Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study

Abstract

This paper presents a retrospective cohort study of weight loss medications in young adults aged 21 to 30 following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between November 2000 and June 2014. Data were collected from patients who used topiramate, phentermine, and/or metformin postoperatively. Percentage of patients achieving ≥5%, ≥10%, or ≥15% weight loss on medications was determined and percent weight change on each medication was compared to percent weight change of the rest of the cohort. Our results showed that 54.1% of study patients lost ≥5% of their postsurgical weight; 34.3% and 22.9% lost ≥10% and ≥15%, respectively. RYGB had higher median percent weight loss (−8.1%) than SG (−3.3%) (p = 0.0515). No difference was found in median percent weight loss with medications started at weight plateau (−6.0%) versus after weight regain (−5.4%) (p = 0.5304). Patients taking medications at weight loss plateau lost 41.2% of total body weight from before surgery versus 27.1% after weight regain (p = 0.076). Median percent weight change on metformin was −2.9% compared to the rest of the cohort at −7.7% (p = 0.0241). No difference from the rest of the cohort was found for phentermine (p = 0.2018) or topiramate (p = 0.3187). Topiramate, phentermine, and metformin are promising weight loss medications for 21 to 30 year olds. RYGB patients achieve more weight loss on medications but both RYGB and SG benefit. Median total body weight loss from pre-surgical weight may be higher in patients that start medication at postsurgical nadir weight. Participants on metformin lost significantly smaller percentages of weight on medications, which could be the result of underlying medical conditions.

Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults

“…This superiority of RYGB was not seen in the adolescent group. Adolescents had a better response to SG than adults, which is consistent with previous studies (22,23). This is encouraging and supportive of the current trend of more frequent SG, with its reduced complexity and lower post-surgical prevalence of micronutrient deficiencies than RYGB, particularly in adolescents (18).…”

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.…”

“…The medications prescribed for weight loss also varied greatly among studies. However, the majority of the studies prescribed topiramate 4,[7][8][9][10]18 , and phentermine 4,9,11,13,14,16,18 as a mono-or combination therapy 9,10,13,16 . Medication initiation in relation to surgery ranged by study and patient, from 14 months 18 to 13 years 12 .…”

“…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.…”

“…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. Conversely, studies reported similar weight loss among RNY, and BDP and AGB patients' post-initiation of weight management medication.…”