Bariatric surgery after GLP-1s: What a Cleveland Clinic study found

 Patients who could not tolerate semaglutide or tirzepatide, or who lost little weight on them, lost substantial weight after bariatric surgery, according to a Cleveland Clinic study published Nov. 3 in Annals of Surgery.

Here are four things to know:

1. The observational study included 4,929 adults who had bariatric surgery at Cleveland Clinic hospitals in Ohio from 2018 to 2024. Researchers compared two-year total body weight loss in three groups: 4,661 patients who had not used semaglutide or tirzepatide, 61 who stopped them because of intolerable side effects and 207 who had inadequate weight loss while taking them. Median body weight at surgery was about 273 to 287 pounds across the groups.

2. Patients who lost little to no weight on the medications had lost about 2% of their body weight or less within two years of starting them. After surgery, and after adjusting for age, sex, diabetes and other factors, those who stopped medication because of side effects lost about 23% to 26% of their total body weight at two years, those with inadequate weight loss on medication lost about 18% to 33% and those who had not used the drugs lost about 24% to 33%. In each group, the lower figure reflects gastric sleeve and the higher reflects gastric bypass. Both approaches had low complication rates.

3. The researchers noted limitations, including the observational design, small medication groups, two-year follow-up and no way to confirm how consistently patients took the drugs. They said the findings do not mean surgery is the right next step for every patient.

4. The study comes as GLP-1 use has coincided with falling surgical volumes. Bariatric surgery volumes continue falling as about 24% of eligible U.S. adults received a GLP-1 prescription by the third quarter of 2025, compared with 0.09% who had surgery. Among adolescents and young adults, bariatric surgery fell from 11.6% to 3.7% of patients over the same period, and research suggests surgery still leads in real-world weight loss.

https://www.beckershospitalreview.com/glp-1s/bariatric-surgery-after-glp-1-intolerance-or-limited-weight-loss-what-a-cleveland-clinic-study-found/