New guidelines for safe use of weight loss medications before surgery
If you or a loved one are taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to manage obesity, type 2 diabetes, or other metabolic conditions, you might have questions about whether it’s safe to continue these medications before surgery or certain medical procedures. Recent updates from leading medical societies bring clarity to this topic, making it easier to navigate these situations safely.
We’ll break down the new guidelines in simple terms, explain the reasoning behind them, and provide practical tips to ensure a smooth experience while staying on track with your health goals.
What are GLP-1 RAs and how do they work?
GLP-1 receptor agonists are medications that mimic a natural hormone called glucagon-like peptide-1. These drugs are used to:
Lower blood sugar levels in people with type 2 diabetes.
Support weight loss by increasing feelings of fullness and decreasing appetite.
Improve other metabolic factors, such as heart and kidney health.
Popular medications in this category include Semaglutide (Ozempic, Wegovy) and Liraglutide (Saxenda, Victoza). While highly effective, GLP-1 RAs slow down the stomach's emptying process, which can sometimes pose challenges during surgical or procedural care.
Why are GLP-1 RAs a concern before surgery or endoscopy?
Because GLP-1 RAs delay stomach emptying, they can leave undigested food in the stomach even after a patient has fasted. This can increase the risk of:
Pulmonary aspiration: Stomach contents accidentally entering the lungs during anesthesia, which can cause serious complications.
Regurgitation and airway compromise during procedures.
Additionally, GLP-1 RAs can cause common side effects such as nausea, vomiting, and abdominal pain, which may overlap with other medical conditions or complicate post-surgery recovery.
What do the new guidelines say about GLP-1 RAs before surgery?
Updated guidance from five major medical societies, including the American Society for Metabolic and Bariatric Surgery and the American Society of Anesthesiologists (ASA), now offers a more flexible approach. Here are the highlights:
1. Most patients can safely continue GLP-1 RAs before surgery
For many individuals, GLP-1 RAs can be taken up until the day of the procedure, as long as precautions are followed.
2. A liquid diet is recommended
To reduce the risk of retained stomach contents, patients may be advised to follow a 24-hour liquid diet before surgery, similar to preparation for a colonoscopy.
3. Risk factors should be assessed
Your health care team will evaluate whether it’s safe for you to continue taking GLP-1 RAs. Factors that may increase risk include:
Being in the escalation phase of your medication (gradually increasing doses).
Taking higher doses of GLP-1 RAs.
Experiencing GI symptoms like nausea or vomiting.
Having conditions like gastroparesis (slowed stomach emptying) or Parkinson’s disease.
4. Individualized plans are key
If you’re considered high-risk, your care team may recommend pausing GLP-1 RAs before surgery:
Daily medications: Stop on the day of surgery.
Weekly medications: Stop one week before surgery.
5. Advanced tools and anesthesia modifications may help
Gastric ultrasound: Some hospitals can use an ultrasound to check for retained stomach contents on the day of the procedure.
Anesthesia adjustments: If there’s a risk of aspiration, doctors may use a special technique called rapid-sequence induction to protect your airway.
How does this benefit patients?
The updated guidelines aim to:
Reduce cancellations and delays: Many surgeries were postponed under older, more cautious protocols.
Provide clarity: A standardized approach helps patients and providers make informed decisions.
Protect patient safety: Tailored recommendations balance the risks of stopping GLP-1 RAs with their metabolic benefits.
What should you do if you’re scheduled for surgery?
Inform your care team about your GLP-1 RA use
Always disclose all medications, including those used for weight loss or diabetes.
Discuss your risk factors
Share any GI symptoms or underlying conditions like gastroparesis with your doctor.
Follow preoperative instructions
If advised, switch to a liquid diet 24 hours before your procedure.
If your doctor recommends pausing your medication, follow their guidance to avoid complications.
Ask about advanced tools
If you’re concerned about risks, ask whether gastric ultrasound is available at your hospital.
Engage in shared decision-making
Work with your care team to weigh the pros and cons of continuing vs. pausing GLP-1 RAs before your procedure.
A patient’s perspective: What this means for you
The new guidance ensures that you can continue managing your metabolic health while prioritizing safety during surgeries and procedures. By collaborating with your health care team and following these recommendations, you can minimize risks and stay on track with your health goals.
FAQs
Should I stop taking my GLP-1 RA before surgery?
It depends. Low-risk patients may continue their medication, but those with high-risk factors might need to pause it. Your doctor will guide you.
What is a liquid diet, and why is it necessary?
A liquid diet involves consuming clear fluids like water, broth, and juice for 24 hours. It reduces the risk of leftover stomach contents before surgery.
Are there any risks of stopping GLP-1 RAs temporarily?
Missing one dose is unlikely to cause harm, but pausing for extended periods may lead to elevated blood sugar levels or weight fluctuations.
What if I forget to stop my medication before surgery?
Notify your care team immediately. They may perform a gastric ultrasound to assess risks or adjust the anesthesia plan.
Can GLP-1 RAs delay my recovery after surgery?
These medications may overlap with postoperative symptoms like nausea or vomiting. Discuss your recovery plan with your doctor.
Are these guidelines final?
No, the guidance is not evidence-based and may evolve as more research becomes available.
If you’re interested in a weight-loss program and want to schedule a free, 10-minute consultation or an appointment with our obesity medicine board-certified doctor, book one below.
