About this episode
What happens when the world of GLP-1s collides with the operating room? Today, we’re diving into the new era of obesity care. Hosts· Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @docmartin2· Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) @DrAdrianDan· Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) @crys_noelle_· Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @cironimacaroniLearning objectives1. Understand the evolving role of OMMs in bariatric surgical practice· Recognize how widespread GLP-1 and dual-incretin therapies have reshaped patient presentations, expectations, and referral patterns.· Appreciate current evidence comparing surgery to GLP-1 therapy, including the JAMA Surgery study out of Allegheny Health (2025), noting:o Superior weight loss with bariatric surgery (~28% TBWL vs ~10% with GLP-1s)o Higher health-care utilization and cost in GLP-1–treated patients.· Frame OMMs not as alternatives but as complementary tools within a chronic disease model when treating obesity.2. Review pharmacologic classes and their expected efficacy· Surgeons should be able to articulate the mechanisms, efficacy, and limitations of:o GLP-1 receptor agonists – incretin-based satiety; 5–12% TBWL.o Dual GIP/GLP-1 agonists – most potent agents; 15–22% TBWL.o Sympathomimetics – norepinephrine-driven appetite suppression; 3–7% TBWL.o Combination agents (bupropion-naltrexone, phentermine-topiramate) – 5–12% TBWL depending on regimen.o Emerging therapies – retatrutide, maritide, oral GLP-1s, with promising TBWL in phase 2 trials3. Apply OMMs strategically in the preoperative phase· Integrate OMMs without compromising surgical eligibility—OMM-related weight loss does not negate the indication for surgery.· Counsel patients that medication response does not equal disease resolution; surgery remains the most durable intervention.· Manage delayed gastric emptying and aspiration risk:o Pause weekly GLP-1 or dual agonists for ?1 week pre-op (longer if symptomatic).o Collaborate closely with the anesthesia/OR teams· Screen for nutritional depletion before surgery, especially protein deficits exacerbated by appetite suppression.· Navigate insurance barriers that may paradoxically approve surgery but deny medication continuation.4. Implement postoperative OMMs safely and effectively· Establish criteria for OMM introd
