Tirzepatide, Ketogenic Diet, or Standard Care Compared for Preoperative Optimization Before Gastric Bypass

Severe obesity is a complex chronic disease often managed with bariatric surgery like one anastomosis gastric bypass (OAGB), which offers significant weight loss and comorbidity resolution. However, optimizing patient outcomes and minimizing surgical risks remains a challenge. Current standard care for preoperative preparation may not fully address the metabolic complexities or achieve maximal weight reduction prior to surgery, potentially impacting long-term success. Investigating targeted preoperative interventions like tirzepatide or a ketogenic diet aims to enhance surgical readiness, improve safety, and ultimately boost sustained weight loss and health improvements post-OAGB.

This clinical trial will assign participants undergoing one anastomosis gastric bypass (OAGB) for severe obesity to one of three preoperative strategies. The intervention arms include tirzepatide medication for 60 days, a ketogenic diet for 4 weeks, or standard care. The study's primary endpoint is to determine which approach leads to the best weight loss one year after surgery. Secondary endpoints will evaluate safety, surgical outcomes, and improvement of obesity-related health conditions such as diabetes, high blood pressure, and sleep apnea.

The study's primary objective is to determine which preoperative strategy leads to the best weight loss one year after surgery, comparing outcomes between the tirzepatide, ketogenic diet, and standard care groups. Secondary endpoints will assess the safety profile of each intervention, including adverse events, and evaluate surgical outcomes such as complication rates.

Researchers will also measure the improvement of obesity-related health conditions, specifically type 2 diabetes, hypertension, and sleep apnea, across the different preoperative regimens. The trial aims to identify the most effective approach for optimizing patient readiness for one anastomosis gastric bypass (OAGB) and enhancing long-term metabolic health and weight management.