Nutritional Challenges in Post-Massive Weight Loss Body Contouring: Guidance for Plastic Surgeons on GLP-1 Agonists and Sleeve Gastrectomy.

With obesity affecting more than 40% of US adults, bariatric surgery has become a cornerstone of obesity treatment, resulting in massive weight loss but also significant nutritional challenges. As demand for body contouring surgery after bariatric surgery increases, plastic surgeons must understand how evolving weight loss strategies, particularly the widespread use of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) and the shift to laparoscopic sleeve gastrectomy, affect nutritional status and wound healing. Laparoscopic sleeve gastrectomy presents fewer malabsorptive risks than Roux-en-Y gastric bypass, but still predisposes patients to deficiencies in iron, vitamin B12, and protein due to reduced intake and food intolerance. The rise of GLP-1 medications, such as semaglutide and tirzepatide, presents new considerations. These agents suppress appetite and delay gastric emptying, which can further reduce protein and micronutrient intake. For patients on GLP-1 RAs undergoing body contouring surgery, nutritional strategies must be tailored to ensure adequate perioperative protein and caloric intake, emphasizing timing, such as spacing protein throughout the day and increasing intake through small, more frequent meals. Protein deficiency, which impairs collagen production, angiogenesis, and immunity, is a key risk factor for poor wound healing. Despite guidelines recommending 60 to 120 g/day of protein, many patients fall short, particularly those losing weight on GLP-1 RAs. Perioperative nutritional optimization, including individualized protein timing plans, aggressive correction of micronutrient deficiencies, and supplementation strategies, is essential. This review provides comprehensive recommendations for plastic surgeons caring for patients with massive weight loss, including those using GLP-1 RAs, to optimize surgical outcomes and minimize complications.