Obesity management medications for the surgeon

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual gut hormone therapies has revolutionised obesity treatment, with implications across all surgical specialties. These medications achieve clinically significant weight loss of 15–22.5% total body weight and demonstrate multisystemic benefits including cardiovascular risk reduction, improved renal outcomes and treatment of metabolic-dysfunction-associated steatohepatitis. For surgeons, GLP-1 RAs are increasingly relevant across the entire care pathway: as alternatives or adjuncts to metabolic and bariatric surgery, tools for perioperative optimisation in elective procedures and potential interventions throughout cancer treatment pathways from prevention to survivorship. This narrative review synthesises current evidence on GLP-1 RA use relevant to surgical practice, important for both clinical and research settings. We examine their integration with bariatric surgery as both preoperative bridges and postoperative adjuncts for recurrent weight regain. In elective surgery, we evaluate perioperative safety data, aspiration risk and potential roles in prehabilitation programmes. Within oncology, we explore emerging evidence for cancer prevention, treatment optimisation and tertiary prevention in survivors. Critical considerations include management of gastrointestinal side effects, gallstone formation, pancreatitis risk, nutritional deficiencies and rare complications including mental health and ophthalmic effects. Understanding these medications is essential for contemporary surgical practice. Surgeons must recognise both therapeutic opportunities and potential complications, ensuring safe perioperative management whilst optimising patient outcomes. As evidence matures, GLP-1 RAs should be positioned not as competitors to metabolic bariatric surgery, but as complementary tools within multidisciplinary obesity and metabolic care pathways.