Tirzepatide for Weight Recurrence After Metabolic and Bariatric Surgery: A Critical Review of Direct and Indirect Evidence with Emphasis on Sleeve Gastrectomy, Nutritional Safety, and Clinical Implications

Background

Obesity is a chronic, relapsing disease associated with substantial morbidity and healthcare burden. Although metabolic and bariatric surgery (MBS) remains the most effective treatment for severe obesity, weight recurrence after sleeve gastrectomy (SG) represents a significant clinical challenge and may require additional therapeutic strategies. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated substantial efficacy in obesity treatment; however, evidence regarding its use after SG remains limited. This review critically evaluates the current evidence regarding the potential role of tirzepatide in the management of weight recurrence after SG, with particular emphasis on treatment efficacy, safety, body composition, nutritional considerations, and implications for dietetic practice.