The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study

Abstract

Background: Patients who undergo bariatric surgery often have inadequate weight loss or weight regain. Objectives: We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain. Setting: Two academic medical centers. Methods: We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000– 2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy. Results: A total of 319 patients (RYGB = 258; sleeve gastrectomy =61) met inclusion criteria for analysis. More than half (54%; n = 172) of all study patients lost ≥5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n = 96) and 15% (n = 49) losing ≥10% (16.7 to 195.2 lbs) and ≥15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a statistically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio 1.9; P .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose ≥5% of their total weight with the aid of weight loss medications. Conclusions: Weight loss pharmacotherapy serves as a useful adjunct to bariatric surgery in patients with inadequate weight loss or weight regain. (Surg Obes Relat Dis 2017;13:491–501.)

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity

“…For patients who do have weight regain after achieving a healthier body mass index or with inadequate weight loss, pharmacotherapy may be an option for postoperative patients to achieve a healthy weight. 30 …”

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

“…After bariatric surgery, anti-obesity drugs are usually started when weight regain ensues. Prescribing weight loss pharmacotherapy before weight regain occurs (at weight plateau) may result in greater amount of total weight loss from the pre-operative period [159] and may prevent weight regain. A recent retrospective review demonstrated that phentermine alone and a phentermine-topiramate combination, in addition to diet and exercise, appear to be viable options for weight loss in RYGB and adjustable gastric banding patients who experienced weight recidivism or weight loss plateau [160].…”

The influence of total bowel length on gastric bypass outcomes

“…[ [16][17][18] Conversely, other patients may develop significant malnutrition when there is not enough absorption of key nutrients [19][20][21] which may even lead to a functional short bowel syndrome which despite its rarity is a far more severe complication and can occur more frequently the shorter the CL length is.…”