Researchers presented findings at the American Society for Metabolic and Bariatric Surgery’s 2024 annual scientific meeting, suggesting that losing weight before bariatric surgery can reduce the risk of complications. The study involved 113 participants, with over 70 of them attempting weight loss before surgery through various methods such as medically supervised diet and exercise, GLP-1 medications, or a combination of both. Participants on multiple medications for 6 to 12 months had the most significant weight loss, followed by those on a single GLP-1 medication and those using diet and exercise. Dr. Mir Ali, a bariatric surgeon, agrees that lowering BMI before surgery can be beneficial, even though GLP-1 medications may not always be feasible due to cost or insurance coverage.
Body mass index (BMI) is a helpful tool to estimate body fat based on a person’s height and weight ratio. A BMI of 30 and above is considered obese, while a normal BMI falls between 18.5 and 24.9. However, BMI does not take into account factors like age, gender, ethnicity, or muscle mass. Different ethnicities may have varying health risks associated with certain BMIs, as seen in Asian populations at higher risk for type 2 diabetes and cardiovascular disease at lower BMIs than white European populations. Medical professionals should consider other risk measurements in addition to BMI when assessing overweight or obesity status.
In 2022, nearly 280,000 metabolic and bariatric surgeries were performed in the United States, representing only 1% of eligible individuals based on their BMI. Obesity affects around 42% of American adults and is linked to various health issues such as weakened immune system function, chronic inflammation, cardiovascular disease, stroke, type 2 diabetes, and certain cancers. Given the prevalence of obesity-related conditions, more studies are needed to determine the optimal use of GLP-1 medications before and after bariatric surgery in different patient populations. Dr. Marina Kurian, ASMBS president, emphasizes the importance of viewing obesity as a chronic disease requiring multiple therapies over time for optimal management.
Research suggests that individuals with a BMI over 70 are at the highest risk for complications from bariatric surgery. Lifestyle changes or first-generation medications did not significantly decrease this risk, highlighting the potential benefits of combining anti-obesity medications like GLP-1 agonists to achieve greater weight loss before surgery. Dr. Phil Schauer, director of the Metamor Metabolic Institute, believes that patients previously considered “too sick for surgery” may now qualify with the help of combination therapies. While BMI is a useful tool for estimating body fat, it should be used alongside other risk measurements to provide a comprehensive assessment of an individual’s health status.
Overall, researchers and healthcare professionals emphasize the importance of weight loss before bariatric surgery to reduce the risk of complications and improve patient outcomes. In some cases, medications like GLP-1 agonists may assist in achieving significant weight loss before surgery, while other individuals may benefit from lifestyle modifications such as diet and exercise. The role of GLP-1 medications in pre-and postoperative care for metabolic and bariatric surgery patients warrants further investigation to determine the optimal treatment approaches for different patient populations. By addressing the complex nature of obesity as a chronic disease, healthcare providers can offer personalized treatment strategies to improve the lives of individuals with extreme obesity.
