Surgery Plus Medication Outperforms Surgery Alone in Young People
Key Takeaways:
- Young people who restarted obesity medication a median of one month after sleeve gastrectomy lost more weight at 12 months than those who had surgery alone.
- Improvements in eating behaviours, including hunger scores, were significantly greater in the early reinitiation group.
- Rates of postoperative complications, readmissions, emergency department visits and reoperations did not differ between the two groups.
Combining pharmacotherapy with surgery in adolescent obesity care
Restarting obesity medication, including glucagon-like peptide-1 (GLP-1) receptor agonists, shortly after sleeve gastrectomy is associated with greater weight loss at one year than surgery alone in adolescents, according to a research letter published online on 22 July in JAMA Surgery.
The finding speaks to a question that has become increasingly pressing as both metabolic and bariatric surgery and highly effective obesity pharmacotherapy have become available to younger patients: whether the two should be sequenced, or used together.
What the researchers set out to examine
Dr Alaina P. Vidmar, of Children’s Hospital Los Angeles, and colleagues evaluated the 12-month safety, weight trajectory and eating behaviour outcomes associated with early reinitiation of obesity medication following metabolic and bariatric surgery.
The analysis included 99 young people aged 7–20 who underwent sleeve gastrectomy between November 2023 and February 2026.
Half the cohort restarted medication within a month of surgery
Of the 99 young people in the cohort, 53 reinitiated obesity medication, with a median time to reinitiation of 1.0 month.
Among those who restarted treatment, most resumed the same class of medication they had been prescribed before surgery. Postoperative regimens were nonetheless generally consolidated, with fewer young people requiring multiagent therapy after their operation than before it.
Weight trajectories diverged after the six-month mark
Through the first six months, the two groups experienced similar early postoperative weight loss.
The picture changed by the end of the first year. The early reinitiation group achieved a greater mean reduction in body mass index (BMI) percentage at 12 months than the group who had surgery alone, at −29.3% versus −25.5%. The same pattern held for excess BMI loss percentage, at −53.6% versus −45.7%.
Eating behaviours improved more with combined treatment
Improvements in eating behaviours were significantly greater in the early reinitiation group at 12 months than in the surgery-only group. Median hunger scores on the Adult Eating Behaviour Questionnaire, for example, fell by 3.5 points in the early reinitiation group, compared with a rise of 0.2 points among those treated with surgery alone.
This behavioural dimension is a reminder that appetite regulation after surgery is not a fixed quantity, and that the interaction between pharmacological and surgical mechanisms is an area where prescribing clinicians increasingly need structured, up-to-date grounding. The College of Contemporary Health addresses precisely this territory in its GLP-1RA Complete Programme, which covers the pharmacology, patient selection, monitoring and behavioural support that underpin safe long-term use of these agents.
Safety outcomes were comparable between the groups
There was no difference between the groups in postoperative complications, including biliary events requiring cholecystectomy, readmissions, emergency department visits and reoperations.
A lifespan view of severe obesity
The authors frame the results as support for treating severe obesity in young people as a chronic condition requiring more than one modality.
“Bariatric surgery is the most durable and effective treatment for severe obesity, but for youth with severe disease, we need a multimodal approach, which means combining medication and surgery over the lifespan,” Vidmar said in a statement.
CCH insight
For clinicians supporting young people through and beyond metabolic and bariatric surgery, findings like these shift the practical question from whether to prescribe to when, what and for how long. Confidence with GLP-1 receptor agonists, and with the behavioural and monitoring work that surrounds them, is becoming a core competency rather than a specialist interest.
The College of Contemporary Health’s GLP-1RA Complete Programme is designed for healthcare professionals who want that grounding: mechanisms of action and the wider incretin landscape, patient selection and contraindications, dose escalation and adverse effect management, and the behaviour change support that helps people sustain outcomes over time. It is CPD-accredited and studied entirely online, so it fits around clinical commitments.
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Almost a Quarter of UK GPs Report Obesity in Children Aged Four and Under
Key Takeaways:
- Nearly one in four UK GPs report seeing children aged four and under where obesity is a clinical concern, with cases identified even in infancy.
- Most GPs find conversations about weight with children and parents difficult, citing fear of distress, stigma and complaints.
- The survey also raises concerns about inappropriate private access to GLP-1 weight loss medicines among adults who do not meet eligibility criteria.
Growing concern among family doctors
Almost a quarter of UK general practitioners report seeing children aged four or under who are living with obesity, according to a new survey of family doctors. The findings point to what respondents described as an “alarming” escalation of childhood obesity presenting at ever younger ages.
The research found that almost half of GPs, 49 per cent, have seen boys and girls up to the age of seven with obesity, including a small number of children younger than one year old. These early presentations raise concerns about long-term health consequences and the pressures faced by primary care clinicians in addressing weight sensitively and effectively.
Survey scope and headline findings
The survey, conducted by MDDUS, asked 540 family doctors about their experiences of managing obesity, the rapid growth in the use of weight loss medications, and the implications of widespread overweight and obesity for the NHS.
Almost one in four respondents, 23 per cent, said they had seen children aged zero to four where obesity was a clinical concern. Across childhood more broadly, 81 per cent of doctors reported seeing obesity in children between the age of 12 months and 11 years.
Dr John Holden, chief medical officer at MDDUS, said:
“These findings are an alarming confirmation of the growing crisis of childhood obesity across the country and the very real difficulties this creates in everyday GP consultations.”
Challenges of discussing weight with families
Despite the scale of the issue, most GPs reported significant difficulty in raising concerns about weight with children and their families. Four in five doctors, 80 per cent, said they find it somewhat or very challenging to talk to the parents of a child under 16 living with obesity about their weight and health. Only 10 per cent said they found such conversations easy.
Nearly two thirds of respondents, 65 per cent, also reported difficulty speaking directly with young people themselves about weight, with just 20 per cent describing those discussions as easy.
Doctors cited multiple reasons for this hesitation. Conversations with parents are often constrained by concerns that parents may become upset, reported by 72 per cent, angry, reported by 47 per cent, or may make a complaint, reported by 24 per cent. A further 74 per cent worried that such discussions could cause shame or stigma. Similar concerns were reported when speaking with children, including fears that conversations about weight could contribute to disordered eating behaviours.
Building confidence in these delicate conversations is the focus of professional training such as the College of Contemporary Health’s Behaviour Change Skills: Person-Centred Communication, a CPD-accredited online short course.
The wider determinants of childhood obesity
Respondents highlighted that obesity is shaped by complex and interrelated factors, including poverty, limited access to nutritious food, and fewer safe or affordable opportunities for children to be physically active. These realities, the survey suggests, shape how GPs approach discussions about weight.
Dr Holden said GPs therefore approach these conversations “with care and empathy for families under pressure”. He added:
“When parents feel judged or blamed, conversations can quickly become emotionally charged and, as our members tell us, can lead to complaints from distressed or angry parents.”
Calls for stronger prevention measures
Katharine Jenner, executive director of the Obesity Health Alliance, said the findings underline a failure to protect children early in life.
She said that the high numbers of GPs seeing infants and very young children with obesity “is another sign we’re letting children down before they even start school. If we’re serious about prevention, it has to begin in the earliest years, otherwise the damage follow them through life.”
Jenner called for a stronger focus on prevention, including reformulation of food and drink products to improve their nutritional quality, tighter restrictions on the marketing of products high in fat, salt and sugar, and better support for families facing structural and financial barriers to healthy eating.
Concerns over private access to weight loss drugs
Alongside childhood obesity, the survey also explored GP experiences of adult patients using weight loss medications inappropriately. Doctors reported that some adults who should not be using GLP-1 weight loss drugs are obtaining them through deception from private pharmacies.
These include people with eating disorders, such as anorexia or bulimia, and people already taking other medications that could interact adversely with so-called “fat jabs” and pose risks to their health.
It is estimated that around 1.5 million people in Britain are using GLP-1 medicines for weight loss, the majority having obtained them privately rather than through the NHS, where eligibility criteria are strict.
One GP told the survey that GLP-1s are being “accessed privately pretty indiscriminately by many people whose body mass index is not in the obese category”. Another described a patient with a history of anorexia nervosa who had also obtained the drugs privately. Overall, 67 per cent of family doctors said they had seen patients using GLP-1s despite not meeting eligibility rules.
These findings raise questions about how rigorously private pharmacies are carrying out appropriate checks, including assessments of medical history and potential drug interactions, before supplying weight loss medications.
Implications for the NHS and future care
The vast majority of GPs surveyed said obesity is likely to be a defining public health challenge during their careers, with 92 per cent agreeing with that statement. An even higher proportion, 95 per cent, believe obesity will significantly affect the NHS’s ability to deliver care.
However, views on weight loss injections were more mixed. While 59 per cent of respondents believe such medications will ultimately save the NHS money, 22 per cent disagreed.
Government response
The Department of Health and Social Care did not comment directly on the survey findings. A spokesperson said:
“Every child deserves the best possible start in life, which is why this government is taking decisive action to tackle childhood obesity.
“We are restricting junk food advertising on television before 9pm and online, a move expected to remove up to 7.2bn calories per year from children’s diets; while giving local authorities new powers to stop fast food shops opening outside schools.
“Through our ten-year health plan, we’re shifting the focus from sickness to prevention to create a healthier nation.”
CCH insight:
This study highlights the considerable challenges that primary care practitioners face in addressing obesity in young children. It is a very sensitive issue, and there may also be cultural attitudes that see overweight children as beautiful or healthy. Unfortunately, healthcare professionals in the UK are not trained to deal with obesity and the unique challenges it presents. It requires a very sensitive approach, communicating with parents in a non-judgemental way, highlighting the role of the obesogenic environment and finding ways to support behaviour change at a family level. On the positive side, if this can be achieved, an entire family can benefit from these interventions, not just the child with excess weight an entire family can benefit from these interventions, not just the child with excess weight. Because so much rests on how these conversations are handled, CCH’s Behaviour Change Skills: Person-Centred Communication CPD short course (2 CPD hours, fully online, CPD-accredited) gives healthcare professionals a practical, evidence-based foundation in person-centred communication – helping them raise sensitive issues like weight with patients and families supportively and without judgement.
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