Patients with a body mass index (BMI) of 70 or higher often face extreme obesity. For these patients, metabolic surgery is a highly effective treatment. Before surgery, losing weight helps make the procedure safer and easier. Traditionally, patients try to lose weight through diet and exercise, but this can be very hard for those with very high BMIs.
Recently, medications called GLP-1 receptor agonists (GLP-1s) have been used to help patients lose weight before surgery. Studies have shown that losing at least 5% of body weight before metabolic surgery can lower the risk of complications after the operation. However, achieving this weight loss with diet alone is difficult.
A new study from the Pennington Biomedical Research Center’s Metamor Institute looked at different ways patients lose weight before surgery. The study compared three approaches: multi-modal anti-obesity medications (mmAOMs), GLP-1 medications alone, and traditional diet and exercise.
The study, published in the International Journal of Obesity, found that patients who took multiple weight-loss medications (mmAOMs) lost the most weight before surgery. On average, these patients lost more than 13% of their body weight. Those using only GLP-1 medications lost about 8.1%, while patients relying on diet and exercise lost nearly 6%.
Dr. Michael Kachmar, a surgeon at the Metamor Institute, said, “We know metabolic surgery works well for severe obesity, but patients often wait a long time for surgery because current weight-loss methods don’t work well enough. Our study shows that using multiple medications helps patients lose weight faster, which could improve preparation for surgery.”
The study also showed that most weight loss with mmAOMs happens within about 51 weeks, but after about 88 weeks, the weight loss slows down. This may be due to the body adapting to the medication or patients stopping treatment because of side effects or cost. Still, mmAOMs provide a clear period when significant weight loss can happen, helping patients with very high BMIs prepare for surgery.
Researchers say more studies are needed to personalize treatments for each patient. Still, the clear benefits of mmAOMs make them a strong choice for those preparing for metabolic surgery. Even small amounts of weight loss can improve surgery safety by reducing liver size and belly fat. All treatment groups in the study lost weight, which is important for better outcomes.
Dr. John Kirwan, Executive Director of Pennington Biomedical, added, “The Metamor Institute leads in treating obesity with many approaches, from medicine to surgery. This research highlights the need for careful, personalized care for extreme obesity, which is rising quickly.”
Another recent study by Pennington Biomedical and Metamor Institute found that obesity rates have risen most sharply in people with BMIs of 60 or more from 2004 to 2023. This shows the urgent need for more research focused on extreme obesity, especially to understand how patients respond to medications like GLP-1s.
This latest study provides important new data on how best to prepare patients with BMI over 60 for surgery, offering hope for better treatment and outcomes.
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