Research Spotlight: Discovering Practice Patterns of Obesity Medication Use Among Pediatric Bariatric Surgeons

Michael Kochis, MD, EdM, a resident in the Department of Surgery at Massachusetts General Hospital, is the first author of a new original investigation published in the Journal of Surgical Research, Practice Patterns of Glucagon-Like Peptide-1 Agonist Use Among Pediatric Bariatric Surgeons: A National Survey. 

Cornelia Griggs, MD, a physician investigator at Mass General for Children, Surgical Lead of the MGH Adolescent Weight Center, and Assistant Professor of Surgery at Harvard Medical School, is the senior author.  

What was the question you set out to answer with this study? 

A class of medications called GLP-1 receptor agonists (GLP-1As), including Ozempic and Wegovy, are an increasingly common treatment for obesity, but little is known about how they're being used in adolescents.  

We sought to characterize practice patterns of GLP-1A use among pediatric bariatric surgeons and affiliated obesity medicine specialists across the country. We asked them about starting GLP-1As in patients who are considering metabolic and bariatric surgery (MBS), holding them prior to elective operations, and restarting them after MBS.  

We hypothesized that there would be substantial variation in all three domains. 

What Methods or Approach Did You Use? 

We surveyed pediatric bariatric surgeons and obesity medicine specialists from major centers across the country to learn about whether and how they utilized these drugs. Through this survey we collected 22 responses (48% response rate) representing 19 different institutions. 

What Did You Find? 

While GLP-1As are commonly prescribed in these young patients, there’s a lot of variation and many unanswered questions about what approach is best.   

Most (86%) respondents do sometimes prescribe GLP-1As for patients considering MBS, but the specific indications vary. Practices for holding the medications preoperatively also vary, from not at all to holding for two weeks. 

Over half (55%) of respondents sometimes restart the medications after MBS as well.  

When invited to share more about their experiences, respondents spoke about still-evolving preoperative utilization patterns, difficulty with access and insurance coverage, and a lack of data informing use of the medications in the pre and postoperative periods. 

What are the potential clinical implications of your work? 

Given the increasing use of these medications for weight loss purposes, this substantial variation in practice highlights a need for further research to examine the safest and most effective use of GLP-1As in the pre and postoperative periods and for practice guidelines to standardize care pathways in pediatric bariatric contexts. 

Paper Cited:
 
Kochis, M., Bizimana, C., Zitsman, J. L., Pratt, J. S. A., & Griggs, C. L. (2024). Practice Patterns of Glucagon-Like Peptide-1 Agonist Use Among Pediatric Bariatric Surgeons: A National Survey. The Journal of surgical research, 301, 172–179. Advance online publication. https://doi.org/10.1016/j.jss.2024.05.045