Background

Preparing the high BMI (≥70) patient for metabolic surgery (MS) is an increasingly frequent clinical challenge. Given recent improvements in obesity medical treatment, we aimed to characterize the success of preoperative weight-loss therapy. We hypothesize a multi-modal approach to anti-obesity medication (AOM) therapy will provide improved pre-operative weight-loss compared to both GLP-1 monotherapy (mono-GLP-1) and non-pharmacologic medically supervised weight-loss (NP-MSWL).

Methods

We identified all patients with BMI ≥70 who sought care at our institution and excluded those who failed to complete ≥1 follow-up visit. A total of 113 patients were analyzed. Biometric values, pharmacologic therapies, and length of treatment were extracted for analysis. Kruskal-Wallis and Dunn’s tests were utilized for statistical analysis.

Results

Length of treatment ranged from 2.7-364 weeks with an average time of 72.9 days. Mean percent total body weight-loss (%TBWL) for NP-MSWL, mono-GLP-1, and multi-modal AOM (mmAOM), were 5.95%, 8.14%, 13.1%, and respectively (p=0.005) (Figure 1.a). Mean absolute BMI reduction for NP-MSWL, mono-GLP-1, and mmAOM were 7.36, 7.51, and 9.61, respectively (p=0.09) (Figure 1.a). When broken into quartile length of therapy, both %TBWL (Figure 1.b) and absolute BMI reduction were highest for those treated for 23-51 weeks with mmAOM therapy.

Conclusions

GLP-1 agonist pharmacotherapy is more potent for pre-operative weight-loss than medically supervised weight-loss alone in patients with BMI > 70. Combining other AOM’s further increases preoperative weight-loss. AOM usage beyond 51 weeks does not yield additional preoperative weight-loss. Larger, prospective studies are needed to confirm these results and identify the best methods for multimodal treatment.