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

With obesity affecting over 40% of U.S. adults, bariatric surgery (BS) has become a cornerstone treatment, leading to massive weight loss (MWL) but also significant nutritional challenges. As demand for body contouring surgery (BCS) grows among post-BS patients, plastic surgeons must understand how evolving weight loss strategies, particularly the widespread use of GLP-1 receptor agonists and the shift to laparoscopic sleeve gastrectomy (LSG), impact nutritional status and wound healing. Unlike Roux-en-Y gastric bypass (RYGB), LSG presents fewer malabsorptive risks but still predisposes patients to deficiencies in iron, 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-1s undergoing BCS, 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 60-120 g/day of protein, many patients fall short, particularly those losing weight on GLP-1RAs. 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 MWL patients, including those using GLP-1RAs, to optimize surgical outcomes and minimize complications.