Impact of Treatment with GLP1 Receptor Agonists, Liraglutide 3.0 mg and Semaglutide 1.0 mg, While on a Waiting List for Bariatric Surgery

Neoadjuvant Semaglutide, Bariatric Surgery Weight Loss, and Overall Outcomes

This case-control study examines the use of glucagon-like peptide-1 receptor agonist before metabolic and bariatric surgery and its postoperative outcome.

Is liraglutide safe and effective in the elderly obese patients?: A single center experience

The prevalence of Obesity is increasing globally, including in Türkiye, and affects all age groups, including the elderly. Previous clinical trials have shown the efficacy and safety of liraglutide in reducing the body weight of older adults. This study aimed to evaluate the effectiveness of liraglutide on weight loss and to identify any adverse effects in elderly individuals with obesity. This retrospective cohort study included patients aged ≥ 60 years with a body-mass index (BMI) ≥ 27 or greater and other comorbidities, as well as those with an initial BMI ≥ 30. All patients referred from a private tertiary clinic were prescribed liraglutide for obesity treatment. Data were collected from September 2023 to September 2024, with metabolic and anthropometric parameters recorded at the first appointment, followed by the monitoring of body weight and adverse effects during treatment. The mean age of the 32 patients was 63.78 years (± 10.50 years), with 90.6% of patients being female. Their mean weight and BMI were 94.31 ± 14.82 kg and 36.49 ± 5.34 kg/m², respectively. The body weight loss percentages were 5.96% at week 4, 10.06% at week 8, 13.85% at week 12, and 15.80% at week 24 (all P < .0001). At week 24, 100% of the patients lost more than 5% and 10% of their initial weight, respectively. Nausea was the most common adverse effect observed, with no reported instances of pancreatitis. This study corroborates the findings of previous research in this field. Evidence indicates that liraglutide is both efficacious and safe for treating obesity in the elderly population.

Preoperative weight loss by noninvasive approach in patients with obesity scheduled for bariatric and metabolic surgery: an update narrative review of indications and results available until 2024

Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity and its metabolic complications. Currently, most MBSs are performed laparoscopically. However, high weight associated with an enlarged liver (especially the left lobe liver section, LLLS) may complicate the technical aspects of this surgery. Therefore, before MBS, moderate preoperative weight loss (PreopWL), and reduction in LLLS are desirable. Moreover, studies are inconclusive regarding which is the best approach to apply. This narrative review aimed to describe the current scientific evidence on the effect of a noninvasive approach, such as dietary or pharmacotherapy or space-occupying devices on PreopWL, peri-operative complications, hospital length of stay, and post-operative complications in patients with obesity scheduled for MBS. We conducted a literature search and screening for relevant publications from January 2010 to June 2024. We found that PreopWL before MBS is helpful for both patients and surgeons, as it leads to various benefits, such as a decrease in body weight and LLLS size, a lower risk of intra- and post-operative complications, shorter surgery times, and reduced hospital stays. In this context, concerning dietary approaches, several dietary protocols have been introduced over time, among which very low-calorie diets and very low energy ketogenic therapy are widely prescribed; however, larger randomized-controlled trials (RCTs) with well-defined dietary protocols are necessary to make definitive conclusions. Obesity management medications, such as the lipase inhibitor orlistat, phentermine/topiramate, naltrexone/bupropion, the glucagon-like peptide-1 receptor agonists (GLP-1RAs) liraglutide and semaglutide, and the novel dual glucose dependent insulinotropic peptide (GIP)/GLP-1 receptor agonist tirzepatide, has shown to be effective in promoting PreopWL before MBS; however, larger, well-designed RCTs are needed to establish optimal treatment protocols and assess their true benefits in patients scheduled for MBS. Space-occupying devices such as the swallowable intragastric balloon and hydrogel capsules, represent a promising tools but further research is essential to confirm their role.

Tackling the dual burden of malnutrition in pregnancy - pregnancy after weight loss surgery

The dual burden of malnutrition is characterised by the coexistence of undernutrition alongside overweight/obesity and diet-related noncommunicable diseases. It is a paradox which disproportionately affects women and is applicable to those who become pregnant after weight loss surgery. Obesity before and during pregnancy is associated with increased risk of adverse perinatal outcomes in both mother and child. Overall lifestyle interventions targeting weight loss in the preconception period have not proven effective, with people, and women in particular, increasingly seeking weight loss surgery. In women with severe obesity, surgery may normalise hormonal abnormalities and improve fertility. In those who become pregnant after surgery, evidence suggests a better overall obstetric outcome compared to those with severe obesity managed conservatively; however, there is heightened risk of maternal nutritional deficiencies and infants born small for gestational age. Specifically, pregnancy soon after surgery, in the catabolic phase when rapid weight loss is occurring, has the potential for poor outcomes. Lifelong micronutrient supplementation is required, and there is considerable risk of malnutrition if nutritional aftercare guidelines are not adhered to. It is therefore recommended that pregnancy is delayed until a stable weight is achieved and is supported by individualised advice from a multidisciplinary team. Further research is required to better understand how weight loss surgery affects the chances of having a healthy pregnancy and to ultimately improve nutritional management and patient care. In this review, we aim to summarise the evidence and guidance around nutrition during pregnancy after weight loss surgery.