# GLP-1 and GIP Changes after Sleeve Gastrectomy and Weight Regain in Adolescents. Do we need a Boost?

## TL;DR

Sleeve gastrectomy helps adolescents lose weight, but some regain weight later; adding semaglutide may help prevent this.

## Contribution

This study identifies hormonal changes after sleeve gastrectomy and shows semaglutide can reduce weight regain in adolescents.

## Key findings

- Weight regain is linked to reduced incretin responses and larger gastric volumes.
- Semaglutide improved weight loss outcomes in adolescents who experienced weight regain.
- GLP-1 and GIP levels initially rise after surgery but decline over time.

## Abstract

Sleeve gastrectomy (LSG) is effective, but weight regain (WR) and variable hormonal responses challenge long-term outcomes. This study evaluated long-term weight and incretin trajectories after LSG in adolescents and assessed the impact of adjunct semaglutide therapy for patients with WR.

A retrospective cohort of 264 adolescents (mean age 15 ± 3 years; 74% female) underwent standardized LSG and was followed for five years with annual measurements of weight, BMI, %TWL, %EWL, GLP-1 and GIP. WR was defined as ≥ 10% gain from nadir plus < 50% excess weight loss at 18 months. Patients meeting these criteria (n = 62) received semaglutide from postoperative year 3.

Mean weight dropped from 133 to 87 kg by year 2, with %EWL peaking at 68% and declining to 63% by year 5. GLP-1 and GIP levels rose in the first postoperative year and diminished thereafter. Adolescents with WR exhibited more pronounced attenuation of incretin responses and larger gastric volumes than those without WR. Semaglutide increased mean %EWL in WR patients from 34 to 68% by year 3. Metabolic comorbidities improved across the cohort.

LSG produces sustained weight loss and metabolic benefits in adolescents. Incretin surges attenuate over time, particularly among those experiencing WR. A one-year course of semaglutide partially reversed WR, suggesting a potential adjunctive role for GLP-1 agonists in selected patients. Early hormonal differences warrant prospective research to clarify predictive value for weight regain.