Randomized Control Trial of Sleeve Gastrectomy With Tirzepatide in Maximizing Weight Loss

Inclusion Criteria: * Adult 18 to 65 years of age * Body Mass Index \>35 with comorbidity of Type 2 Diabetes and/or Hypertension and/or Hyperlipidemia and/or Obstructive Sleep Apnea OR Body Mass Index \>40 with or without comorbidity * Undergoing primary sleeve gastrectomy Exclusion Criteria: * Prior metabolic and bariatric surgery * Prior use of GLP-1 agonist * Prior history of pancreatitis * Personal/family history of medullary thyroid cancer or MEN type 2 * Secondary cause of obesity * Any eating disorder * Pregnancy/lactation * History of acute coronary syndrome or myocardial infarction * History of stroke * Hepatic dysfunction: AST/ALT \>3 ULN * Renal dysfunction eGFR\<45ml/min/1.73m2 * Active malignancy * History of diabetic retinopathy * History of gastroparesis