Metabolic bariatric surgery (MBS) induces weight loss through a complex interplay of mechanisms, including alterations in humoral and neural signals in the gut–brain axis, bile acid metabolism pathways, and gut microbiota¹. However, weight loss outcomes following MBS are highly variable at the individual level, similar to other modalities for the treatment of obesity².

The landscape of obesity treatment is rapidly evolving with the advent of a newer generation of obesity management medications (modern OMMs). These exhibit remarkable weight loss efficacy similar to MBS while maintaining acceptable safety profiles³. Since 2005, gastrointestinal peptide-based agents have emerged as essential therapeutic options for managing obesity-related complications, like type 2 diabetes. Among these, glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been widely integrated into the treatment regimens of obesity and diabetes due to their efficacy^4,5. Currently, liraglutide and semaglutide are the most frequently used GLA-1RAs, but promising new drugs are on the horizon, including tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist, and other compounds are being evaluated in phase 3 clinical trials^6–8.

OMMs can be integrated into the treatment of patients undergoing MBS through (1) preoperative OMMs administration to optimize patients’ health for MBS, (2) postoperative concurrent OMMs usage to enhance overall outcomes regarding additional weight reduction to improve obesity complications, and (3) postoperative OMMs utilization as adjunctive therapy for patients with a suboptimal initial response to MBS (weight loss and remission of obesity-related complications) or recurrent weight gain. This systematic Cutting Edge Review aims to examine current research on OMMs use in patients after MBS.