Obesity medications including semaglutide, liraglutide, and naltrexone/bupropion produced a median 8.8% additional weight loss in 121 patients who experienced weight regain or suboptimal results after bariatric surgery.
8.8% total body weight loss in 9 monthsPatients who had regained nearly 28% of their surgically-lost weight achieved meaningful additional weight loss with adjuvant medication, suggesting these drugs can rescue suboptimal surgical outcomes
What the researchers found
Among 121 patients who had regained weight (median 9.7 kg, or 27.9% of total weight previously lost) or had suboptimal weight loss after bariatric surgery, adjuvant obesity medications produced a median 8.8% total body weight loss (IQR 5.7-14.1%) over a median follow-up of 9 months.
Semaglutide was the most commonly prescribed (52.8% of patients), followed by naltrexone/bupropion (28.1%) and liraglutide (19.1%). The medications were effective across all surgery types: sleeve gastrectomy (59.7%), one-anastomosis gastric bypass (11.8%), adjustable gastric banding (6.7%), and conversional procedures (21.8%). Adverse effects were minor and consistent with those seen in non-surgical clinical trial populations.
Why it matters
Weight regain after bariatric surgery is common — affecting 20-30% of patients — and has been one of the most frustrating challenges in obesity medicine. Previously, the options were limited to revision surgery or lifestyle counseling. This study provides real-world evidence that GLP-1 receptor agonists and other obesity medications can serve as effective 'rescue' therapy, supporting the growing consensus that obesity is a chronic disease requiring ongoing management even after surgery.
How the study worked
This was a single-center observational study of 121 patients prescribed obesity management medications for recurrent weight gain or suboptimal weight loss following primary or conversional bariatric surgery. Patients received either naltrexone/bupropion extended-release (8/90 mg), liraglutide (3.0 mg), or semaglutide (1.0 mg). Data were analyzed using parametric and nonparametric statistics with results reported as median with interquartile ranges.
What this study cannot tell us
This is an observational study without a control group, so the weight loss cannot be definitively attributed to the medications versus other factors. The three medications were not compared head-to-head with equal group sizes (semaglutide was prescribed to over half the patients). The semaglutide dose used (1.0 mg) is the diabetes dose, not the higher 2.4 mg dose approved for obesity. Follow-up was relatively short (median 9 months). Patient selection for each medication was not randomized, introducing potential selection bias.
How to read the evidence
This is a single-center observational study without randomization or a control group. While the sample size of 121 patients is reasonable, the lack of blinding, unequal medication group sizes, and absence of a no-treatment comparison limit causal conclusions.
When this study was published
Published in 2025, this is a very current study reflecting the growing clinical practice of combining bariatric surgery with GLP-1 receptor agonists for ongoing weight management.
The bigger picture
The concept of combining bariatric surgery with obesity medications represents a paradigm shift from viewing surgery as a standalone cure. As GLP-1 drugs have become widely available, clinicians are recognizing that the best outcomes may come from a multimodal approach — surgery to create anatomical changes, plus medications to sustain hormonal appetite suppression. This 'surgery + pharmacotherapy' model mirrors how other chronic diseases (like diabetes or hypertension) are managed with multiple interventions rather than a single treatment.
Questions still open
- Would the higher obesity dose of semaglutide (2.4 mg) produce even greater weight loss in post-bariatric patients?
- Which of the three medications is most effective specifically for post-surgical weight regain — is a head-to-head randomized trial warranted?
- Should GLP-1 medications be started prophylactically after bariatric surgery to prevent weight regain, rather than waiting for it to occur?
Common questions
Is it normal to regain weight after bariatric surgery?
Can you take Ozempic or Wegovy after bariatric surgery?
Read the original research
Naltrexone/Bupropion, Liraglutide, or Semaglutide as Adjuvant Therapy After Metabolic and Bariatric Surgery: An Observational Study.
Obesity science & practice, 11(6), e70097
Citation
Brancatisano, Anthony; Ryan, Brendan. (2025). Naltrexone/Bupropion, Liraglutide, or Semaglutide as Adjuvant Therapy After Metabolic and Bariatric Surgery: An Observational Study.. Obesity science & practice, 11(6), e70097. https://doi.org/10.1002/osp4.70097