Cleveland Clinic: bariatric surgery gave 2-year weight loss after semaglutide or tirzepatide failure
In a retrospective cohort of 4929 adults at Cleveland Clinic, bariatric surgery was followed by weight loss at 2 years after semaglutide or tirzepatide intolerance or inadequate response.
A team led by Ali Aminian at Cleveland Clinic evaluated 2-year weight loss after bariatric surgery in adults who had intolerable adverse effects or inadequate weight loss with semaglutide or tirzepatide. According to ovid.com, the retrospective cohort included adults with BMI ≥35 kg/m² who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at Cleveland Clinic hospitals from 2018 to 2024. The study was published online Nov. 3 in the Annals of Surgery. It covered 4929 patients in total ovid.com
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Cohort and design
Of the 4929 patients, 4661 had no prior exposure to the drugs and formed the comparator group. A further 61 discontinued semaglutide or tirzepatide because of intolerable adverse effects, and 207 had an inadequate weight-loss response. Electronic health record and dispensing data were used to classify preoperative exposure and response.
The primary outcome was estimated 2-year total body weight loss (TBWL), stratified by procedure and by type 2 diabetes (T2DM) status. Before surgery, the estimated 2-year medication-associated weight change was a 1.4% gain in the intolerance group and 1.5% TBWL in the inadequate-response group.
Weight loss after RYGB and SG
In the intolerance group, 2-year TBWL after RYGB was 27.9% in patients without T2DM and 22.7% in those with T2DM. After SG it was 20.1% and 21.6%, respectively ovid.com
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In the inadequate-response group, the corresponding estimates were 35.8% and 27.4% after RYGB, and 14.3% and 14.2% after SG. In the comparator group, they were 33.3% and 28.7% after RYGB, and 23.6% and 19.9% after SG.
In the adjusted analysis of the inadequate-response group, RYGB was associated with greater 2-year TBWL than SG: 32.7% versus 17.8%. The difference was 14.9 percentage points (95% CI, 13.1%–16.7%).
The authors concluded that bariatric surgery was associated with clinically meaningful 2-year weight loss after semaglutide or tirzepatide intolerance or inadequate response, with RYGB potentially offering greater benefit after inadequate response. In a statement, Aminian said the findings show that bariatric surgery can be a next step for patients for whom these drugs do not work. The design is observational, so the results describe associations.
