Pharmacological Rescue After Bariatric Surgery Failure: The Role of GLP-1 Receptor Agonists in Weight Regain Management

Abstract

Background:
Obesity is a chronic, multifactorial disease with rapidly growing global prevalence. Bariatric surgery remains the most effective intervention for long-term weight reduction and improvement of obesity-related comorbidities; however, 16 - 37% of patients experience inadequate weight loss or weight regain, prompting the search for less invasive pharmacological strategies.

Aim:
To review the efficacy and safety of GLP-1 receptor agonists in adults after bariatric surgery presenting with insufficient weight loss or weight regain.

Material and methods:
A narrative literature review was conducted using medical databases and current guidelines, including original and review articles in English involving adult post-bariatric patients treated with GLP-1 receptor agonists, reporting weight-related outcomes and safety data.

Results:
Liraglutide 3.0 mg achieved additional weight loss of approximately 5 - 6% over 6 - 8 months, with early onset of effect and comparable efficacy across surgical techniques. Once-weekly semaglutide (0.5 mg) demonstrated weight loss of 10.3% at 6 months. After 12 months of GLP-1 receptor agonist therapy (liraglutide or semaglutide combined), median total body weight loss reached 11.2%. Preliminary data on tirzepatide suggest superior efficacy: 15.5% weight loss at 6 months versus 10.3% with semaglutide after sleeve gastrectomy. Adverse events were predominantly mild to moderate gastrointestinal symptoms.

Conclusions:
GLP-1 receptor agonists represent a promising, less invasive option for post-bariatric weight management and should be considered before revisional surgery in appropriately selected patients. Larger randomised studies - particularly with tirzepatide - are needed to define optimal drug choice, timing, and patient selection.