Recent research indicates a remarkable increase in the use of weight loss medications among individuals undergoing metabolic and bariatric surgery. This trend represents a significant shift in managing obesity and Type 2 diabetes.
The findings are set to be presented at the American College of Surgeons (ACS) Clinical Congress 2025 in Chicago from October 4-7.
“There’s no universal solution for obesity, metabolic syndrome, or diabetes,” said Patrick J. Sweigert, MD, senior author of the study and bariatric and foregut surgeon at The Ohio State University Wexner Medical Center. “We are entering a new era of multidisciplinary care and weight management, which patients and surgeons must consider carefully.”
Study Overview: GLP-1 Prescriptions Before Surgery
The research team conducted a cross-sectional analysis examining the use of glucagon-like peptide-1 receptor agonists (GLP-1s), including semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro), in patients preparing for metabolic and bariatric surgery.
Nearly 365,000 patients who underwent primary bariatric surgery from 2018 to 2024 were analyzed using the Epic Cosmos database, which contains over 300 million patient records nationwide. Prescription patterns for these two medications, some of the newest GLP-1 therapies, were carefully studied.
Key Findings: Rapid Uptick in GLP-1 Use
Preoperative prescriptions: The proportion of patients receiving at least one GLP-1 prescription in the year before surgery rose from 1.8% in Q1 2020 to 29.4% in Q4 2024, a sixteenfold increase.
Impact on non-diabetic patients: GLP-1 use among patients without Type 2 diabetes increased elevenfold over three years, from 2.1% in Q1 2022 to 23.2% in Q4 2024.
Impact on diabetic patients: Among patients with Type 2 diabetes, use increased fourfold, from 11.3% to 45.2% during the same period.
Patient demographics: Median age was 43 years, median preoperative BMI 46, with 80% women and 33% diagnosed with Type 2 diabetes.
Changing Perceptions of Treatment
Stefanie C. Rohde, MD, lead author and general surgery resident at The Ohio State University Wexner Medical Center, emphasized the shift in patient perspectives:
“Patients no longer feel they must choose between GLP-1 therapies and surgery. Many are now combining both approaches. GLP-1s can enhance post-surgery weight loss, but optimal management strategies are still evolving.”
Dr. Rohde noted that real-world data from sources like Epic Cosmos could guide evidence-based guidelines on when to initiate, combine, or transition treatments before or after surgery.
Study Limitations and Considerations
The researchers highlighted potential limitations, such as inaccuracies in health records and uncertainty regarding whether patients actually filled or adhered to their prescriptions.
