Combination anti‐obesity medications to effectively treat bariatric surgery weight regain at an academic obesity center

Abstract

Background: Combination anti-obesity medications (AOMs) to treat postoperative bariatric surgery weight regain have limited data on their use in the clinical setting.Understanding the optimal treatment protocol in this cohort will maximize weight loss outcomes. Methods: A retrospective review of bariatric surgery patients (N = 44) presenting with weight regain at a single academic multidisciplinary obesity center who were prescribed AOM(s) plus intensive lifestyle modification for 12 months. Results: Age: 28-76 years old, 93% female, mean weight 110.2 � 20.3 kg, BMI 39.7 � 7.4 kg/m 2 , presenting 5.2 � 1.6 years post-bariatric surgery [27 (61.4%), 14 (31.8%), and 3 (6.8%) laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic vertical sleeve gastrectomy (VSG), and open RYGB, respectively], with 15.1 � 11.1 kg mean weight gain from nadir. Mean weight loss after medical intervention at 3-, 6-, and 12-month time points was 4.4 � 4.6 kg, 7.3 � 7.0 kg, and 10.7 � 9.2 kg, respectively. At 12 months, individuals prescribed 3 or more AOMs lost more weight than those prescribed one (−14.5 � 9.0 kg vs. −4.9 � 5.7 kg, p < 0.05) irrespective of age, gender, number of comorbidities, initial weight or BMI, type of surgery, or GLP1 use. RYGB patients lost less weight overall (7.4% vs. 14.8% VSG respectively; p < 0.05).Conclusions: Combination AOMs may be needed to achieve optimal weight loss results to treat post-operative weight regain.

Special considerations for the adolescent with obesity: An obesity medicine association (OMA) clinical practice statement (CPS) 2024

“…Evidence for the safety and effectiveness of MBS and AOMs exists in both adults and children. There is evidence for both the need and effectiveness of using AOM's in adults who have had MBS [ [67] , [68] , [69] , [70] , [71] , [72] ], but the reports suffer from a lack of consistent methods, techniques, and definitions. Despite the variety of responses of adolescents with obesity to MBS and the obvious rationale for using AOM's in some select situations, we could find no reports discussing the use of AOMs after MBS in adolescents.…”

“…This section focuses on adolescents who are post-MBS and when they may benefit from the addition of AOM's as an adjunct therapy. The available MBS data for children [ [20] , [21] , [22] , [23] , [24] , 66 ] and adults [ [67] , [68] , [69] , [70] , [71] , [72] ] is examined for the variety of responses to MBS ( Table 2 ). This information is provided as guidance for the pediatric obesity medicine team.…”

“… −8 subjects discontinued treatment (4 per group) −2 subjects (3.0-mg liraglutide group) & 1 subject (placebo group) lost to follow-up. Wong et al., 2022 [ 70 ] −44 patients reviewed post MBS receiving AOM -Weight regain defined as 10 % above nadir -time of nadir in relation to MBS not defined -AOM's in study included: GLP-1RA, phentermine, topiramate, metformin, setmelanotide, lisdexamphetamine, bupropion, naltrexone. --selection of specific AOM's based on clinical decision making for each patient.…”

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

“…Although previous results with various antiobesity medications have been largely disappointing, much better weight loss and comorbidity control are being seen with newer agents mainly from the glucagon-like peptide-1 agonist family. 74,75 Although these agents are not likely to cause an emergent surgical presentation, they do significantly delay gastric emptying and likely increase aspiration risk perioperatively. 76,77 Increased attention to adequate gastric decompression and aspiration precautions during rapid sequence intubation should be maintained for any patient taking these medications.…”

“…The other obesity treatment that is rapidly gaining traction is pharmacotherapy, either as standalone treatment or as adjuvant therapy following bariatric surgery. Although previous results with various antiobesity medications have been largely disappointing, much better weight loss and comorbidity control are being seen with newer agents mainly from the glucagon-like peptide-1 agonist family 74,75 . Although these agents are not likely to cause an emergent surgical presentation, they do significantly delay gastric emptying and likely increase aspiration risk perioperatively 76,77 .…”