Bariatric surgery is effective rescue strategy after GLP-1 receptor agonist failure

by Lori Solomon

edited by Gaby Clark, reviewed by Andrew Zinin

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Bariatric surgery is associated with clinically meaningful two-year weight loss after semaglutide or tirzepatide intolerance or inadequate response, according to a study published online Nov. 3 in the Annals of Surgery.

Ali Aminian, M.D., from the Cleveland Clinic, and colleagues evaluated two-year weight loss after bariatric surgery among adults with intolerable adverse effects or inadequate weight loss with semaglutide or tirzepatide. The analysis included adults with a body mass index ≥35 kg/m² undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2018 to 2024 (4,661 had no prior exposure [comparator group]; 61 discontinued semaglutide or tirzepatide; 207 had inadequate weight-loss response).

The researchers found that before surgery, the estimated two-year medication-associated weight change was a 1.4% gain in the intolerance group and 1.5% total body weight loss (TBWL) in the inadequate-response group. Following surgery, in the intolerance group, two-year TBWL was 27.9% and 22.7% after RYGB for patients without and with type 2 diabetes, respectively, and 20.1% and 21.6% after SG.

In the inadequate-response group, corresponding estimates were 35.8% and 27.4% after RYGB and 14.3% and 14.2% after SG. In the comparator group, corresponding two-year TBWL estimates were 33.3% and 28.7% after RYGB and 23.6% and 19.9% after SG. In the inadequate-response group, in an adjusted analysis, RYGB was associated with greater two-year TBWL than SG (32.7% versus 17.8%).

"GLP-1 medications have transformed obesity care, but they don't work for everyone," Aminian said in a statement. "A growing number of patients and their doctors are asking: What's the next step? Our findings show that bariatric surgery can be that next step."

Two authors disclosed ties to the pharmaceutical industry.

Publication details

Ali Aminian et al., Bariatric Surgery as a Rescue Strategy After Semaglutide or Tirzepatide, Annals of Surgery (2026). DOI: 10.1097/sla.0000000000007251

Journal information: Annals of Surgery

Key medical concepts

GastrojejunostomiesSemaglutideTirzepatide

Clinical categories

General surgeryWeight managementEndocrinology Who's behind this story?

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Citation: Bariatric surgery is effective rescue strategy after GLP-1 receptor agonist failure (2026, November 6) retrieved 7 November 2026 from https://medicalxpress.com/news/2026-11-bariatric-surgery-effective-strategy-glp.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.