Adjuvant semaglutide post-sleeve gastrectomy significantly improves 12-month weight loss for class II-III obesity.

Despite the efficacy of metabolic bariatric surgery (MBS), particularly laparoscopic sleeve gastrectomy (LSG), a substantial number of patients with class II-III obesity struggle with insufficient weight loss or weight regain. Current post-surgical management often lacks robust pharmacological interventions to sustain optimal outcomes. This study explores whether early, short-term adjunctive therapy with a GLP-1 receptor agonist like semaglutide can bridge this gap, enhancing and maintaining the initial surgical weight loss, thereby improving long-term metabolic health.

This prospective, non-randomized controlled clinical study enrolled 103 patients with class II-III obesity (BMI ≥ 35 kg/m²) undergoing LSG. The treatment group (n=48) received adjunctive Semaglutide therapy from 1 to 6 months postoperatively, while the control group (n=55) received LSG alone. The primary endpoint was the percentage of total weight loss (%TWL) at 12 months post-surgery. Secondary outcomes included percentage of excess weight loss (%EWL) at 12 months and 6 months, distributions of %TWL and %EWL, and metabolic parameters. Exploratory analyses also assessed body composition.

At 12 months postoperatively, patients receiving adjunctive semaglutide demonstrated significantly superior weight loss compared to the control group. The treatment group achieved a mean %TWL of -35.14 ± 6.88% versus -30.73 ± 6.91% in controls (P = 0.002), representing a 4.41% greater total weight loss. Similarly, %EWL was significantly higher in the treatment group (86.42 ± 19.94%) compared to controls (76.87 ± 22.95%) (P = 0.026), indicating a 9.55% improvement in excess weight loss. These differences were robust even after propensity score adjustment for baseline confounders. At 6 months postoperatively, %TWL was also significantly greater in the treatment group (-29.74 ± 5.38% vs. -26.32 ± 4.10%, P < 0.001), though %EWL differences were not significant at this earlier time point. The distributions of both %TWL and %EWL were more favorable in the semaglutide group. Both groups showed comparable safety profiles.