Obesity
Conditions
Keywords
obesity, Glucagon-Like Peptide-1 Receptor Agonists, Bariatric Surgery
Brief summary
Obese patients exhibit considerable heterogeneity and complex comorbidities, making long-term effective management challenging with single therapies. While bariatric surgery remains the most effective weight-loss intervention, postoperative weight regain and metabolic deterioration require attention. GLP-1 RAs offer distinct advantages for weight and metabolic improvement, and their combined application with surgery may yield synergistic benefits. This study investigates the efficacy and safety of bariatric surgery combined with GLP-1 receptor agonist adjuvant therapy for severe obesity.
Detailed description
"bariatric surgery is guideline-recommended as an effective obesity treatment. Substantial evidence demonstrates its ability to significantly reduce weight, improve comorbidities like type 2 diabetes (T2DM) and dyslipidemia, and lower cardiovascular risk. However, the significant heterogeneity and complex comorbidity profiles among obese patients challenge long-term effective management with single therapeutic approaches. While currently the most effective weight-loss intervention, bariatric surgery requires attention to issues such as postoperative weight regain and metabolic deterioration. In parallel, Glucagon-like peptide-1 receptor agonists (GLP-1RA) have demonstrated significant efficacy in obesity management. Agents like semaglutide promote weight loss and metabolic improvement through mechanisms including insulin secretion promotion, appetite suppression, delayed gastric emptying, and enhanced satiety. Given the distinct advantages of both bariatric surgery and GLP-1RA therapy in weight and metabolic control, this study will combine these modalities into a comprehensive treatment strategy. The investigators will compare the long-term safety and effectiveness of different combination regimens for weight management and metabolic improvement in patients with severe obesity."
Interventions
COMBINATION_PRODUCTBS-GLP group
1. Basic Treatment Measures Within 0-30 days after sleeve gastrectomy, all patients received very low-calorie enteral nutrition powder (100 kcal/day). From 30 to 90 days post-surgery, a low-energy diet (400 kcal/day) was provided. Beyond 90 days post-surgery, a calorie-restricted diet was implemented (1,500 kcal/day for men and 1,200 kcal/day for women). 2. In addition to laparoscopic sleeve gastrectomy and postoperative basic nutritional counseling,the intervention group received subcutaneous semaglutide injections from 1 to 6 months postoperatively.The specific protocol was as follows:In the intervention group, semaglutide treatment was initiated at 1 month after LSG. The starting dose was 0.25 mg per week and was subsequently titrated up based on individual patient response to a maximum maintenance dose of 2.4 mg per week. The treatment continued until the completion of the 6-month postoperative period.
PROCEDUREBS group
1. Basic Treatment Measures Within 0-30 days after sleeve gastrectomy, all patients received very low-calorie enteral nutrition powder (100 kcal/day). From 30 to 90 days post-surgery, a low-energy diet (400 kcal/day) was provided. Beyond 90 days post-surgery, a calorie-restricted diet was implemented (1,500 kcal/day for men and 1,200 kcal/day for women). 2. Observation Group: Received only basic nutritional recommendation interventions after surgery.
Sponsors
China-Japan Friendship Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
1. Primary metabolic surgery candidates: Patients undergoing initial laparoscopic sleeve gastrectomy (LSG) 2. obesity:BMI ≥35 kg/m² 3. Metabolic comorbidities: Diagnosis of metabolic syndrome or type 2 diabetes mellitus (T2DM) meeting standard criteria 4. Age range: 18-60 years (inclusive) 5. Informed consent: Willing participation with documented consent
Exclusion criteria
1. Recent GLP-1RA use: Treatment with GLP-1 receptor agonists within 6 months preoperatively 2. Prior bariatric surgery: History of any metabolic/bariatric surgical procedure 3. Postoperative complications: Requiring reoperation for severe complications (e.g., hemorrhage, anastomotic leak) 4. Non-indicated candidates: Patients not meeting standard bariatric surgery indications 5. Significant comorbidities: * Advanced hepatic/renal dysfunction (Child-Pugh C or eGFR \<30 mL/min/1.73m²) * Active malignancy (except non-melanoma skin cancers) * Autoimmune disorders requiring immunosuppression * Uncontrolled psychiatric conditions (e.g., active psychosis, severe depression)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the Percentage of weight loss | 1 year | Through study completion, an average of 1 year, the investigators will observe the Percentage of weight loss. |
Secondary
| Measure | Time frame |
|---|---|
| Gender | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Ethnicity | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Height in meters | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Weight in kilograms | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Waist circumference in centimeters | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Hip circumference in centimeters | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Blood pressure | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Serum creatinine | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Glomerular filtration rate | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Fasting blood glucose | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Average blood glucose from continuous glucose monitoring | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Postprandial 2-hour blood glucose | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| HbA1c | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Urinary microalbumin and other Urinalysis indexes | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Total cholesterol | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Low-Density Lipoprotein(LDL) | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| High-Density Lipoprotein(HDL) | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Triglycerides | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Alanine Aminotransferase(ALT) | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| Aspartate Aminotransferase(AST) | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| urine microalbumin-to-creatinine ratio (ACR) | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
| uric acid(UA) | Immediately postoperatively (Day 0), and at 1, 3, 6, and 12 months postoperatively. |
Countries
China
Contacts
CONTACTYishan Huang, Ph.D
PRINCIPAL_INVESTIGATORHua Meng, Ph.D
China-Japan Friendship Hospital
Outcome results
None listed