Impact of glucagon-like peptide-1 receptor agonist or glucagon-like peptide-1 receptor agonist/glucose-dependent insulinotropic polypeptide receptor agonists after bariatric surgery in the veteran population

Background Obesity is a progressive chronic disease that increases the risk of metabolic complications. Bariatric surgery is recommended alongside comprehensive lifestyle interventions for patients with a body mass index (BMI) of > 40 kg/m 2 , BMI of > 35 kg/m 2 with obesity-related comorbidities, or BMI of > 30 kg/m 2 with a history of type 2 diabetes mellitus (T2DM). Bariatric procedures result in weight loss and improved metabolic outcomes, although weight regain can occur after surgery. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and GLP-1 RA/glucose-dependent insulinotropic polypeptide receptor agonists (GIP RAs) have emerged as effective injectable therapies for weight loss and management of obesity-related comorbidities. Objective This project evaluated the efficacy and tolerability of GLP-1 RA and GLP-1 RA/GIP RA therapy after bariatric surgery. Methods This single-center, retrospective project included patients who underwent bariatric surgery, were initiated on GLP-1 RA or GLP-1/GIP RA at least 1 year after surgery, and were on therapy for at least 6 months. The primary outcome was the percentage change in body weight from initiation of therapy to 6 months after. Secondary outcomes included the percentage of patients achieving ≥ 5%, ≥ 10%, or ≥ 15% reduction in weight; time from bariatric surgery to therapy initiation; discontinuation or dose reduction of therapy; and weight change comparison between patients with a history of T2DM and not enrolled in a weight loss clinic compared with those enrolled in a weight loss clinic. Results Fifty patients met the inclusion criteria. The mean percentage weight change at 6 months was −8.4%. For percentage weight reduction, 16 patients achieved ≥ 5%, 13 achieved ≥ 10%, and 7 achieved ≥ 15%. Median time from surgery to initiation of therapy was 111 months. Adverse events occurred in 3 patients (6%). Conclusion Overall, in patients receiving GLP-1 RA at least 1 year after bariatric surgery, additional weight loss was observed with minimal reported adverse events.