Kachmar Michael, Corpodean Florina, Popiv Iryna, LaPenna Kyle B, Danos Denise M, Cook Michael W, Saunders Brian A, Domercant Jean J, Albaugh Vance L, Schauer Philip R
Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, LA, USA.
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Int J Obes (Lond). 2025 Jun 2. doi: 10.1038/s41366-025-01798-2.
BACKGROUND/OBJECTIVES: Optimizing patients with a body mass index (BMI) ≥ 70 kg/m² for metabolic surgery (MS) is challenging. However, pre-operative weight loss may be important for improving the safety of MS for these high-risk patients. Multi-modal anti-obesity medications (mmAOM) may enhance preoperative weight loss compared to non-pharmacologic medically supervised weight loss (NP-MSWL) or glucagon-like peptide-1 receptor agonist monotherapy (Mono-GLP-1) alone.
SUBJECTS/METHODS: This retrospective study analyzed 113 patients with BMI ≥ 70 kg/m² at a single metabolic disease treatment institute.
INTERVENTIONS/METHODS: Patients were categorized into NP-MSWL (n = 13), Mono-GLP-1 (n = 54), and mmAOM (n = 46) groups. The primary outcome was mean percent total body weight loss (%TBWL). Secondary outcomes included %TBWL across time intervals (0-23, 23-51, 51-88, and 88+ weeks).
The mmAOM group achieved the highest average - 13.07% - and median (9.93% [5.57-14.29]) %TBWL; followed by Mono-GLP-1 (5.58% [0.98-10.19]); and NP-MSWL (5% [2.97-7.02]). Significant differences among groups were confirmed by Kruskal-Wallis test (p = 0.0047). The highest median %TBWL was at 51-88 weeks (10.25 [6.49-16.45]) (p = 0.0093).
mmAOM treatment yields the highest %TBWL, especially within the first 51 weeks of preoperative preparation, demonstrating superior efficacy over Mono-GLP-1 and NP-MSWL in patients with BMI ≥ 70 kg/m². These findings suggest that incorporating mmAOM in preoperative protocols could optimize weight loss and improve surgical outcomes for high BMI patients.
背景/目的：对于体重指数（BMI）≥70kg/m²的患者进行代谢手术（MS）的优化具有挑战性。然而，术前减重对于提高这些高危患者MS的安全性可能很重要。与非药物医学监督下的减重（NP-MSWL）或单独使用胰高血糖素样肽-1受体激动剂单药治疗（Mono-GLP-1）相比，多模式抗肥胖药物（mmAOM）可能会增强术前减重效果。
对象/方法：这项回顾性研究分析了一家代谢疾病治疗机构的113例BMI≥70kg/m²的患者。
干预措施/方法：患者被分为NP-MSWL组（n = 13）、Mono-GLP-1组（n = 54）和mmAOM组（n = 46）。主要结局是平均总体重减轻百分比（%TBWL）。次要结局包括不同时间间隔（0 - 23、23 - 51、51 - 88和88周以上）的%TBWL。
mmAOM组实现了最高的平均-13.07%和中位数（9.93%[5.57 - 14.29]）的%TBWL；其次是Mono-GLP-1组（5.58%[0.98 - 10.19]）；以及NP-MSWL组（5%[2.97 - 7.02]）。通过Kruskal-Wallis检验确认组间存在显著差异（p = 0.0047）。最高的中位数%TBWL出现在51 - 88周（10.25[6.49 - 16.45]）（p = 0.0093）。
mmAOM治疗产生的%TBWL最高，尤其是在术前准备的前51周内，在BMI≥70kg/m²的患者中显示出优于Mono-GLP-1和NP-MSWL的疗效。这些发现表明，在术前方案中加入mmAOM可以优化减重效果并改善高BMI患者的手术结局。
