Real-world Physical Activity and Sedentary Time Trends in Patients Undergoing Obesity Treatment: Insights From the All of Us Research Program.

INTRODUCTION: Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) effectively reduce weight, but outcomes vary widely among individuals. While the effects of physical activity (PA) and sedentary time following obesity treatments are documented, objective wearable data in large, diverse populations remain limited. We aimed to evaluate how objective PA and sedentary time data differs between obesity treatment types and over time among patients treated with semaglutide, sleeve gastrectomy (SG), or Roux-en-Y gastric bypass (RYGB) using the All of Us Research Program. METHODS: We conducted a retrospective analysis of patients aged ≥ 18 years receiving semaglutide, SG, or RYGB. Demographic, clinical, and Fitbit-derived wearable data (step count, sedentary time, active zone minutes and maximum heart rate [HR]) were analyzed using mixed-effects linear models adjusted for demographics, BMI, and comorbidities. RESULTS: A total of 669 patients were included (581 semaglutide, 65 SG, 23 RYGB). Sedentary minutes significantly decreased across all treatment groups, with RYGB showing the greatest long-term reduction (25% at 5 years). Step counts did not show sustained improvement, with semaglutide and RYGB patients remaining below baseline; SG initially showed 21% increase at 4 years (not significant) that returned to baseline at 5 years. Activity minutes (lightly, fairly, and very active) did not significantly increase over time, and very active minutes declined in the surgical groups, though not significantly. Maximum heart rate increased significantly over time in all groups, with semaglutide showing the largest rise (6% at 5 years). CONCLUSION: All forms of obesity treatment significantly increase maximum heart rate after intervention, though the effect on other PA metrics is inconsistent and not sustained. Objective data captured via wearable devices have the potential to complement traditional follow-up, though prospective trials are needed to understand how they can be best utilized in the perioperative setting to affect patient activity.