Metabolic bariatric surgery (MBS) is the most effective long-term treatment option for clinical obesity and its complications. Nonetheless, modern pharmacotherapy involving intestinal hormonal analogues, such as semaglutide and tirzepatide, have shown good weight loss outcomes in the short and medium term. Potentially, such obesity management medications (OMMs) may be synergistic with or additive to MBS for selected patients before and/or after MBS regarding improved outcomes.

The impact of pharmacotherapy before surgery is unclear, with a lack of high-level evidence regarding the efficacy of preoperative OMMs in reducing intraoperative risks and complications. Similarly, the evidence is scarce for the use of OMMs as an adjunct therapy to MBS or in patients with a suboptimal initial clinical response or with recurrent weight gain after surgery. For these reasons, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) asked a multidisciplinary group of international experts in obesity management to develop evidence-based recommendations to serve as a global reference for using OMMs before and after MBS. These recommendations were developed through a Delphi process, identifying areas of expert consensus after a systematic review of the published literature and highlighting areas warranting further research