Journal of Surgery Concepts & Practice >
Application of GLP-1 receptor agonists in postoperative combined therapy for obesity: a perspective of metabolic surgery
Received date: 2025-05-10
Online published: 2025-09-01
The global prevalence of obesity continues to rise, accompanied by various metabolic complications. While metabolic surgery has significant efficacy, there are still problems, such as suboptimal clinical outcomes and recurrent weight gain. The superior metabolic regulatory of glucagon-like peptide-1 (GLP-1) receptor agonists has made them a new option for bariatric treatment. This article systematically explored the clinical application framework of combining metabolic surgery with GLP-1 receptor agonists, including target populations (e.g., patients with postoperative weight regain, unremitted diabetes, or comorbid complications), intervention timing, drug selection strategies, and multidisciplinary collaboration pathways. Although combination therapy holds broad prospects, it still faces challenges, such as optimal treatment strategies, long-term safety, and cost-effectiveness. We should emphasize multidisciplinary collaboration and individualized plans to optimize the long-term effective management of obesity in the future.
Key words： Obesity; Metabolic surgery; Glucagon-like peptide-1(GLP-1)
MENG Hua , SONG Yujia , WANG Siqi . Application of GLP-1 receptor agonists in postoperative combined therapy for obesity: a perspective of metabolic surgery[J]. Journal of Surgery Concepts & Practice, 2025 , 30(03) : 207 -213 . DOI: 10.16139/j.1007-9610.2025.03.05
| [1] | World Obesity Federation. World obesity altas 2024[EB/OL]. London: World Obesity Federation, 2024. (2024-03-04)[2025-05-10]. https://data.worldobesity.org/publications/?cat=22.html. |
| [2] | GLOY V L, BRIEL M, BHATT D L, et al. Bariatric surgery versus non-surgical treatment for obesity: a systema-tic review and meta-analysis of randomised controlled trials[J]. BMJ, 2013,347:f5934. |
| [3] | EL ANSARI W, ELHAG W. Weight regain and insufficient weight loss after bariatric surgery: definitions, prevalence, mechanisms, predictors, prevention and management strategies, and knowledge gaps-a scoping review[J]. Obes Surg, 2021, 31(4):1755-1766. |
| [4] | NIE Y, ZHANG Y, LIU B, et al. Glucagon-like peptide-1 receptor agonists for the treatment of suboptimal initial clinical response and weight gain recurrence after baria-tric surgery: a systematic review and meta-analysis[J]. Obes Surg, 2025, 35(3):808-822. |
| [5] | HADDAD A, SUTER M, GREVE J W, et al. Therapeutic options for recurrence of weight and obesity related complications after metabolic and bariatric surgery: an IFSO position statement[J]. Obes Surg, 2024, 34(11):3944-3962. |
| [6] | RUBINO F, NATHAN D M, ECKEL R H, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations[J]. Surg Obes Relat Dis, 2016, 12(6):1144-1162. |
| [7] | DE ABREU SESCONETTO L, DA SILVA R B R, GALLETTI R P, et al. Scores for predicting diabetes remission in bariatric surgery: a systematic review and meta-analysis[J]. Obes Surg, 2023, 33(2):600-610. |
| [8] | ?ALIK BA?ARAN N, DOTAN I, DICKER D. Post metabolic bariatric surgery weight regain: the importance of GLP-1 levels[J]. Int J Obes(Lond), 2025, 49(3):412-417. |
| [9] | LAUTI M, LEMANU D, ZENG I S L, et al. Definition determines weight regain outcomes after sleeve gastrectomy[J]. Surg Obes Relat Dis, 2017, 13(7):1123-1129. |
| [10] | ANGRISANI L, FERRARO L, SANTONICOLA A, et al. Long-term results of laparoscopic Roux-en-Y gastric bypass for morbid obesity: 105 patients with minimum follow-up of 15 years[J]. Surg Obes Relat Dis, 2021, 17(4):727-736. |
| [11] | BONOUVRIE D S, UITTENBOGAART M, LUIJTEN A A P M, et al. Lack of standard definitions of primary and secondary (non)responders after primary gastric bypass and gastric sleeve: a systematic review[J]. Obes Surg, 2019, 29(2):691-697. |
| [12] | AL-KHYATT W, RYALL R, LEEDER P, et al. Predictors of inadequate weight loss after laparoscopic gastric bypass for morbid obesity[J]. Obes Surg, 2017, 27(6):1446-1452. |
| [13] | CSENDES A, BURGOS A M, MARTINEZ G, et al. Loss and regain of weight after laparoscopic sleeve gastrectomy according to preoperative BMI: late results of a prospective study (78-138 months) with 93% of follow-up[J]. Obes Surg, 2018, 28(11):3424-3430. |
| [14] | MANNING S, PUCCI A, CARTER N C, et al. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass[J]. Surg Endosc, 2015, 29(6):1484-1491. |
| [15] | POKALA B, HERNANDEZ E, GIANNOPOULOS S, et al. Early postoperative weight loss predicts nadir weight and weight regain after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass[J]. Surg Endosc, 2023, 37(6):4934-4941. |
| [16] | NANNIPIERI M, BALDI S, MARI A, et al. Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones[J]. J Clin Endocrinol Metab, 2013, 98(11):4391-4399. |
| [17] | GORGOJO-MARTíNEZ J J, FEO-ORTEGA G, SERRANO-MORENO C. Effectiveness and tolerability of liraglutide in patients with type 2 diabetes mellitus and obesity after bariatric surgery[J]. Surg Obes Relat Dis, 2016, 12(10):1856-1863. |
| [18] | CARDOSO S, PEREIRA S S, ALMEIDA R F, et al. Accuracy of prediction models for long-term type 2 diabetes remission after gastric bypass[J]. Acta Diabetol, 2023, 60(8):1019-1026. |
| [19] | ARON-WISNEWSKY J, SOKOLOVSKA N, LIU Y, et al. The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass[J]. Diabetologia, 2017, 60(10):1892-1902. |
| [20] | AMINIAN A, BRETHAUER S A, ANDALIB A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity[J]. Ann Surg, 2017, 266(4):650-657. |
| [21] | DAVIES M J, ARODA V R, COLLINS B S, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)[J]. Diabetes Care,2022, 45(11):2753-2786. |
| [22] | LLEWELLYN D C, LOGAN ELLIS H, AYLWIN S J B, et al. The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review[J]. Obesity(Silver Spring), 2023, 31(1):20-30. |
| [23] | THARAKAN G, BEHARY P, WEWER ALBRECHTSEN N J, et al. Roles of increased glycaemic variability, GLP‐1 and glucagon in hypoglycaemia after Roux‐en‐Y gastric bypass[J]. Eur J Endocrinol, 2017, 177(6):455-464. |
| [24] | MIN T, PRIOR S L, CHURM R, et al. Effect of laparoscopic sleeve gastrectomy on static and dynamic measures of glucose homeostasis and incretin hormone response 4-years post-operatively[J]. Obes Surg, 2020, 30(1):46-55. |
| [25] | PETERLI R, STEINERT R E, WOELNERHANSSEN B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial[J]. Obes Surg, 2012, 22(5):740-748. |
| [26] | MOZAFFARIAN D. GLP-1 agonists for obesity-a new recipe for success?[J]. JAMA, 2024, 331(12):1007-1008. |
| [27] | RUBINO D, ABRAHAMSSON N, DAVIES M, et al. Effect of continued weekly subcutaneous semaglutide vs. placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial[J]. JAMA, 2021, 325(14):1414-1425. |
| [28] | ARONNE L J, SATTAR N, HORN D B, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial[J]. JAMA, 2024, 331(1):38-48. |
| [29] | LIAO T, ZHANG S L, YUAN X, et al. Liraglutide lowers body weight set point in DIO rats and its relationship with hypothalamic microglia activation[J]. Obesity(Silver Spring), 2020, 28(1):122-131. |
| [30] | WILDING J P H, BATTERHAM R L, DAVIES M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension[J]. Diabetes Obes Metab, 2022, 24(8):1553-1564. |
| [31] | KHAN S S, NDUMELE C E, KAZI D S. Discontinuation of glucagon-like peptide-1 receptor agonists[J]. JAMA, 2025, 333(2):113-114. |
| [32] | GLEASON P P, URICK B Y, MARSHALL L Z, et al. Real-world persistence and adherence to glucagon-like peptide-1 receptor agonists among obese commercially insured adults without diabetes[J]. J Manag Care Spec Pharm, 2024, 30(8):860-867. |
| [33] | 中华医学会内分泌学会. 肥胖患者的长期体重管理及药物临床应用指南(2024版)[J]. 中华内分泌代谢杂志, 2024, 40(7):545-564. |
| Chinese Society of Endocrinology. Guideline for chronic weight management and clinical practice of anti-obesity medications (2024 version)[J]. Chin J Endocrinol Metab, 2024, 40(7):545-564. | |
| [34] | WILLARD F S, DOUROS J D, GABE M B, et al. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist[J]. JCI Insight, 2020, 5(17):e140532. |
| [35] | JASTREBOFF A M, KAPLAN L M, FRíAS J P, et al. Triple-hormone-receptor agonist retatrutide for obesity - a phase 2 Trial[J]. N Engl J Med, 2023, 389(6):514-526. |
| [36] | ROSENSTOCK J, FRIAS J, JASTREBOFF A M, et al. Retatrutide, a GIP, GLP-1 and glucagon receptor agonist, for people with type 2 diabetes: a randomised, double-blind, placebo and active-controlled, parallel-group, phase 2 trial conducted in the USA[J]. Lancet, 2023, 402(10401):529-544. |
| [37] | LINGVAY I, SUMITHRAN P, LE ROUX C W, et al. There is no magic bullet for obesity[J]. Lancet Diabetes Endocrinol, 2023, 11(8):541. |
| [38] | KANOSKI S E, RUPPRECHT L E, FORTIN S M, et al. The role of nausea in food intake and body weight suppression by peripheral GLP-1 receptor agonists, exendin-4 and liraglutide[J]. Neuropharmacology, 2012, 62(5-6):1916-1927. |
| [39] | NAUCK M A, KEMMERIES G, HOLST J J, et al. Rapid tachyphylaxis of the glucagon-like peptide 1-induced deceleration of gastric emptying in humans[J]. Diabetes, 2011, 60(5):1561-1565. |
| [40] | RYE P, MODI R, CAWSEY S, et al. Efficacy of high-dose liraglutide as an adjunct for weight loss in patients with prior bariatric surgery[J]. Obes Surg, 2018, 28(11):3553-3558. |
| [41] | MOK J, ADELEKE M O, BROWN A, et al. Safety and efficacy of liraglutide, 3.0 mg, once daily vs. placebo in patients with poor weight loss following metabolic surgery: the BARI-OPTIMISE randomized clinical trial[J]. JAMA Surg, 2023, 158(10):1003-1011. |
| [42] | DRUCKER D J. Efficacy and safety of GLP-1 medicines for type 2 diabetes and obesity[J]. Diabetes Care, 2024, 47(11):1873-1888. |
| [43] | JENSEN S B K, S?RENSEN V, SANDSDAL R M, et al. Bone health after exercise alone, GLP-1 receptor agonist treatment, or combination treatment: a secondary analysis of a randomized clinical trial[J]. JAMA Netw Open, 2024, 7(6):e2416775. |
| [44] | MONAMI M, NREU B, SCATENA A, et al. Safety issues with glucagon-like peptide-1 receptor agonists (pancreatitis, pancreatic cancer and cho-lelithiasis): data from randomized controlled trials[J]. Diabetes Obes Metab, 2017, 19(9):1233-1241. |
| [45] | NREU B, DICEMBRINI I, TINTI F, et al. Cholelithiasis in patients treated with glucagon-like peptide-1 receptor: an updated meta-analysis of randomized controlled trials[J]. Diabetes Res Clin Pract, 2020,161:108087. |
| [46] | DAI Y, LUO B, LI W. Incidence and risk factors for cholelithiasis after bariatric surgery: a systematic review and meta-analysis[J]. Lipids Health Dis, 2023, 22(1):5. |
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