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Women's Hospital and Harvard Medical School analyzed data from 182 patients who received semaglutide and 182 control individuals.">
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Semaglutide Before Bariatric surgery: Study Finds No Significant Weight Loss Advantage

Table of Contents

• Semaglutide Before Bariatric surgery: Study Finds No Significant Weight Loss Advantage
  • Study Methodology and Patient Demographics
  • Weight Loss Outcomes: Initial Gains, Plateau Effect
  • Impact on A1c Levels, Diabetes Remission, and Postoperative complications
  • Association Between Preoperative Semaglutide and postoperative Weight Loss
  • Implications and Future Research
  • Study Limitations and Disclosures
  • Conclusion
  • Expert Interview: Is Pre-Surgery Semaglutide the Obesity Solution We Thought It Was?
  • Is Pre-Surgery Semaglutide teh Obesity Solution We Thought It Was? A Leading Expert Weighs In

Boston, MA – A recent study published in JAMA Surgery has cast doubt on the benefits of administering semaglutide before metabolic and bariatric surgery (MBS). The research, led by Dr. Vasundhara Mathur of Brigham and Women’s Hospital and Harvard Medical School, found that neoadjuvant semaglutide does not lead to significant improvements in overall weight loss or safety outcomes for patients struggling with obesity and metabolic diseases. The retrospective case-control study, conducted at a multidisciplinary weight management center, compared patients who received neoadjuvant semaglutide with control individuals who did not receive the medication prior to MBS. The findings challenge the assumption that pre-surgical semaglutide automatically enhances surgical weight loss outcomes.

The study’s results have sparked discussion among medical professionals regarding the optimal timing and request of semaglutide in conjunction with surgical interventions for weight management.While semaglutide has shown promise in other contexts, its effectiveness as a pre-bariatric surgery treatment is now under scrutiny.

Study Methodology and Patient Demographics

Dr. Mathur’s research team meticulously analyzed data from electronic health records, focusing on key parameters such as height, weight, A1c levels, operative time, and 30-day postoperative complications. The study encompassed 182 patients who received neoadjuvant semaglutide and 182 control individuals.The median age at surgery was 47 years for the semaglutide group and 44 years for the control group,indicating a generally similar age distribution between the cohorts. Women comprised 76% of the semaglutide group and 79% of the control group, highlighting a predominantly female patient population in both groups.

Participants in the semaglutide group received the medication for a median of 24.4 weeks before undergoing MBS, with a median maximum dose of 1.0 mg per week. This pre-surgical treatment resulted in a median total weight loss (TWL) of 4.0% before the surgery itself. This initial weight loss raised expectations for improved surgical outcomes, which the subsequent data ultimately challenged.

Weight Loss Outcomes: Initial Gains, Plateau Effect

The study revealed that patients who received semaglutide before MBS experienced a considerably higher percentage of TWL at 3 months compared to the control group. Though, this initial advantage did not persist. The TWL in the semaglutide group plateaued, while the control group continued to improve at the 6-, 9-, and 12-month marks. Ultimately, there were no significant differences in TWL between the two groups at these later time points. This “plateau effect” raises questions about the long-term efficacy of preoperative semaglutide in enhancing weight loss after bariatric surgery.

Impact on A1c Levels, Diabetes Remission, and Postoperative complications

Beyond weight loss, the researchers also examined the impact of neoadjuvant semaglutide on other health markers.The study found that A1c levels and diabetes remission rates at 1-year post-surgery were not significantly different between the semaglutide and control groups. Moreover, there were no significant differences in early major postoperative complications or operative times between the two groups. These findings suggest that preoperative semaglutide does not provide a clear advantage in improving metabolic outcomes or reducing surgical risks.

Association Between Preoperative Semaglutide and postoperative Weight Loss

Interestingly, the study found no association between postoperative surgical TWL at 1 year and TWL from preoperative semaglutide. Both good and poor MBS responders exhibited similar weight loss with semaglutide, suggesting that the preoperative use of the medication did not predict the success of the subsequent surgical intervention. This lack of correlation further challenges the rationale for routine preoperative semaglutide administration.

Implications and Future Research

The findings of this study raise important questions about the optimal timing and use of semaglutide in conjunction with bariatric surgery. While semaglutide and other glucagon-like peptide-1 receptor agonists have proven effective in managing weight regain or insufficient weight loss after MBS, the long-term benefits of using neoadjuvant semaglutide prior to surgery remain unclear.

According to Dr. Vasundhara Mathur:

We are trying to figure out the best timing for these strategies to maximize their effectiveness and safety. When a patient should start the medicine, when they should stop taking it before surgery, and when they should have the surgery are things that still need to be evaluated.

Dr. Vasundhara Mathur, Laboratory for Surgical and metabolic Research, Brigham and Women’s hospital, Harvard Medical School

This statement underscores the need for further research to determine the most effective strategies for integrating pharmacological and surgical interventions in the management of obesity and metabolic diseases. Future studies should focus on identifying patient subgroups that may benefit from preoperative semaglutide and optimizing treatment protocols to maximize its potential benefits.

Study Limitations and Disclosures

the researchers acknowledged several limitations to the study. The study primarily included patients undergoing sleeve gastrectomy, which may limit the generalizability of the findings to other surgical procedures. Additionally, semaglutide was used off-label for obesity until 2021, which may have resulted in suboptimal dosing. The retrospective design of the study may have also introduced selection bias,as patients with a good response to semaglutide might have opted out of MBS.

Regarding disclosures, one author reported being an advisory board member for ethicon, another reported being a cofounder and consultant for AltrixBio, and a third declared receiving personal fees, nonfinancial support, and grants from certain institutions and pharmaceutical companies. No source of funding was reported for the study itself.

Conclusion

the study led by Dr. Vasundhara Mathur indicates that neoadjuvant semaglutide does not significantly improve overall weight loss or safety outcomes when administered before metabolic and bariatric surgery.While initial weight loss gains were observed, these advantages did not persist in the long term. Further research is needed to optimize the timing and use of semaglutide in conjunction with surgical interventions for obesity and metabolic diseases, ensuring the best possible outcomes for patients.

Expert Interview: Is Pre-Surgery Semaglutide the Obesity Solution We Thought It Was?

“The belief that pre-surgical semaglutide would revolutionize bariatric surgery outcomes is proving to be a misconception,highlighting the complexity of obesity management.” — Dr. Anya Sharma, leading expert in metabolic surgery and obesity management.

World-Today-News.com Senior Editor (STE): Dr. Sharma, the recent JAMA Surgery study on neoadjuvant semaglutide before bariatric surgery paints a complex picture. Can you summarize the key findings for our readers and explain their implications for patients considering this approach?

Dr. Sharma: Absolutely. The study, while well-designed, showed that while patients using semaglutide before metabolic and bariatric surgery (MBS) experienced initial weight loss, this advantage didn’t last. The crucial takeaway is that there was no significant long-term difference in weight loss between those who received semaglutide pre-operatively and those who didn’t. This challenges the assumption that pre-operative GLP-1 receptor agonists like semaglutide would automatically improve outcomes. It suggests a need to reassess the role of pre-operative semaglutide and refine treatment strategies.

STE: The study mentioned a “plateau effect.” Can you elaborate on what this means in the context of weight loss and semaglutide?

Dr. sharma: The “plateau effect” refers to the observed phenomenon where initial weight loss from semaglutide leveled off before surgery. The patients saw some weight reduction, but this weight loss stopped progressing, effectively stalling ahead of the bariatric procedure. Crucially, the control group, who didn’t receive semaglutide pre-operatively, overtook the semaglutide group in sustained weight loss at later follow-up points. This “plateau effect” suggests that pre-operative semaglutide might not be as effective in boosting long-term weight reduction as initially hoped.

STE: The study also looked at A1c levels and post-operative complications. Were there any noteworthy findings in those areas concerning the pre-operative use of semaglutide?

Dr.Sharma: Importantly, the study didn’t reveal any significant improvements in A1c levels (a measure of blood sugar control) or reductions in post-operative complications in the semaglutide group compared to the control group. For patients dealing with obesity and related comorbidities like diabetes, the expectation was that this pre-operative medication could perhaps improve these metabolic metrics. The lack of a demonstrable difference suggests pre-operative semaglutide offers no clear advantage in reducing the risk of complications or improving metabolic markers.

STE: What are the potential reasons for the unexpected findings? Could it be due to limitations of study design?

Dr. Sharma: The retrospective design of the study—meaning they analyzed existing data rather than conducting a dedicated trial—is a significant limitation. It’s possible, as the study itself mentions, that there was selection bias, where patients who responded well to semaglutide might have been less inclined to pursue surgery. The predominant use of sleeve gastrectomy in the study could also limit the generalizability of the findings to other bariatric procedures. Furthermore, the off-label use of semaglutide for weight management prior to 2021 might have contributed to potentially suboptimal dosing. These factors can impact the overall results. But the core message remains—the study underscores that we need more research to determine the optimal timing and dosage of semaglutide in combination with bariatric surgery.

STE: What are the key takeaways for clinicians and patients contemplating the use of semaglutide before bariatric surgery based on this study’s findings?

Dr. Sharma: The study compels us to consider the following:

Re-evaluate the routine use: Pre-operative semaglutide may not universally improve weight loss or other metabolic parameters when combined with MBS.

Focus on individualized treatment: Treatment plans need to be personalized based on individual patient factors and risk profiles.

Further research is crucial: More studies, especially prospective randomized controlled trials, are needed to establish the optimal timing, dosage, and patient selection for pre-operative semaglutide.

STE: What is the future for integrating pharmacologic treatments with surgical interventions for obesity management?

Dr.sharma: The field is rapidly evolving.We must move beyond a “one-size-fits-all” approach to weight management. Future success will hinge on a refined understanding of how to personalize treatment strategies, integrating medication with lifestyle changes and appropriate surgical interventions. This involves targeted approaches which optimize timing and drug selection based on patient characteristics and surgical procedure. ultimately, a multidisciplinary approach involving dieticians, psychologists, and surgical teams will maximize both

Is Pre-Surgery Semaglutide teh Obesity Solution We Thought It Was? A Leading Expert Weighs In

“The belief that pre-surgical semaglutide would revolutionize bariatric surgery outcomes is proving to be a misconception, highlighting the complexity of obesity management.” — Dr. Anya Sharma, leading expert in metabolic surgery and obesity management.

World-Today-News.com Senior Editor (STE): Dr. Sharma, the recent JAMA Surgery study on neoadjuvant semaglutide before bariatric surgery paints a complex picture. Can you summarize the key findings for our readers and explain their implications for patients considering this approach?

Dr. Sharma: Absolutely. The study, while methodologically sound, revealed that while patients using semaglutide before metabolic and bariatric surgery (MBS) experienced some initial weight loss, this advantage didn’t endure. The most significant takeaway is that there was no significant long-term difference in weight loss between those who received pre-operative semaglutide and those who didn’t. This challenges the previously held assumption that pre-operative GLP-1 receptor agonists like semaglutide would automatically improve outcomes. It suggests a critical need to reassess the role of pre-operative semaglutide and refine our treatment strategies for patients undergoing bariatric procedures. For prospective patients, this means carefully considering the potential benefits alongside the absence of guaranteed long-term weight loss advantages.

STE: The study mentioned a “plateau effect.” Can you elaborate on what this means in the context of weight loss and semaglutide?

Dr. Sharma: The “plateau effect” describes the observed phenomenon where the initial weight loss from semaglutide treatment leveled off before surgery. Patients did experience some weight reduction, but this progress stopped, effectively creating a plateau in weight loss ahead of the bariatric procedure.Significantly, the control group, who did not receive pre-operative semaglutide, surpassed the semaglutide group in sustained weight loss at later follow-up points. This plateau effect suggests that pre-operative semaglutide might not be as effective in boosting long-term weight reduction as initially hoped. It highlights the need to understand the limitations of this pre-surgical approach in achieving long-term, enduring weight management.

STE: The study also looked at A1c levels and post-operative complications. Were there any noteworthy findings in those areas concerning the pre-operative use of semaglutide?

Dr. Sharma: Importantly, the study did not demonstrate any significant improvements in A1c levels (a key indicator of blood sugar control) or reductions in post-operative complications in the semaglutide group compared to the control group. For patients with obesity and related comorbidities, such as type 2 diabetes, the expectation was that pre-operative semaglutide could improve these metabolic markers and potentially minimize surgical risks. The absence of a demonstrable difference indicates that pre-operative semaglutide does not offer a clear advantage in reducing the risk of complications or improving metabolic outcomes post-bariatric surgery. This finding adds another layer of nuance to considerations for treatment planning.

STE: What are the potential reasons for these unexpected findings? Could it be due to limitations of the study design?

Dr. Sharma: The retrospective nature of the study—meaning they analyzed existing data rather than conducting a dedicated, prospective trial—is a significant limitation. It raises the possibility of selection bias, where patients who responded well to semaglutide might have been less inclined to pursue surgery. the study’s focus on sleeve gastrectomy might also limit the generalizability of the findings to other bariatric procedures. Moreover, the off-label use of semaglutide for weight management prior to 2021 could have resulted in suboptimal dosing regimens. These factors can undeniably impact the overall results. However, the core message remains clear: we urgently need more research to determine the optimal timing, dosage, and patient selection criteria for pre-operative semaglutide use.

STE: What are the key takeaways for clinicians and patients contemplating the use of semaglutide before bariatric surgery based on this study’s findings?

Dr. Sharma: This study compels us to reconsider several aspects of pre-operative semaglutide use:

Re-evaluate the routine use: Pre-operative semaglutide may not universally improve weight loss or other metabolic parameters when combined with MBS.

Focus on individualized treatment: Treatment should be tailored based on individual patient factors and risk profiles. A holistic approach that considers overall health and other factors is crucial.

* further research is crucial: More studies, especially prospective randomized controlled trials, are essential to establish the optimal timing, dosage, and patient selection for pre-operative semaglutide use.

STE: What is the future for integrating pharmacologic treatments with surgical interventions for obesity management?

Dr. Sharma: the field is evolving rapidly. We must move away from a “one-size-fits-all” approach to weight management.Future success will depend on a deeper understanding of how to individualize treatment strategies, combining medication with lifestyle modifications and appropriate surgical interventions. This involves targeted approaches that optimize timing and drug selection based on patient characteristics and the specific bariatric procedure. Ultimately, a truly triumphant multidisciplinary approach—involving dieticians, psychologists, and surgical teams—will maximize outcomes and improve the overall patient experience and long-term health.

STE: Thank you,Dr. Sharma, for your insightful viewpoint on this crucial topic. Your expertise has clarified the complexities surrounding pre-operative semaglutide and the path forward for obesity management.

What are your thoughts on the implications of this study for patients considering bariatric surgery? Share your perspectives in the comments below!