Brave new world we are in, where people can lose significant weight without doing surgery. GLPs have been used by 12% of all Americans for weight loss and 25% of diabetics. (I would venture those numbers are higher). The two methods of weight loss are significantly different.
With the ease of obtaining GLPs, the number of people doing bariatric surgery is declining. There are also people who are not obese (ie BMI 25-30) who are doing GLPs in increasing numbers.
This was a published study in the November 2025 Aesthetic Surgery Journal, “New Contours, Different Risks: A 9 Year Comparison of Trends and Postoperative Complications in Patients Undergoing Aesthetic Surgery With Previous Bariatric Surgery Vs. Glucagon Like Peptide 1 Receptor Agonist Use.” The study looked at patients between 2016 and 2021. They matched patients- Age, gender, BMI, Diabetes, tobacco use, HbA1c, and kidney disease. They looked at complications including hematoma, seroma, infection, wound healing issues, DVT and PE, emergency room visits, readmissions, and mortality.
Before they matched the cohorts, they did notice some trends. GLP patients were older, more commonly female, and greater preop BMI than those who did bariatric surgery. They also had higher history of Diabetes.
Findings?
When I first saw this study, I thought it would be skewed but they fixed that by matching the cohorts (age/BMI/etc). They show a clear lower risk for GLP patients. Given all complications they looked at, the advantage was not across the board.
As expected, GLP users had better protein (albumin levels) levels as they don’t have malabsorption, but lower B12 and Magnesium levels. (I’m unclear on why that is. Those on metformin need to supplement Vitamin B, but I couldn’t find a study showing that was true for GLPs.)
In their discussion, they talk about how 96% of patients after bariatric surgery have excess skin. Combined procedures (breast and body) have higher odds of major complication rates, with seroma being the most commonly reported complication. (NOTE: I do breast lifts and reductions and extended tummy tucks frequently. I disagree with this study’s cited complication rates as too high. It may be true if patients are not optimized before surgery. We focus on your health, weight, nutrition, blood levels, and more prior to your surgery to minimize complications. To avoid seromas, I use progressive tension quilting sutures and TXA.)
They cite other studies which show GLP users had lower risks of sepsis, joint infections and readmission. The thought is the GLP improvement is due to their lower weight and better glycemic control (higher BMI and diabetes are risk factors for almost all complications, but particularly infection and wound healing issues).
GLPs DO have issues, particularly with gastric motility, so we have our patients stop them 2 weeks ahead of surgery to prevent aspiration issues.
I agree more studies need to be done. With the explosion of patients on these bioactive medications, including those who are microdosing for other health benefits, we need to understand how they may help or hinder healing and surgical risk.
I am an enormous advocate of being at your ideal weight prior to surgery. BMI studies show clear increases in complications with increased BMI. GLPs have been shown to have all sorts of health benefits, from improvement in fatty liver to improvement in sleep apnea to better glycemic control.
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