Pre-surgical
GLP-1 weight loss before surgery
Bariatric, joint-replacement, and transplant programs increasingly use GLP-1 medications to drive pre-op weight loss. The protocols share common threads: start ≥6 months before surgery, stop 7 days pre-op, plan anesthesia accordingly.
Anesthesia note: GLP-1 slows gastric emptying. Anesthesia societies (ASA, 2023) updated pre-op guidance recommending GLP-1 hold of at least 1 weekly-dose interval (7 days) + confirmation of an empty stomach via ultrasound or extended fasting.
Pre-bariatric surgery
- Typical target
- Often 5-10% loss before procedure
- Timeline
- Start GLP-1 6-12 months pre-op
Many bariatric programs use GLP-1 specifically to reduce hepatic fat (smaller liver = easier surgical retraction). Wegovy or Zepbound at standard titration; stop 7 days before surgery per most program protocols.
Pre-joint replacement
- Typical target
- BMI <40 (some surgeons require <35)
- Timeline
- Start GLP-1 6-9 months pre-op
Higher BMI strongly correlates with periprosthetic infection and revision rates. GLP-1 has replaced extreme calorie restriction as the standard preparation in many orthopedic programs.
Pre-transplant
- Typical target
- Center-specific BMI limits (often 30-35)
- Timeline
- Variable; depends on transplant urgency
Kidney and liver transplant programs increasingly accept GLP-1-mediated weight loss. Cardiothoracic programs are more conservative. Discuss with the transplant coordinator before starting.
Post-op resumption
Most surgical programs resume GLP-1 at 4-6 weeks post-op, after the patient is eating normally and has cleared the immediate healing window. Titration restarts at the lower-than-pre-op dose to re-assess GI tolerance; full dose can usually be regained in 8-12 weeks.