Researchers presented findings at the American Society for Metabolic and Bariatric Surgery’s 2024 annual scientific meeting indicating that people who lose weight before undergoing bariatric surgery can reduce their risk of complications. Individuals with a body mass index (BMI) exceeding 70 pre-surgery are at the highest risk for complications. The study included 113 participants, with over 70 of them attempting to lose weight through various methods such as medically supervised diet and exercise, single GLP-1 medication, and multimodal therapy with multiple GLP-1 medications. Participants on multiple medications experienced the most significant weight loss (13%), followed by those using a single GLP-1 (8%), and those using diet and exercise (6%).
Dr. Mir Ali, a bariatric surgeon and medical director, recommends that patients lower their BMI to the 50s before surgery, if possible. While GLP-1 medications can be effective in aiding weight loss, they may not always be covered by insurance and can be costly. In such cases, patients may work with a diet counselor or follow a liquid diet to help jumpstart weight loss. Ali notes that losing weight before bariatric surgery is beneficial, as it can lead to continued weight loss post-surgery. Metabolic surgery is generally considered safe and can offer better outcomes for individuals with extreme obesity compared to traditional methods of weight loss.
The study also found that weight loss before bariatric surgery can decrease the risk of complications, particularly in individuals with a BMI over 70. Lifestyle changes or first-generation medications were not as effective in lowering potential complications. Combining anti-obesity medications, such as GLP-1 agonists like Ozempic, may lead to greater pre-surgery weight loss for those with extreme obesity. The use of such medications can potentially expand the pool of patients who qualify for bariatric surgery, including those who were previously considered too high-risk for the procedure.
BMI is a useful tool for estimating body fat based on a person’s height and weight. However, it does not account for factors such as age, gender, ethnicity, or muscle mass. Medical professionals should consider additional risk measurements and individual factors when using BMI to assess overweight or obesity. The World Health Organization has issued guidelines for using BMI in different populations, as different ethnicities may show varying risks for health conditions at different BMI levels. It is important to consider a comprehensive approach to evaluating obesity, considering factors beyond BMI alone.
In 2022, nearly 280,000 metabolic and bariatric surgeries were performed in the United States, representing only a small percentage of those eligible based on BMI. Obesity affects a significant portion of the adult population in the US, with potential health consequences such as weakened immune systems, chronic inflammation, cardiovascular disease, type 2 diabetes, and certain cancers. Further research is needed to determine the optimal role of GLP-1 medications before and after metabolic and bariatric surgery for different patient groups. Obesity should be viewed as a chronic disease, requiring individualized treatment approaches over time to address various factors contributing to the condition.
