The Glucagon-like Peptide-1 Receptor Agonist Era and Its Influence on Body-Contouring Referrals After Weight Loss in Appalachia

Background: Obesity remains a major public health concern in the United States, with increasing demand for body-contouring procedures following significant weight loss. Appalachia—a region characterized by limited healthcare access and a high prevalence of obesity—provides a unique setting to evaluate evolving referral patterns for post–weight-loss body contouring in the era of modern obesity pharmacotherapy. Methods: A retrospective review was conducted of patients referred for body-contouring procedures between October 2022 and November 2024 at a tertiary referral center serving Appalachia. Patients were categorized by primary method of weight loss: lifestyle modification, glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy, or bariatric surgery. Temporal trends were evaluated across 4 consecutive 6-month intervals using χ² testing and linear regression. Differences in age and body mass index were assessed using 1-way analysis of variance and Kruskal–Wallis testing. Results: A total of 134 patients met inclusion criteria. Lifestyle modification accounted for the largest proportion of referrals (n = 67, 50.0%), followed by bariatric surgery (n = 49, 36.6%) and pharmacological therapy (n = 23, 17.2%). Among pharmacological patients, semaglutide was the most commonly used GLP-1 RA (78.3%), whereas sleeve gastrectomy represented the most frequent bariatric procedure (73.5%). Although age and body mass index differences between groups were not statistically significant, patients using pharmacotherapy tended to be older. Referral volumes increased across all pathways, with a positive but nonsignificant trend toward GLP-1–associated referrals (slope = +2.7 patients per interval; R ² = 0.75; P = 0.14). Conclusions: Lifestyle modification remains the predominant referral pathway for post–weight-loss body contouring in Appalachia. However, referrals associated with GLP-1 RA therapy are increasing and may soon rival traditional sources, reflecting evolving strategies in obesity management.