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Clinical Takeaway  ·  TL;DR
Domain Key Finding Evidence Level
GLP-1 → Surgery Risk-reduction tool only — preoperative GLP-1 does not improve postoperative weight loss (20.7% vs 22.0% TWL at 12 mo, P=0.19) Cohort studies; systematic review evidence inconsistent
Surgery → GLP-1 Targeted rescue for ~20–25% of surgical non-responders — tirzepatide achieves 15.5% TWL; BARI-OPTIMISE: 9.2 kg (8.03 percentage-point) advantage over placebo at 24 weeks RCT (BARI-OPTIMISE); multiple systematic reviews
Core Biology Surgery restructures gut-brain hormone axis anatomically; GLP-1 drugs suppress appetite pharmacologically — two fundamentally different mechanisms Established mechanistic evidence

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