This protocol addresses the management of morbid obesity when a structured course of weight-loss pharmacotherapy — combined with lifestyle changes — has failed to produce the required degree of weight reduction, warranting escalation to the next evidence-based intervention.
The preceding treatment — obesity pharmacotherapy (preferred agents: GLP-1 receptor agonists or dual GIP/GLP-1 receptor agonists; alternative approved weight-loss agents also considered) initiated alongside lifestyle modification — did not meet the escalation threshold: greater than 5% total body weight loss after 3 months of use.
For patients who are appropriate surgical candidates, a metabolic surgical intervention carried out at a high-volume centre is the next management step. The two predominant procedure types each carry a distinct outcomes profile; which procedure is selected, and for whom, is specified in the complete protocol.
Successful outcomes following this intervention include substantial reduction in total body weight and, where applicable, remission of type 2 diabetes.
DOI: 10.2337/dc26-S008