Incretin-based therapies like GLP-1 receptor agonists (GLP-1RAs) and metabolic and bariatric surgery (MBS) are both effective obesity treatments, with emerging evidence supporting their combined use for enhanced outcomes. This JAMA Insights review synthesizes data from major studies on efficacy, safety, and the best strategies for integrating medications with surgery.

Why It Matters To Your Practice

• Obesity management is evolving, requiring a tailored approach that leverages both pharmacologic and surgical options.

• Combining GLP-1RAs with bariatric surgery may address inadequate weight loss or weight regain postoperatively.

• New evidence highlights the importance of pre- and postoperative pharmacotherapy in optimizing surgical results.

• Staying current with multimodal strategies can enhance patient outcomes and satisfaction.

Clinical Benefits

• MBS yields significant and sustained weight loss (25–31% at 1 year) and reduces mortality and diabetes risk versus nonsurgical care.

• GLP-1RAs help patients lose 12–15% of body weight, and adding them after surgery can deliver an extra 8–15% loss in those with suboptimal response.

• Preoperative weight loss of ≥10% lowers perioperative mortality by 42%.

• Combination strategies can improve diabetes remission rates and long-term quality of life.

Managing Risks

• MBS carries short-term risks: 5% major adverse event rate for gastric bypass and 2.6% for sleeve gastrectomy.

• About 10–30% of surgical patients experience inadequate weight loss or regain, impacting health and quality of life.

• GLP-1RAs may cause intolerance in ~7% of patients and are less accessible due to insurance barriers.

• Monitor for micronutrient deficiencies and bone health in patients on combined therapy; ensure supplementation and resistance training.

The Bottom Line

• Combining bariatric surgery and GLP-1RAs offers additive benefits for weight loss and metabolic health.

• Individualized therapy—considering timing, risks, and patient factors—can maximize outcomes.

• Clinicians should monitor for surgical and medication-related complications and provide ongoing nutritional support.

• Multimodal obesity care is becoming the new standard to improve long-term patient success.