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

doi:10.1016/j.soard.2016.10.018

Surgery for Obesity and Related Diseases

Volume 13, Issue 3, March 2017, Pages 491-500

https://doi.org/10.1016/j.soard.2016.10.018 Get rights and content

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.

Section snippets

Study sample and data collection

Our study sample consisted of patients who had undergone a Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from November 2000 to June 2014 at 2 academic centers and received subsequent weight loss medications. All patients who underwent the aforementioned procedures and were placed on medication were considered. Eligible patients had a primary weight loss surgery at 2 major academic medical centers with at least 12 months of documented postoperative follow up. Patients were excluded

Participants

Baseline characteristics of study patients are denoted in Table 1. Of the 5110 patient records that were reviewed, 319 (6.2%) met criteria for inclusion. Patients were predominantly female (n = 247; 77%), Caucasian (n = 231; 72.4%), and had an age from 20–73 years (mean = 45). At the time of surgery, RYGB patients had higher mean BMI (49.1 kg/m²; standard deviation [SD] = 9.0) versus (45.0 kg/m²; SD = 7.8), higher percentage of obesity related co-morbidities, took longer to reach their weight

Discussion

The principal finding in our study is that many patients who received weight loss medication after bariatric surgery had an additional weight loss benefit. The mean of this added weight loss was−7.6% (17.8 lbs) of total postsurgical weight. After further stratification, we found that patients who were prescribed medication at weight plateau lost a similar amount of weight compared to those who were prescribed medication after weight regain, (−6.9% or 16.1 lbs and−7.7% or 18.2 lbs) consistent

Conclusions

Our study demonstrates that weight loss medications are a useful tool for patients with inadequate weight loss or weight regain after bariatric surgery. While patients who underwent RYGB were more likely to have more weight loss with the use of weight loss medications, both groups demonstrate benefit from their use. Our data also suggest that prescribing weight loss medication before weight regain occurs (at weight plateau) may result in greater amount of total weight loss from the preoperative

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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

Abstract

Background

Objectives

Setting

Methods

Results

Conclusions

Section snippets

Study sample and data collection

Participants

Discussion

Conclusions

Disclosures

Nutrition

Surg Obes Relat Dis

Am J Surg

Gastrointest Endosc

Surg Obes Relat Dis

Prevalence of childhood and adult obesity in the United States, 2011-2012

JAMA

The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis

BMC Public Health

Bariatric surgery: A systematic review and meta-analysis

JAMA

The effectiveness and risks of bariatric surgery: An updated systematic review and meta-analysis, 2003-2012

JAMA Surg

Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications

JAMA

Medication cost is significantly reduced after Roux-en-Y gastric bypass in obese patients

Obes Surg

Revisional bariatric surgery for inadequate weight loss

Obes Surg

Gender and racial/ethnic background predict weight loss after Roux-en-Y gastric bypass independent of health and lifestyle behaviors

Obes Surg

Do gastric bypass patient characteristics, behavior, and health differ depending upon how successful weight loss is defined?

Obes Surg

Does exercise improve weight loss after bariatric surgery? A systematic review

Obes Surg

Hormone changes affecting energy homeostasis after metabolic surgery

Mt Sinai J Med

Weight recidivism post-bariatric surgery: A systematic review

Obes Surg

Behavioral predictors of weight regain after bariatric surgery

Obes Surg

The role of hormonal factors in weight loss and recidivism after bariatric surgery

Gastroenterol Res Pract

Relationship between gut hormones and glucose homeostasis after bariatric surgery

Diabetol Metab Syndr

Associations of markers in 11 obesity candidate genes with maximal weight loss and weight regain in the SOS bariatric surgery cases

Int J Obes (Lond)

Determinants of weight regain after bariatric surgery

Arq Bras Cir Dig

Review: Long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status

J Clin Endocrinol Metab

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