{
  "abstract": "A suboptimal clinical response after metabolic and bariatric surgery (MBS) is common and carries considerable health concerns. Here a double-blinded, randomized (1:1), placebo-controlled trial using semaglutide 2.4 mg weekly (BARI-STEP) recruited adult participants at least 1 year after gastric bypass or sleeve gastrectomy with a suboptimal clinical response, defined as less than 20% weight loss from surgery. This was an adjunct to lifestyle intervention with a 500-kcal daily energy deficit. The primary outcome was percentage weight loss after 68-week treatment on an intention-to-treat analysis. Seventy participants (mean (s.d.) age = 47.3 (10.3) years, 58 (82.9%) female and 12 (17.1%) male) were randomized to receive 2.4 mg semaglutide (n = 35) or placebo (n = 35). The intention-to-treat sample included 63 participants. Estimated change in mean (s.d.) percentage weight loss from baseline to week 68 was -18.0 (9.2) with semaglutide 2.4 mg (n = 34) versus +0.4 (7.0) with placebo (n = 29). The mean adjusted treatment difference in percentage body weight change for semaglutide 2.4 mg versus placebo was -19.18 (95% confidence interval -23.4 to -14.8; P < 0.001). Adverse events (AEs) were consistent with the known safety and tolerability profile of semaglutide, with no new safety concerns for the post-bariatric population. There were eight serious AEs, one suspected unexpected serious adverse reaction and no treatment-related deaths. BARI-STEP demonstrates that in people with a suboptimal clinical response after MBS, semaglutide results in substantial and clinically significant body weight reduction along with improvement in metabolic parameters and quality of life, compared to placebo. These findings suggest that semaglutide 2.4 mg is a safe and effective treatment option for this patient population. ClinicalTrials.gov: NCT05073835 .",
  "abstract_shown": true,
  "affiliations": [
    "Centre for Obesity Research, University College London, London, UK",
    "National Institute for Health Research (NIHR) University College London Hospital Biomedical Research Centre, London, UK",
    "Blizard Institute, Queen Mary University of London, London, UK",
    "Department of Diabetes and Metabolism, Barts Health NHS Trust, London, UK",
    "Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London, UK",
    "Department of Endocrinology, Diabetology, and Metabolism, Geneva University Hospitals, Geneva, Switzerland",
    "Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany",
    "Behavioural Science and Health, University College London, London, UK",
    "Digestive Disease & Surgery Institute, Cleveland Clinic London, London, UK",
    "Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK",
    "Homerton University Hospitals, London, UK",
    "Auralia Clinic, Dublin, Ireland",
    "Blizard Institute, Queen Mary University of London, London, UK. j.makaronidis@ucl.ac.uk",
    "Centre for Obesity Research, University College London, London, UK. j.makaronidis@ucl.ac.uk",
    "Department of Diabetes and Metabolism, Barts Health NHS Trust, London, UK. j.makaronidis@ucl.ac.uk",
    "Homerton University Hospitals, London, UK. j.makaronidis@ucl.ac.uk",
    "National Institute for Health Research (NIHR) University College London Hospital Biomedical Research Centre, London, UK. j.makaronidis@ucl.ac.uk"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 23,
  "authors": [
    {
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        0,
        1
      ],
      "name": "Chloe Stanley"
    },
    {
      "affs": [
        2,
        0,
        3,
        1
      ],
      "name": "Ritwika Mallik",
      "orcid": "0000-0002-0150-8127"
    },
    {
      "affs": [
        4,
        0,
        1
      ],
      "name": "Nausheen Hamid"
    },
    {
      "affs": [
        4,
        0,
        5,
        6,
        1
      ],
      "name": "Friedrich C. Jassil",
      "orcid": "0000-0002-9721-7665"
    },
    {
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        0,
        1
      ],
      "name": "Victoria Reuven"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Tapiwa Ruwona"
    },
    {
      "affs": [
        7,
        0,
        1
      ],
      "name": "Samuel James Dicken",
      "orcid": "0000-0001-5663-1715"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Sulmaaz Qamar"
    },
    {
      "affs": [
        0,
        8,
        1
      ],
      "name": "Benjamin Charles Norton",
      "orcid": "0000-0003-2058-3162"
    },
    {
      "affs": [
        9
      ],
      "name": "Helen Kingett"
    },
    {
      "affs": [
        4,
        0,
        1
      ],
      "name": "Andrea B. F. Pucci",
      "orcid": "0000-0002-5099-079X"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Cormac G. Magee",
      "orcid": "0000-0003-2063-1857"
    },
    {
      "affs": [
        0
      ],
      "name": "David R Boniface",
      "orcid": "0000-0002-0320-5234"
    },
    {
      "affs": [
        4,
        0
      ],
      "name": "Rachel Louise Batterham",
      "orcid": "0000-0002-5477-8585"
    },
    {
      "affs": [
        10
      ],
      "name": "Kalpana Devalia",
      "orcid": "0009-0008-1885-7682"
    },
    {
      "affs": [
        0,
        10
      ],
      "name": "Jessica Mok",
      "orcid": "0000-0002-2846-2819"
    },
    {
      "affs": [
        4
      ],
      "name": "Mohamed Elkalaawy",
      "orcid": "0000-0002-0713-8198"
    },
    {
      "affs": [
        11
      ],
      "name": "JOHN LOY"
    },
    {
      "affs": [
        4
      ],
      "name": "Andrew D. Jenkinson"
    },
    {
      "affs": [
        4
      ],
      "name": "Haris Charalampos Markakis"
    },
    {
      "affs": [
        4
      ],
      "name": "Marco Adamo"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Alanna Kathleen Brown",
      "orcid": "0000-0002-0104-3251"
    },
    {
      "affs": [
        12,
        13,
        14,
        15,
        16
      ],
      "name": "Janine Makaronidis",
      "orcid": "0000-0003-1045-2871"
    }
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  "bibtex": "https://research.draconitic.com/paper/78v1cg68zpnz8.bib",
  "cited_by": 15,
  "doi": "10.1038/s41591-026-04416-4",
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  "landing_url": "https://doi.org/10.1038/s41591-026-04416-4",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "pdf_url": "https://www.nature.com/articles/s41591-026-04416-4.pdf",
  "pmcid": "PMC13375533",
  "pmid": "42174253",
  "published": "2026-05-22",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/78v1cg68zpnz8.ris",
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  "subjects": [
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      "subfield": "surgery"
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  "title": "Semaglutide versus placebo in individuals with poor weight loss after bariatric surgery: a double-blinded, randomized, placebo-controlled trial",
  "title_text": "Semaglutide versus placebo in individuals with poor weight loss after bariatric surgery: a double-blinded, randomized, placebo-controlled trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T13:21:16Z",
  "url": "https://research.draconitic.com/paper/78v1cg68zpnz8",
  "venue": "Nature Medicine",
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