Use of Glucagon-Like Peptide-1 Agonists Among Individuals Undergoing Bariatric Surgery in the US

Importance Although randomized and well-controlled observational studies demonstrate the efficacy of glucagon-like peptide-1 receptor agonists (GLP-1s) for weight management after bariatric surgery, little is known regarding the frequency and predictors of such use. Objective To characterize the use of and factors associated with GLP-1 initiation among US adults undergoing bariatric surgery. Design, Setting, and Participants This retrospective cohort study was conducted using a national multicenter database of electronic health records of approximately 113 million US adults. Adults undergoing bariatric surgery from January 2015 to May 2023 who did not use GLP-1s during the 12 months prior to surgery were eligible for inclusion. Data were analyzed from October 2024 to May 2025. Exposures Sociodemographic factors (age, sex, race, region, etc) and clinical factors (bariatric surgery procedures, body mass index [BMI, calculated as weight in kilograms divided by height in meters squared], comorbidities, comedications). Main Outcomes and Measures The primary outcome was GLP-1 initiation after bariatric surgery, first characterized using descriptive statistics. Cox proportional hazards models were then used to identify baseline patient characteristics associated with GLP-1 initiation. Time-dependent Cox models were also used to examine the association of postsurgery BMI with GLP-1 initiation. Results Among 112 858 individuals undergoing bariatric surgery, mean (SD) age was 45.2 (12.9) years, and 88 994 individuals (78.9%) were female. By self-reported race, 1210 individuals (1.1%) were Asian, 24 941 (22.1%) were Black or African American, 72 423 (64.2%) were White, and 14 284 (12.6%) reported other race (American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or unknown). A total of 15 749 individuals (14.0%) initiated GLP-1s after surgery, with 3391 (21.5%) beginning within 2 years of surgery and the remainder initiating during postsurgical years 3 to 4 (5082 [32.3%]), years 5 to 6 (3964 [25.2%]), or beyond (3312 [21.0%]). The overall median (IQR) BMI before GLP-1 initiation was 42.0 (38.3-45.6). In regression models, female patients (adjusted hazard ratio [aHR], 1.61; 95% CI, 1.54-1.69), those undergoing sleeve gastrectomy (aHR, 1.42; 95% CI, 1.37-1.47), and those with type 2 diabetes (aHR, 1.34; 95% CI, 1.28-1.39) were more likely to initiate GLP-1s than their counterparts. Each 1-unit increase in postsurgical BMI was associated with an 8% increase in likelihood of GLP-1 initiation (aHR, 1.08; 95% CI, 1.08-1.08). Conclusions and Relevance In this retrospective cohort study using a nationwide database, among a cohort of US adults undergoing bariatric surgery, approximately 1 in 10 initiated a GLP-1. Initiation was greater among women, those undergoing sleeve gastrectomy, and individuals with larger BMI regain than among their counterparts.