# Body Composition Changes After Bariatric Surgery or Treatment With GLP-1 Receptor Agonists

## TL;DR

This study compares how bariatric surgery and GLP-1 receptor agonist treatments affect body composition, finding that both reduce fat mass but surgery leads to a better fat-free mass to fat mass ratio.

## Contribution

The study provides clinical evidence on the effects of bariatric surgery and GLP-1RAs on body composition over 24 months.

## Key findings

- Bariatric surgery leads to greater fat mass loss compared to GLP-1RA treatment.
- Both interventions improve the fat-free mass to fat mass ratio over 24 months.
- Surgical patients maintain a higher fat-free mass to fat mass ratio than GLP-1RA patients.

## Abstract

How are bariatric surgery and treatment with newer glucagon-like peptide-1 receptor agonists (GLP1-RAs; semaglutide and tirzepatide) associated with body composition in a clinical setting?

In this single-center cohort study of 3066 patients, both bariatric surgery and GLP-1RA treatment were associated with substantial fat mass loss, modest fat-free mass loss, and increased fat-free mass to fat mass ratio over 24 months. All these changes were more evident among patients who underwent bariatric surgery.

This study suggests that both bariatric surgery and GLP-1RAs are associated with effective reduction of fat mass over 2 years, with bariatric surgery associated with a more favorable fat-free mass to fat mass ratio than GLP-1RAs due to greater fat mass loss.

The association of bariatric surgery and newer glucagon-like peptide-1 receptor agonists (GLP-1RAs; semaglutide and tirzepatide) with body composition still lack evidence from clinical settings.

To examine temporal changes in fat-free mass (FFM), fat mass (FM), and FFM to FM ratio after bariatric surgery or GLP-1RA treatment over 24 months.

This retrospective cohort study used electronic health records from Vanderbilt University Medical Center of 1257 patients aged 18 to 65 years who underwent first-time bariatric surgery from November 21, 2017, to July 21, 2022, without GLP-1RA treatment from 1 year before to 2 years after surgery, and 1809 nonsurgical patients who started semaglutide or tirzepatide between November 12, 2018, and December 6, 2023, with 2 or more prescriptions or 5% or more weight loss. All patients had 2 or more bioelectrical impedance analysis measures and no history of end-stage kidney disease or congestive heart failure.

Bariatric surgery or GLP-1RA (semaglutide or tirzepatide) treatment.

Relative changes in FFM, FM, and FFM to FM ratio over 24 months, controlling for age, sex, race, baseline body mass index (BMI), diabetes history, treatment year, time (restricted cubic splines), and time spline-by-treatment interaction.

The study comprised 3066 patients: 1257 in the surgery group (mean [SD] age, 43.4 [10.3] years; mean [SD] baseline BMI, 46.8 [7.1]; 1033 women [82.2%]) and 1809 in the GLP-1RA group (mean [SD] age, 45.4 [11.3] years; mean [SD] baseline BMI, 41.0 [7.9]; 1457 women [80.5%]). Adjusted mean relative FM reductions in the surgery group were 42.4% (95% CI, 41.5%-43.2%) at 6 months, 49.7% (95% CI, 48.8%-50.6%) at 12 months, and 49.7% (95% CI, 47.8%-51.5%) at 24 months; reductions in the GLP-1RA group were 10.3% (95% CI, 9.5%-11.0%) at 6 months, 17.3% (95% CI, 16.5%-18.1%) at 12 months, and 18.0% (95% CI, 16.4%-19.7%) at 12 months. Adjusted mean relative FFM reductions in the surgery group were 7.8% (95% CI, 7.2%-8.4%) at 6 months, 10.6% (95% CI, 10.0%-11.2%) at 12 months, and 11.7% (95% CI, 10.4%-12.9%) at 24 months; reductions in the GLP-1RA group were 1.8% (95% CI, 1.3%-2.4%) at 6 months, 3.0% (95% CI, 2.4%-3.5%) at 12 months, and 3.3% (95% CI, 2.1%-4.4%) at 24 months. FFM to FM ratios increased significantly in both groups, with surgical patients maintaining a higher ratio throughout: the FFM to FM ratios in the surgery group were 1.8 (95% CI, 1.8-1.8) at 6 months, 2.1 (95% CI, 2.1-2.1) at 12 months, and 2.0 (95% CI, 2.0-2.1) at 24 months; the FFM to FM ratios in the GLP-1RA group were 1.4 (95% CI, 1.4-1.4) at 6 months, 1.5 (95% CI, 1.4-1.5) at 12 months, and 1.5 (95% CI, 1.5-1.6) at 24 months. Similar trends were observed in stratified analyses by sex, race, baseline BMI, baseline diabetes status, and GLP-1RA treatment duration, although men showed better FFM preservation than women, especially after GLP-1RA treatment.

In this single-center cohort study, both bariatric surgery and semaglutide or tirzepatide treatment were associated with substantial FM loss, moderate FFM loss, and improved FFM to FM ratio. These findings provide evidence to guide interventions aimed at preserving FFM while promoting fat loss.

This cohort study examines the associations of bariatric surgery or glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment with body composition over 24 months.