The number of obese older adults is on the rise, although we lack a proper definition of obesity in this age group. The ambiguity is primarily related to sarcopenia, the progressive loss of muscle and gain in fat that come with aging. Whether to treat and how to treat obesity in the elderly is controversial because of a paucity of established guidelines, but also because of the obesity paradox-ie, the apparently protective effect of obesity in this age group.

Adjuvant weight loss medications halted weight regain in patients who underwent bariatric surgery. More than one third achieved>5% weight loss with the addition of weight loss medication. The observed response was significantly better in gastric bypass and gastric banding patients compared with sleeve gastrectomy patients. Furthermore, adjuvant pharmacotherapy was more effective in patients with higher body mass index. Given the low risk of medications compared with revisional surgery, it can be a reasonable option in the appropriate patients. Further studies are necessary to determine the optimal medication and timing of adjuvant pharmacotherapy after bariatric surgery.

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More than 80% of post-bariatric surgery VTE events occurred post-discharge. Congestive heart failure, paraplegia, dyspnea at rest, and reoperation are associated with the highest risk of post-discharge VTE. Routine post-discharge pharmacoprophylaxis can be considered for high-risk patients (ie, VTE risk >0.4%).