Multi-modal neo-adjuvant anti-obesity medications may be more effective than medically supervised weight loss or GLP-1 therapy alone in preparing BMI≥70 patients for metabolic surgery

Figures

• 

  Fig. 1. Percent Total Body Weight Loss (%TBWL) by Treatment Group and Treatment Length Intervals. A Box plots representing the distribution of %TBWL by treatment group: non-pharmacologic medically supervised weight loss (NP-MSWL) glucagon-like peptide-1 receptor agonist monotherapy (Mono-GLP-1) and multi-modal anti-obesity medication (mmAOM). Kruskal–Wallis test p = 0.0047 annotated p values represent post-hoc pairwise comparisons using Wilcoxon rank-sum tests. B %TBWL across four treatment length intervals: 0–23 weeks, 23–51 weeks, 51–88 weeks, and 88+ weeks. Kruskal–Wallis test p = 0.0022 annotated p values represent post-hoc pairwise comparisons using Wilcoxon rank-sum tests. In both panels boxes represent the interquartile range (IQR) horizontal black lines denote median %TBWL black squares indicate mean %TBWL and whiskers extend to the minimum and maximum values within the 95% confidence interval (CI).

• 

  Fig. 2. Interaction between treatment modality and duration on percent total body weight loss (%TBWL). Box plots illustrating percent total body weight loss (%TBWL) broken out by treatment modality and duration of treatment over four time intervals: 0–3 weeks, 23–51 weeks, 51–88 weeks, and 88+ weeks. The treatment groups include Non-Pharmacologic Medically Supervised Weight Loss (NP-MSWL), Glucagon-Like Peptide-1 Receptor Agonist Monotherapy (Mono-GLP-1), and Multi-Modal Anti-Obesity Medication (mmAOM). The boxes represent the interquartile range (IQR), the horizontal black lines denote the median %TBWL, and the black squares indicate the mean %TBWL. The whiskers extend to the minimum and maximum values within the 95% confidence interval (CI). Kruskal-Wallis test p = 0.0093; annotated p-values represent post-hoc pairwise comparisons nested by quartile length using Wilcoxon rank-sum tests.

• 

  Fig. 3. Representative patient weight and BMI trajectory with neo-adjuvant AOM and operative intervention. Figure illustrating the trajectory of a representative patient’s body weight (A) and BMI (B) over time in relation to key interventions. The timeline was centered around the first-stage operation (Sleeve Gastrectomy), marked as month 0. Body weight and BMI were optimized prior to surgery using neo-adjuvant anti-obesity medication (AOM) therapy, as indicated by the “AOMs Started” line. Post-operatively, continued weight and BMI reductions were demonstrated. The dashed vertical lines indicate significant dates for the start of AOM therapy, the first-stage operation, Sleeve Gastrectomy, and the second-stage operation, single anastomosis duodenal bypass (SADI).