bariatric surgery, as a rising number of patients turn to glucagon-like peptide-1 (GLP-1) receptor agonist drugs to augment their weight loss journey. The comprehensive analysis of over 112,000 individuals who underwent bariatric surgery from 2015 to 2023 unveils a clear trend: 14% of these patients started using GLP-1 medications such as semaglutide (Wegovy) or tirzepatide (Zepbound) within a decade after their procedures. This observation marks a notable evolution in post-surgical care, aligning with the increasing availability and potency of GLP-1 therapies.
Bariatric surgery has long been recognized as one of the most effective interventions for severe obesity. These surgical procedures, including sleeve gastrectomy and Roux-en-Y gastric bypass, operate mainly by physically reducing stomach capacity, thereby limiting caloric intake. Patients typically experience a substantial weight reduction, averaging between 25% and 33% of their preoperative weight. Despite this success, a substantial minority—estimated between 20% and 30%—fail to achieve adequate or sustained weight loss. This patient subset often faces persistent obesity-related health challenges, including type 2 diabetes and cardiovascular disease, underscoring the need for adjunctive therapies.
Emerging GLP-1 receptor agonists represent a transformative class of medications originally developed for type 2 diabetes management but later approved for obesity treatment. These drugs mimic the incretin hormone GLP-1, which enhances insulin secretion, suppresses glucagon release, slows gastric emptying, and promotes satiety via central nervous system pathways. Semaglutide and tirzepatide have demonstrated remarkable efficacy in clinical trials, inducing significant weight loss and metabolic improvements in patients with obesity, including those who have undergone bariatric surgery.
The researchers utilized the TriNetX database, a vast repository of de-identified electronic health records managed by a health care technology firm, to track medication initiation post-bariatric surgery over an extended follow-up period of up to ten years. Patients included in the study had not used GLP-1 drugs in the year prior to surgery, ensuring the analysis focused on new adopters of this pharmacotherapy. Findings revealed that the uptake of GLP-1 drugs rose steadily over the study interval, correlating with the introduction of newer, more potent agents.
Diving deeper into patient demographics and clinical characteristics, the study revealed several predictive factors for GLP-1 drug use after surgery. Female patients were 61% more likely than males to commence GLP-1 therapy postoperatively, potentially reflecting gender differences in healthcare utilization or weight loss trajectories. Additionally, Black patients showed a 27% higher likelihood of using these drugs compared to white patients, highlighting possible disparities in treatment approaches or disease burden.
The type of bariatric surgery performed also influenced GLP-1 drug use frequency. Patients who underwent sleeve gastrectomy were 42% more prone to initiate GLP-1 treatment than those who had Roux-en-Y gastric bypass. This variation may relate to differing efficacy and weight loss profiles between surgical modalities, with sleeve gastrectomy sometimes associated with comparatively less dramatic or durable results.
Beyond demographic factors, preoperative clinical profiles played a significant role. Individuals with severe obesity (classified by BMI) were increasingly likely to start GLP-1 therapy. Compared with overweight patients (BMI 25–29.9), those with class 1 obesity had a 73% greater chance of drug initiation; this likelihood rose to 119% for class 2 and 169% for class 3 obesity, the most severe category (BMI ≥ 40). The presence of type 2 diabetes prior to surgery further elevated GLP-1 use rates by 34%.
This intersection of severe obesity, metabolic comorbidities, and surgical intervention underscores the complexity of long-term obesity management. GLP-1 receptor agonists appear to fill a critical therapeutic niche, addressing residual weight and glycemic control challenges where surgery alone falls short. Their mechanisms of action complement the anatomical alterations induced by bariatric surgery, collectively enhancing satiety signaling and metabolic homeostasis.
However, the study’s results prompt important clinical questions, particularly regarding optimal treatment timing and thresholds. What postoperative weight benchmarks should trigger consideration of GLP-1 therapy? Would earlier combined utilization of surgery and medication yield better long-term outcomes than sequential approaches? These inquiries remain open, emphasizing the need for prospective trials to elucidate best practices.
The implications extend beyond individual patient care into the broader landscape of obesity treatment paradigms. Dr. Hemalkumar Mehta, the study’s senior author, suggests that the future of managing severe obesity may move away from either-or choices toward integrated multimodal strategies. Instead of relying solely on surgical or pharmacological options, patients might increasingly benefit from tailored combinations that leverage the strengths of both modalities.
This evolving model aligns with rising obesity prevalence—currently an estimated 40% among U.S. adults—and the attendant public health burden of related diseases such as cardiovascular disease, cancer, and diabetes. The routine incorporation of GLP-1 drugs post-bariatric surgery exemplifies precision medicine tailored to patients’ dynamic clinical trajectories, offering renewed hope for sustained weight management and improved quality of life.
As the use of GLP-1 medications in surgical populations increases, it also poses new challenges for healthcare systems, including considerations around medication accessibility, cost, and long-term safety monitoring. While GLP-1 receptor agonists have demonstrated a strong safety profile in controlled settings, real-world data—especially in combination with anatomical changes from surgery—will be crucial to inform guidelines and reimbursement policies.
This study, published August 27 in the prestigious journal JAMA Surgery, was co-authored by experts from the Bloomberg School of Public Health, including Minji Kim, Michael Schweitzer, Ji Soo Kim, and G. Caleb Alexander alongside Dr. Mehta. Supported by the National Institute on Aging, the research sets a cornerstone for future investigations into integrated obesity therapies, highlighting a new era where surgical and pharmaceutical interventions increasingly converge.
As the obesity epidemic persists globally, the insights from this large-scale, electronic health record–based analysis provide a roadmap for clinicians and policymakers aiming to optimize treatment algorithms. The combined use of bariatric surgery and GLP-1 receptor agonists not only expands therapeutic options but also redefines the scope and expectations of obesity management in the 21st century.
Subject of Research: Use of GLP-1 receptor agonists among bariatric surgery patients in the United States
Article Title: Use of Glucagon-like Peptide 1 Agonists Among Individuals Undergoing Bariatric Surgery in the U.S.
News Publication Date: August 27
Web References: JAMA Surgery Study Link
References: Mehta H. et al., JAMA Surgery, 2024
Keywords: Obesity, Bariatric Surgery, GLP-1 Receptor Agonists, Semaglutide, Tirzepatide, Weight Loss, Metabolic Disorders
