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Evidence review

GLP-1s After Bariatric Surgery: What Was Studied

Compare postoperative trials by surgery, weight history and follow-up, without treating study averages as a personal treatment plan.

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After surgery, the useful comparison starts with the operation and weight history, rather than an average from a different population. We would ask which study resembles the proposed treatment and what its follow-up can establish.5

A poor-response trial

BARI-OPTIMISE randomized 70 adults at least a year after sleeve or bypass, with no more than 20% postsurgical loss and a reduced meal-stimulated GLP-1 response. It compared liraglutide with placebo for 24 weeks, not newer medicines. More weight was lost with liraglutide.1

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Semaglutide also has randomized evidence

BARI-STEP randomized 70 adults at least a year after sleeve or bypass with less than 20% postsurgical loss. At 68 weeks, unadjusted mean change from trial baseline was −18.0% with injected semaglutide and +0.4% with placebo, alongside lifestyle support. The efficacy analysis included 63 participants: 34 semaglutide and 29 placebo, excluding withdrawals or losses to follow-up. One semaglutide participant withdrew after a suspected unexpected serious adverse reaction. This was not a comparison with another medicine.2

A regain trial asked another question

Another randomized trial enrolled 132 people 18–120 months after Roux-en-Y bypass following ≥25% total body weight loss and ≥10% total body weight regain after nadir. It compared liraglutide with placebo over 56 weeks. Liraglutide produced more weight loss than placebo. Completion was 65% and 53.4%, respectively, amid pandemic disruption. Those criteria describe a specific recurrence history, rather than every person with a disappointing surgical result.3

Short sleeve follow-up is observational

A 2024 retrospective cohort included 115 people treated for recurrence after sleeve surgery: 70 received semaglutide and 45 tirzepatide. Reported mean loss from medication baseline at six months was 10.3% and 15.5%, respectively. Treatment was not randomly assigned, so that difference cannot establish which medicine would work better for you. The authors called for longer follow-up; this was not a durability trial.4

We would keep surgery type, weight trajectory and the proposed medicine together when discussing these findings. A short cohort result is too little information to choose treatment or decide whether another procedure is needed.4

A larger cohort still has selection limits

A 2026 nationwide postoperative study also compared semaglutide and tirzepatide retrospectively. Its weight analysis selected people starting at least a year after surgery with a year of renewed prescriptions. Tirzepatide was associated with greater loss; that is not causation. Orders did not prove dispensing or adherence, and continuing-treatment selection could favor responders. Matching did not turn those observations into a randomized drug comparison.5

References

  1. Mok J, Adeleke MO, Brown A, et al. (2023). 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. JAMA Surgery. PubMed · PMID 37494014
  2. Stanley C, Mallik R, Hamid N, et al. (2026). Semaglutide versus placebo in individuals with poor weight loss after bariatric surgery: a double-blinded, randomized, placebo-controlled trial. Nature Medicine. PubMed · PMID 42174253
  3. Lofton HF, Maranga G, Hold R, et al. (2025). A randomized, double-blind, placebo-controlled trial of weight loss using liraglutide 3.0 mg for weight recurrence after Roux-en-Y gastric bypass. Surg Obes Relat Dis. PubMed · PMID 39401933
  4. Jamal M, Alhashemi M, Dsouza C, et al. (2024). Semaglutide and Tirzepatide for the Management of Weight Recurrence After Sleeve Gastrectomy: A Retrospective Cohort Study. Obesity Surgery. PubMed · PMID 38430320
  5. Gillikin A, Lee Y, Varney C, et al. (2026). Weight loss and cardiovascular outcomes with incretin-based therapies after metabolic and bariatric surgery: a nationwide US cohort study. eClinicalMedicine. PubMed · PMID 42382138

Medical disclaimer: This content is for general educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a licensed healthcare professional before starting, stopping, or changing any treatment.

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