Using obesity-management medications prior to bariatric surgery: Does it lead to better outcomes?

Objective The influence of preoperative weight loss (preWL) on outcomes following metabolic/bariatric surgery (MBS) remains a topic of ongoing discussion. This study aimed to evaluate the impact of preWL on weight loss outcomes after MBS. Methods A retrospective analysis was conducted on 123 consecutive patients who underwent primary MBS. Postoperative weight loss (postWL) was calculated using the weight at the time of surgery, while overall weight loss (OWL) was based on the highest weight within 3 months prior to MBS or before starting pharmacotherapy. Maximal overall weight loss (MWL) was evaluated in 100 patients who reached their nadir weight during the follow-up period. Results Thirty-nine patients (31.7 %) received pharmacotherapy to facilitate weight loss before surgery. The median duration of pharmacotherapy was 49.5 days, resulting in a loss of 4.1 ± 5.4 % of their initial body weight, which was significantly greater than the 0.3 ± 2.7 % observed in patients not receiving pharmacotherapy (p < 0.001). In patients with preWL ≥5 %, postWL appeared less favorable in the early postoperative phase; however, OWL was significantly higher compared to those with preWL <5 % up to 9 months after surgery. The MWL at nadir weight was 25.6 ± 7.9 % and exhibited a positive correlation with the Roux-en-Y gastric bypass procedure, preWL(%), and younger age. A suboptimal weight loss response (MWL <20 %) was associated with preWL <5 % and male sex. Conclusion Pharmacotherapy before MBS facilitated preWL. Increased preWL was associated with enhanced MWL following MBS, and preWL ≥5 % reduced the likelihood of suboptimal weight loss responses.