Alterations in GLP-1 and GIP Levels After Sleeve Gastrectomy and Weight Regain in Adolescents

Overview

This study evaluated adolescents undergoing laparoscopic sleeve gastrectomy (LSG), focusing on changes in GLP-1 and GIP hormone levels, weight loss outcomes, and incidence of weight regain (WR). Findings highlight early postoperative increases in incretin hormones contributing to weight loss, with subsequent declines associated with WR, suggesting the potential benefit of adjunctive therapies like semaglutide.

Background

Adolescent obesity is a growing global health concern with unique physiological and behavioral challenges affecting treatment outcomes. LSG is the most common bariatric procedure in adolescents, producing significant weight loss and metabolic improvements through mechanical and hormonal mechanisms, notably involving GLP-1 and GIP. However, weight regain typically emerges 2–3 years postoperatively, potentially linked to declining incretin responses and behavioral factors. Understanding hormonal changes post-LSG is critical to optimizing long-term management in this population.

Data Highlights

Key Findings

• LSG induces early significant increases in GLP-1 and GIP levels, contributing to weight loss and improved insulin sensitivity.
• GLP-1 levels peak shortly after surgery but tend to decline over time, correlating with the onset of weight regain in some adolescents.
• GIP levels also increase postoperatively but have a less clearly defined role in sustained weight loss.
• Weight regain typically occurs 2–3 years after LSG and is associated with declining incretin hormone responses and possible behavioral or anatomical changes.
• Adjunctive pharmacotherapy with GLP-1 receptor agonists like semaglutide shows promise in supporting weight loss maintenance after LSG.
• Comprehensive multidisciplinary care including psychological evaluation, nutritional counseling, and long-term follow-up is essential for optimizing outcomes.

Clinical Implications

Clinicians should monitor incretin hormone levels and weight trajectories closely in adolescents after LSG to identify early signs of weight regain. Incorporating adjunctive therapies such as semaglutide may enhance long-term weight maintenance. Multidisciplinary support addressing behavioral, nutritional, and psychological factors remains critical to sustain surgical benefits.

Conclusion

LSG effectively induces hormonal changes that promote weight loss in adolescents, but declining GLP-1 and GIP levels over time may contribute to weight regain. Additional support, including pharmacologic interventions and comprehensive follow-up, is necessary to optimize long-term outcomes.

References

1. Shehata et al. 2025 -- Seven-year follow-up study on adolescent LSG outcomes
2. American Diabetes Association 2024 -- Criteria for T2DM remission
3. Pediatric Hypertension Guidelines 2023
4. National Lipid Association Recommendations 2023