Efficacy of adjuvant weight loss medication after bariatric surgery

Abstract

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.

Liraglutide 3.0 mg for the management of insufficient weight loss or excessive weight regain post‐bariatric surgery

“…The studies which have primarily examined the use of phentermine, phentermine/topiramate, and naltrexone/bupropion, and report no differences for patients who had undergone RNYGB and AGB. However, individuals who had undergone gastric sleeve lost less weight than those who had undergone RNYGB and AGB . Consistent with previous literature, we did observe similar reductions in weight while taking liraglutide 3.0 mg for patients who had undergone RNYGB or AGB.…”

“…Currently, there is no weight management pharmaceutical approved for use in patients who have had bariatric surgery as having had bariatric surgery is often an exclusion for non‐surgical weight loss trials. However, research on the off‐labelled prescription of weight management pharmaceuticals in post‐bariatric surgery patients have reported significant decrease in weight post‐initiation of these agents . Consistent with these findings, post‐bariatric surgery patients in the current study taking liraglutide 3.0 mg lost a significant amount of weight.…”

The effectiveness and safety of pharmaceuticals to manage excess weight post-bariatric surgery: a systematic literature review

“…There were differences in the study design of the 13 articles included in this review. Eleven of the studies were cohort studies 4,[7][8][9][10][11][12][13][14][15][16] , and the remaining two are a matched prospective cohort 17 and case series 18 . Types of bariatric surgery procedures also varied, but the most common procedure was roux-en-y gastric bypass (RNY), in ten [7][8][9][10][11][12][13]15,16,18 studies, followed by adjustable gastric banding (AGB) 4,10,12,13,[15][16][17] and sleeve gastrectomy (SG) [7][8][9][10]12,13,15 both in seven studies.…”

“…Five studies [7][8][9]11,13 examined weight loss outcomes by the type of bariatric surgery procedure. Four studies reported less weight loss for patients who have undergone SG compared to AGB 13 (p ¼ .02) and RNY [7][8][9]13 when taking weight loss pharmaceuticals. Two of these four studies were posthoc analysis of an original study 9 and showed the same consistent pattern in younger (21-30 years; p ¼ .05151) 8 and older (!60 years; p ¼ .03) 7 adults.…”

“…Five 12,14,15,17,18 papers focused on one medication for weight loss post bariatric surgery, whereas eight 4,[7][8][9][10][11]13,16 papers studied the use of multiple medications. Four [7][8][9]16 of these eight studies compared weight loss outcome according to type of medication.…”